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Also known as: '''''Lymphocytic-plasmacytic cholangitis —Cholangiohepatitis — Non-suppurative cholangitis'''''

 

 

Also known as ''lymphocytic-plasmacytic cholangitis or cholangiohepatitis'', ''lymphocytic portal hepatitis'' and ''non-suppurative cholangitis or cholangiohepatitis''.

==Signalment==

==Signalment==

*Young to middle-aged cats, 50% under 4 years old.

Young to middle-aged cats, 50% are under 4 years old. Persians are often predisposed.

 

 

'''Lymphocytic cholangitis''' is a slowly progressive chronic disease characterised by infiltration of the portal areas of the liver with inflammatory cells, mostly [[Lymphocytes|lymphocytes]] and [[B cell differentiation - WikiBlood#Plasma cells|plasma cells]].  Bile duct hypertrophy and [[Liver Fibrosis|fibrosis]] are present.  However, lymphocytic cholangitis does not progress to biliary [[Cirrhosis|cirrhosis]].  An immune-mediated aetiology has been postulated but this has not been substantiated to date. It is rarely associated with [[Pancreatitis - WikiClinical|pancreatitis]], compared to [[Cholangitis, Neutrophilic]]

 

==Diagnosis==

==Diagnosis==

===Clinical Signs===

===Clinical Signs===

*History of chronic waxing and waning low-grade illness.

History of chronic waxing and waning low-grade illness.

*Vague clinical signs which may include  

Vague clinical signs which may include anorexia, depression, weight loss, intermittent [[Vomiting|vomiting]] and [[Diarrhoea|diarrhoea]], [[Icterus|jaundice]],lymphadenomegaly. Severe illness and pyrexia is less likely compared to [[Cholangitis, Neutrophilic]].   

**anorexia

Some cats in the UK are polyphagic and are frequently presented with ascites and/or jaundice. Many show hepatomegaly and some have generalised lymphadenopathy. Possible sequel is chronic biliary cirrhosis and ascites. Due to the likelihood of liver being affected too, [[Hepatic Encephalopathy|hepatic encephalopathy]] and bleeding disorders may occur.

**depression

**weight loss

**intermittent [[Stomach and Abomasum Consequences of Gastric Disease - Pathology|vomiting]] and [[Diarrhoea|diarrhoea]]

**[[Icterus|jaundice]]

**lymphadenomegaly

*Severe illness and pyrexia is less likely compared to [[Cholangitis, Neutrophilic]].   

*Some cats in the UK are polyphagic and are frequently presented with ascites and/or jaundice.

 

===Laboratory Tests===

===Laboratory Tests===

====Haematology====

====Haematology====

*[[Changes in Inflammatory Cells Circulating in Blood - Pathology#Neutrophilia|Neutrophilia]] is less common than with [[Cholangitis, Neutrophilic]]

[[Neutrophilia|Neutrophilia]] is less common than with [[Cholangitis, Neutrophilic]]

====Biochemistry====

====Biochemistry====

*Increased alkaline phosphatase (ALP)

Increased alkaline phosphatase (ALP), alanine aminotransferase (ALT), Hyperbilirubinaemia and Hyperglobulinaemia.

*Increased alanine aminotransferase (ALT)

*Hyperbilirubinaemia

*Hyperglobulinaemia

 

===Diagnostic Imaging===

===Diagnostic Imaging===

====Ultrasonography====

====Ultrasonography====

Ultrasonography is more helpful.  Biliary tract dilation can be seen in all cases.  Common bile duct is normally dilated and the [[Gall Bladder - Anatomy & Physiology|gall bladder]] may also be dilated with "sludge".  Main differential is extrahepatic biliary obstruction.

Ultrasonography is more helpful.  Biliary tract dilation can be seen in all cases.  Common bile duct is normally dilated and the [[Gall Bladder - Anatomy & Physiology|gall bladder]] may also be dilated with "sludge".  Main differential is extrahepatic biliary obstruction.

===Histopathology===

===Histopathology===

Liver biopsy is important to rule out Feline Infectious Peritonitis.  It is vital to obtain a haemostasis profile prior to biopsy due to risk of prolonged coagulation with liver disease.  It is unnecessary to obtain a bile sample unless the presentation is acute, in which case [[Cholangitis, Neutrophilic]] needs to be ruled out.

Liver biopsy is important to rule out [[Feline Infectious Peritonitis|Feline Infectious Peritonitis]] .  It is vital to obtain a haemostasis profile prior to biopsy due to risk of prolonged coagulation with liver disease.  It is unnecessary to obtain a bile sample unless the presentation is acute, in which case [[Cholangitis, Neutrophilic]] needs to be ruled out.

 

==Treatment==

==Treatment==

*Immunosuppressives

*Immunosuppressives

**Glucocorticoid at initial immunosuppressive dose for 6-12 weeks.

Glucocorticoid at initial immunosuppressive dose for 6-12 weeks. This should be tapered gradually to alternate day dosing.  However, recurrence is common following initial amelioration of clinical signs.  Response to therapy is hard to assess due to the slowly progressive nature of this disease.  A persistent rise in ALT and/or increasing total serum bilirubin indicates an inadequate control of the disease.

***This should be tapered gradually to alternate day dosing.  However, recurrence is common following initial amelioration of clinical signs.  Response to therapy is hard to assess due to the slowly progressive nature of this disease.  A persistent rise in ALT and/or increasing total serum bilirubin indicates an inadequate control of the disease.

**These are used to counteract the potent oxidising property of bile.

==Prognosis==

==Prognosis==

Poor due to the waxing and waning feature of this disease.  In cats, this disease does not usually progress to end-stage cirrhosis and therefore it does not usually result in death, which is in contrast to dogs.

Poor due to the waxing and waning feature of this disease.  In cats, this disease does not usually progress to end-stage cirrhosis and therefore it does not usually result in death, which is in contrast to dogs.

==References==

==References==

*Ettinger, S.J. and Feldman, E. C. (2000) '''Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2''' (Fifth Edition) ''W.B. Saunders Company''.

Ettinger, S.J. and Feldman, E. C. (2000) '''Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2''' (Fifth Edition) ''W.B. Saunders Company''.

*Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.

 

*Marks, S.L. (2003). '''Update on the Diagnosis and Management of Feline Cholangiohepatitis''' ''Waltham Feline Medicine Symposium''.

Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.

 

Marks, S.L. (2003). '''Update on the Diagnosis and Management of Feline Cholangiohepatitis''' ''Waltham Feline Medicine Symposium''.