Chronic cholangitis and triaditis in cats Flashcards
(10 cards)
Anatomical differences in cats
- 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
Metabolic differences in cats
- ineffective glucuronidation pathway reduces ability to metabolise drugs and toxins
- more susceptible to toxic damage
- sensitive to many hepatotoxic drugs
Dietary differences in cats
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
Liver pathological processes differences in cats
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
Neutrophilic cholangitis - tx
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
Neutrophilic cholangitis - prognosis
Prognosis can be excellent -> full recovery
Lymphocytic cholangitis - tx
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
Lymphocytic cholangitis - prognosis
Waxing and waning disease continues but rarely fatal
- cats don’t tend to develop fibrosis the way dogs with chronic liver dz do
Hepatic lipidosis - tx
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
Hepatic lipidosis - prognosis
- can be good but others will be guarded