Cholangitis

Introduction

Cholangitis describes an inflammation of the biliary tract. Cholangiohepatitis describes the inflammation of the biliary tract and the surrounding hepatic parenchyma. It is typically categorised into Neutrophilic Cholangitis and Lymphocytic Cholangitis.

Signalment

Cholangitis is common in cats, where a periportal hepatocellular necrosis is seen together with the presence of neutrophils in the portal area. Cats can be acutely or chronically affected, and male, pure bred cats are over represented.

The condition is also seen in calves as a secondary condition to bacterial infection, such as Salmonella.

Causes

• ascending infections from the intestine where stasis of bile flow has developed
• associated with organisms excreted via the bile such as salmonellosis infection in calves

Clinical Signs

See neutrophilic and lymphocytic cholangitis separately.

Laboratory Findings

Biochemistry may show raised ALT, serum bilirubin, bile acids and globulin levels and decreased albumin. Haematology may reveal mild anaemia, lymphocytosis or lymphopaenia, monocytosis and possibly thrombocytopenia.

There may be prolonged clotting.

Abdominocentesis typically shows high protein.

Ultrasound

Hyperechogenicity of the liver may be observed with distension of the biliary tree, thickened gall bladder. The common bile duct may be obstructed. Mesenteric lymph nodes may be enlarged, duodenal walls thickened and pancreas irregular.

Biopsy

Liver biopsy is required for definitive diagnosis. Blood clotting and platelet count should be assessed first.

Histology

Lymphocytic infiltration of the portal areas is seen, with mild fibrosis and biliary hyperplasia.

Exploratory Laparotomy

Exploratory laparotomy may be indicated to assess patency of the biliary tract and collect samples for histopathology from the liver, small intestine, mesenteric lymph nodes and pancreas. Bile and liver sample may be sent for culture.

Treatment

Treatment is mainly empirical. Analgesics should be administered, particularly if laparotomy was performed. Intravenous fluids with added potassium and feeding should initiate. Anti-emetic may be needed. Antibiotic therapy (ideally according to culture and sensitivity in neutrophilic cholangitis) may last for one to three months. Immunosuppressive treatment is used for chronic neutrophilic and lymphocytic cholangitis. Corticosteroids are used commonly but methotrexate, chlombucil or cyclosporin A should be considered not forgetting their hepatotoxic potential.

Supportive treatment

Liver antioxidants including SAMe, vitamin E and milk thistle (silybin), ursodeoxycholic acid is antiinflammatory and for improved bile flow, metoclopramide as a pro-kinetic and anti-emetic, antacid, cholchicine if fibrosis is severe and B vitamins to counteract deficiency due to anorexia and improve appetite. Vitamin C, L-carnitine and liver supporting diet. Vitamin K may be needed if there are problems with haemostasis.

Any associated conditions must be addressed, including possible surgery for obstructed bile duct.

Prognosis

Prognosis varies but it is guarded if ascites, sever fibrosis or cirrhosis has developed.

References

Gunn-Moore, D. (2010), Cholangitis complex in the cat Veterinary Times, Vol.40, No. 43

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