Doctors tend to use a lot of big words. We get that. Those big words are great when medical professionals are communicating with each other. The words have very specific meanings, a medical shorthand if you will. But for most pet owners, words like cholangiohepatitis get lost in the haze. At the Animal Clinic at Thorndale, we do not expect our pet owners to be experts in medical jargon. We speak plain English. We will even take the time to “translate” what other veterinary specialists have discussed with you. We want you to understand what is happening to your pet and to feel confident in working with us to restore your pet’s health. So let’s talk about one of those big words which might be the diagnosis given your cat.
Cholangiohepatitis Defined
An “itis”, the last part of this word, means “an inflammation or infection of”. We are all familiar with word “appendicitis”, an inflammation or infection of the appendix. Cholangiohepatitis is a long and intimidating word that means an inflammation or infection in the gall bladder (cholangitis) and liver (hepatitis). Put it all together and you have cholangiohepatitis. It is a disease that is fairly common in cats of any age. Liver disease in cats can be due to a variety of causes other than infections.
How it Develops
The liver produces bile that is vital to digestion. Although it is constantly produced, it is only needed when food is in the stomach or upper intestines. Therefore, unneeded bile is sent to the gall bladder for storage.
The upper small intestine (duodenum) not only needs bile for digestion, but it also needs bacteria. These are considered “good bacteria” as long as they stay in the duodenum and aid digestion.
The gall bladder is connected to the duodenum by the bile duct. This duct is designed to have one-way flow of bile. However, occasionally normal duodenal bacteria leave the duodenum and ascend the bile duct to the gall bladder and liver. This creates the infection we call cholangiohepatitis.
We do not know the precise circumstances that cause bacteria to enter the liver and gall bladder. Therefore, we consider this to be a disease of unknown cause.
Clinical Signs
Cats with cholangiohepatitis are usually quite ill. They often do not eat and usually have fever. Dehydration often results.
Any disease that affects the liver has the potential to produce icterus or jaundice. Cholangiohepatitis does this in most cats resulting in a yellow color to the skin and whites of the eyes. Liver disease also may cause vomiting.
Diagnosis
Liver diseases can be due to a variety of causes. Generally a complete blood count and blood chemistry will show elevated liver enzymes in the blood stream. These enzymes leak from the damaged liver cells. Certain other enzymes, associated with the bile ducts may be elevated as well. In bacterial infections, the white blood cell numbers may be increased in an attempt to fight the infection. An x-ray is helpful to rule out other causes of vomiting, such as foreign body ingestion.
Abdominal ultrasounds are very helpful to see characteristic changes in the liver and gall bladder. Gall stones, tumors in the liver, fatty changes in the liver, lymphosarcoma, a more diffuse cancer of the liver, can generally be ruled in or out with an ultrasound examination.
Treatment
Treating any infection requires that we use antibiotics that are effective against the specific bacterium. If we can perform a culture of the infected site, we can make that determination. However, it is not usually possible to culture the liver or gall bladder without surgery or an ultrasound guided biopsy under anesthesia. Liver disease can be due to other causes besides bacterial infections.
Fortunately, we know that the typical bacteria that inhabit the duodenum are fairly limited in number. We also know that a few specific antibiotics are almost always effective against these bacteria. Therefore, most cats are treated very successfully with antibiotic therapy. It usually takes 1-2 weeks to clear this infection, so do not discontinue antibiotics before the prescription is completed no matter how well your cat appears to be doing.
Some cats are very ill and require hospitalization so fluid therapy and nutritional support can be given. The hospital stay usually lasts 3-7 days. When your cat is discharged, antibiotics are usually dispensed to be continued at home.
Prognosis
A very large majority of cats with cholangiohepatitis recover completely without any long-term effects. Therefore, we definitely encourage treatment.
Recurrence
Because cholangiohepatitis is caused by the cat’s normal intestinal bacteria, the disease can occur again. However, in reality, very few cats have this disease a second time.