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Cholangitis (Cholangiohepatitis) in Cats
Veterinary & Aquatic Services Department, Drs. Foster & Smith
Liver and Pancreas
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Persian siloCholangitis is an inflammation of the bile ducts. If the liver is also inflamed, it may be termed 'cholangiohepatitis.' One of the functions of the liver is to produce bile, which helps in the digestion of fats. The bile is made by the liver cells and travels down small ducts to the gall bladder. The gall bladder stores the bile, which then travels from the gall bladder to the intestine via the bile ducts.

There are three main types of cholangitis in cats:

  1. The neutrophilic type is characterized by finding certain cells called 'neutrophils' in a biopsy. It can further be divided into an acute form, whose onset is very rapid, and a chronic form, in which the onset is more gradual.
  2. The second form of cholangitis in cats is the lymphocytic form, characterized by finding lymphocytes in the biopsy.
  3. A third form is caused by the liver fluke, Platynosomum, and is only found in subtropical and tropical areas.

What causes cholangitis in cats?

The acute neutrophilic form is caused by a bacterial infection. The bacteria move from the intestine up the bile duct. It is thought that the chronic neutrophilic form is a progression of the acute form. The cause of the lymphocytic form of cholangitis is not certain, but may be due to an abnormality of the immune system.

There is a condition called 'triaditis.' In this condition, the cholangitis is accompanied by pancreatitis and inflammatory bowel disease. It is unknown which of these may be a factor in causing the others.

What are the signs of cholangitis in cats?

Signs of cholangitis in cats vary depending upon the type of disease. The acute neutrophilic type causes the most serious signs, with cats becoming quite ill. The cat will usually suddenly not eat, and have vomiting and possibly diarrhea. The cat is often depressed and may have a fever. The acute neutrophilic type is more common in young adult cats, and in males.

In the chronic neutrophilic form, which is seen more in older cats, the cat may have intermittent or persistent vomiting and develop jaundice (a yellowing of the skin, gums, and whites of the eyes). Jaundice can also occur in the lymphocytic form of cholangitis, along with ascites (fluid accumulation in the abdomen), which presents as a swollen abdomen.

Cats with the liver fluke will show vomiting, a loss of appetite and an intermittent fever.

Type of Cholangitis Cause Symptoms Treatment
Neutrophilic      
Acute Infection with bacteria from the intestine Sudden loss of appetite, vomiting, diarrhea, depression, fever, jaundice, abdominal pain Antibiotics, supportive care
Chronic Progression of the acute form Vomiting, jaundice Corticosteroids, supportive care, possibly antibiotics
Lymphocytic Perhaps immune-mediated Jaundice, ascites Corticosteroids and other immunosuppressants, supportive care
Liver flukes Liver flukes Vomiting, loss of appetite, fever Praziquantel, supportive care

How is cholangitis in cats diagnosed?

A biopsy is necessary to determine what type of cholangitis is present, and thus what treatment is required.

The cat will receive a thorough physical exam, and blood tests including a complete blood count (CBC) and a chemistry panel will be performed. The chemistry panel often shows an increase in liver enzymes and bilirubin.

An ultrasound examination will help determine what changes are occurring in the biliary system and the liver. This exam can demonstrate if the flow of bile is being obstructed. It also allows for a sample of bile to be collected. A biopsy is necessary to determine what type of cholangitis is present, and thus what treatment is required.

If liver flukes are suspected, a fecal examination is performed since the fluke eggs are passed in the feces.

How is cholangitis in cats treated?

Specific treatments will be determined by the type of cholangitis. Because acute neutrophilic cholangitis is associated with a bacterial infection, antibiotics are a key component of therapy. These often need to be given for several months. In chronic neutrophilic and lymphocytic cholangitis, the goal is to decrease the inflammation, so corticosteroids are used, possibly along with other immunosuppressive drugs. In cholangitis associated with liver flukes, the drug praziquantel is used to kill the flukes.

Regardless of the type of cholangitis, supportive care is necessary to allow the biliary system and liver to heal, and to support the cat's recovery.

Supportive treatment of cats with cholangitis includes:

  • Vitamin K injections
  • Pain relief
  • Proper nutrition, which may require a feeding tube
  • Ursodeoxycholic acid (Actigall) to improve bile flow and decrease inflammation
  • SAMe and other antioxidants, possibly including Vitamin E and milk thistle

If the flow of bile is obstructed, surgery will need to be performed to remove the blockage.

 
References and Further Reading

Armstrong, PJ. Feline cholangitis: Causes? Diagnosis? Treatment? Presented at the Western Veterinary Conference, Las Vegas Nevada, 2011.

Burrows, DF; Taboada, J. In Schaer, M (ed), Clinical Medicine of the Dog and Cat. Manson Publishing, London UK. 2010:400-402.

Scherck, M. Cholangitis/cholangiohepatitis complex. Presented at the Western Veterinary Conference, Las Vegas Nevada, 2010.

Twedt, DC. Update on feline liver diseases. Presented at the British Small Animal Veterinary Congress, Birmingham, United Kingdom, 2011.

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