23. Gallbladder and biliary tract diseases in dogs and cats Flashcards
Info on gallbladder and biliary tract diseases in dogs and cats?
Group of diseases characterised by inflammation of the biliary
system & peribiliary hepatocyte
Inflammation of the biliary tract & surrounding liver
Cats > Dogs
Types of cholangitis:
§ Neutrophilic cholangitis:
Acute & suppurative form
Chronic & mixed form
§ Lymphocytic cholangitis
§ Lymphocytic portal hepatitis
§ Liver fluke-caused cholangitis
Acute Neutrophilic Cholangitis (ANC)?
Acute Neutrophilic Cholangitis (ANC)
Suppurative form
Neutrophilic infiltration within the bile ducts & portal triads
Essentially a septic inflammatory process
Aetiology
Ascending bacterial infection (translocation through GI wall/
haematogenous)
§ Bacteroides spp. § E.coli
§ Enterococcus spp. § Staphylococcus spp.
§ Streptococcus spp § Clostridium spp.
§ Helicobacter spp.
Triggering factors
§ Cholelitis
§ Anatomical abnormalities
§ Pancreatitis
§ Parasites
Triaditis (concurrent inflammation of the liver, pancreas & small
intestine) has been recorded in 40% of acute neutrophilic cholangitis
cases, and 76% of the chronic course of the disease.
Clinical signs
Severe; Acute onset; Short-period illness
§ Fever § Weight loss
§ Acute vomiting § Anorexia
§ Diarrhoea § Depression
§ Dehydration § Apathy
§ Icterus § Abdominal pain
Chronic Neutrophillic cholangitis (CNC)
Chronic Neutrophilic Cholangitis (CNC)
Mixed form (Because inflammation includes lymphocytes, plasma
cells & neutrophil granulocytes)
Old-age > Young age
Bile ducts & portal region
§ Inflammatory infiltration of bile duct epithelial cells
(leading to necrosis)
§ Portal area break through → Periportal parenchyma
§ Biliary hyperplasia
AETIOLOGY
Unknown causative factor; ANC → CNC
Often concurrent with pancreatitis & IBD
Persistent inflammation caused by bacteria
CLINICAL SIGNS
Intermittent signs
§ Weakness § Vomiting
§ Weight loss § Hepatomegaly
§ Anorexia § Ascites
§ Apathy § Icterus
LAB. D
§ Leucocytosis (Neutrophilia; Left-shift) Mostly in the acute
form
§ Intrahepatic Cholestasis
↑ALP; ↑ALT; ↑AST; ↑GGT; ↑BA (bile acid)
↑↑ Br
↑ Cholesterol in cases of EBDO (extrahepatic bile duct obstruction)
DIAGNOSIS
Liver biopsy → Histopathology: Gold standard
Laparoscopy is the best method of biopsy; Allows for biopsy of
multiple liver lobes
Laparotomy should always be done in cases of EBDO
Alternatively, US-guided biopsy may be performed
§ Intrahepatic cholestasis
Distended intrahepatic bile ducts; Exudate;
Neutrophil infiltration & necrosis of bile duct epithelium &
periportal hepatocytes
Oedema of the portal area; Necrosis
§ Chronic form
Bile duct proliferation; Fibrosis (depending on stage of disease);
Pseudolobule production
FNA (Cholecystocentesis)
Bacterial culture: E.coli; Helicobacter spp.
May be misleading (as the liver structure can’t be seen)
Bile cytology: Neutrophils; Bacteria (normal bile has Ø cells)
Ultrasound: Distended & thickened gall bladder wall; Oedema;
Sludging; Inspissation of bile; Normal liver size or hepatomegaly;
Swollen pancreatitis
Bacterial culture
Lymphocytic Cholangitis?
Lymphocytic Cholangitis
The most common form of cholangitis in cats
Young/middle-aged > Older; Persian cats
Chronic & slow-progressing; Develops over months to years
Bile ducts & portal region
§ Inflammatory infiltrate of lymphocytes in the portal areas
(plasma cells & eosinophils)
§ Bile ducts undergo inflammation → Cholestasis
AETIOLOGY
Unknown; Possibly immune-mediated; Chronic bacterial infection
CLINICAL SIGNS
§ Varying appetite § Nausea
§ Hepatomegaly § Icterus
§ Weight loss § Ascites
LAB. D
§ Neutrophilia § Lymphopenia
§ Non-regenerative anaemia § (Leucocytosis)
§ ↑ ALT; ↑AST; ↑AP § ↑ Ɣ-Globulin
§ ↑↑ BA § ↓ Albumin
§ ↑ Br § Coagulopathy
DIAGNOSIS
Liver biopsy → Histopathology: Gold standard
§ Small lymphocyte infiltration into the portal region
§ Periductal fibrosis; Bile duct proliferation; Hyperplasia
§ Disturbed liver structure
Ultrasound
Important for diagnosis
§ Wide, irregular distension of bile ducts; Wall thickening
§ Common bile duct: Narrowed & twisted → Obstruction
§ Cholelith; Sludge; Cholecystitis;
§ Liver: Hepatomegaly; Hyperechogenic
FNA: Not reliable
PROGNOSIS
§ Will not recover; Likely will survive for 1-3 years;
§ May lead to biliary cirrhosis & irreversible fibrosis of the
bile ducts
Lymphocytic portal hepatitis?
Lymphocytic Portal Hepatitis
Lymphocytic & plasmocytic
Non-specific lymphocytic infiltration of the portal region; Ø
Concurrent cholangitis
Old cats > Young cats
Treatment of cholangitis?
Treatment of Cholangitis
ANTIBIOTICS
Acute & suppurative cases
In lymphocytic cholangitis before glucocorticoid therapy to eliminate bacteria.
Suppurative inflammation: 6-week course is required
Amoxiclav; Cefazolin; Cephalexin; Metronidazole
Chronic, systemic & recurrent cases
Fluroquinolones – Marbofloxacin; Pradofloxacin; Amikacin
Course of 4 weeks is required
May be combined with other abx, Glucocorticoids & UDCA
(Ursodeoxycholic acid – A secondary bile acid)
ANALGESIA
Mostly used in cases of acute neutrophilic cholangitis
Buprenorphine; Butorphanol; Fentanyl patch; Hydromorphone
SURGERY
In cases of inspissated bile to restore bile flow
Cholecystectomy; Cholecystoduodenostomy; Antegrade flushing from gall bladder
ANTI-INFLAMMATORY & IMMUNOSUPPRESANTS
Non-suppurative; Chronic cases; Immunologically-caused cases
Prednisolone; UDCA
SUPPORTIVE THERAPY
§ Vit. K1
§ Vit. B12
§ Silymarin
§ SAMe (Methyl donor; Precursor of glutathione)
§ NAC
§ Diet – Avoid hepatic lipidosis
