Cholangitis, Neutrophilic

Also known as suppurative cholangitis, exudative cholangitis/cholangiohepatitis and acute cholangitis/cholangiohepatitis.

Signalment

More common in cats than in dogs. Cats of all breeds and ages can be affected, but often young to middle-aged cats. Male cats are more at risk.

Aetiology and Pathogenesis

Neutrophilic cholangitis/cholangiohepatitis results from asecending bacterial infection from the small intestines. Escherichia coli, Staphylococcus spp., Streptococcus spp., Clostridium spp., Bacillus, Actinomyces, Bacteroides and occasionally Salmonella spp. have been isolated. Concurrent biliary tract disease are common in cats, especially pancreatits and inflammatory bowel diesease. Other predisposing factors include bile duct obstruction, cholelithiasis, cholecystitis.

Diagnosis

• Clinical Signs

Acute presentation with pyrexia, abdominal pain, lethargy, jaundice.

• Haematology & Biochemistry

Increased segmented and band neutrophils. Increased ALT and total bilirubin concentration

• Imaaging

A coarse or nodular texture to the liver on ultrasonography. More chronic cases may have dilation of the biliary tract.

• Cytology and Culture

Bile samples for cytology is needed for a definitive diagnosis. Histopathology of the liver alone is not adequate as the disease tend to be confied to the bialiary tract and pathology of the liver can be non speciic and mild. Cytology shows bacteria and neutrophils. Culture and sensitivity should be performed for appropriate choice of antibiotics.

Treatment

• Long course, 4-6 weeks, of an appropiate antibiotic following culture and senstitivity should be used. Amoxicillin at 15-20 mg/kg PO q8hours is a good initial choice.
• Ursodeoxycholic acid at 15 mg/kg q24hours may be given due to its choleretic, which promotes increased fluidity of biliary secretions to treat or prevent sludging, and hepatoprotective (anti-inflammatory, immunomodulatory and antifibrotic effects) properties.
• A high protein diet rather than a protein-restricted diet is more appropriate for feeding anorexic cats to prevent the development of hepatic lipidosis