Chronic cholangitis and triaditis in cats

Question 1

Anatomical differences in cats

Answer 1

• concurrent biliary tract dz, pancreatitis and IBD/(F)CE more common in cats
• pancreatic duct joints the CBD before reaching the duodenum in most cats
• ‘triaditis’ or multi-organ inflammatory dz

Question 2

Metabolic differences in cats

Answer 2

• ineffective glucuronidation pathway reduces ability to metabolise drugs and toxins
• more susceptible to toxic damage
• sensitive to many hepatotoxic drugs

Question 3

Dietary differences in cats

Answer 3

Cats must eat and they must eat high quality protein
- in cats hepatic gluconeogenesis relies on protein
- protein calorie malnutrition occurs if they’re fed a low protein diet

Cats rely on dietary taurine and arginine
- arginine deficient diet -> increased ammonia (i.e. compromises urea cycle)
- taurine essential for conjugation of bile salts

Question 4

Liver pathological processes differences in cats

Answer 4

Cats rarely get severe fibrosis and cirrhosis; portal hypertension and acquired PSS are uncommon.

Cats are prone to infiltrative dz
1. neutrophilic cholangitis
- infiltration of neutrophils
- is a septic inflammatory dz
2. lymphocytic cholangitis
- infiltration of lymphocytes
- usually a chronic dz, suspected to be immune mediated
3. hepatic lipidosis
- the result of peripheral fat mobilisation, overwhelming the liver
- severe cholestasis is caused by compression secondary to hepatocyte triglyceride vacuolar distension
- underlying diseases can include: DM, pancreatitis, IBD/FCE, anything that stops food intake

Question 5

Neutrophilic cholangitis - tx

Answer 5

Appropriate antibiotic
- 4-6w course
- amoxicillin is good 1st choice or if no diagnostics

Ursodeoxycholic acid
- choleretic effects
- anti-inflammatory / immune modulating properties

Antioxidants
- SAMe
- silmarin

Supportive care if sick
- (can be septic -> SIRS -> MODS)
- IVFT ± potassium, gluocse
- analgesia esp if triaditis

Enteral nutrition to avoid hepatic lipidosis as a complication
- ‘IBD/FCE diet’ or high protein critical care diet
- don’t protein restrict

Question 6

Neutrophilic cholangitis - prognosis

Answer 6

Prognosis can be excellent -> full recovery

Question 7

Lymphocytic cholangitis - tx

Answer 7

Best tx unclear as underlying cause not known

Corticosteroid (± chlorambucil as 2nd immune suppressant agent in cats)
- immunosuppressive doses
- manage acute flare ups but tends to recur
- doesn’t interfere with biochemical monitoring

Antibiotic tx
- rule out infection if you can do diagnostics
- if not, maybe a tx trial is justified

Ursodeoxycholic acid

Antioxidants
- SAMe
- vitamin E

Enteral nutrition

Supportive care

Question 8

Lymphocytic cholangitis - prognosis

Answer 8

Waxing and waning disease continues but rarely fatal
- cats don’t tend to develop fibrosis the way dogs with chronic liver dz do

Question 9

Hepatic lipidosis - tx

Answer 9

Enteral feeding ASAP
- continue for 4-6w

Anti-emetics ± prokinetics
- maropitant, metoclopramide
- ranitidine

IVFT
- monitor K and glucose

Antioxidants

Vitamin K
- if evidence of coagulopathy

Treat the underlying cause/concurrent dz

Question 10

Hepatic lipidosis - prognosis

Answer 10

• can be good but others will be guarded