Page 356 - Problem-Based Feline Medicine

348 PART 6 CAT WITH WEIGHT LOSS OR CHRONIC ILLNESS

If there is significant biliary stasis, intestinal absorption
CHOLANGIOHEPATITIS COMPLEX*
of vitamin K may be impaired leading to impaired sec-
ondary hemostasis and a coagulopathy.
Classical signs
Abdominal radiography may be normal or reveal:
● Inappetence and weight loss.
● Hepatomegaly.
● Lethargy.
● Loss of abdominal contrast due to the presence of
● Jaundice.
ascites, or if more localized, due to pancreatitis.
● Hepatomegaly and/or ascites.
● Occasionally, choleliths may be noted.
See main references on page 427 for details (The Hepatic parenchymal changes on abdominal ultra-
Yellow Cat or Cat With Elevated Liver Enzymes). sound are not specific to cholangiohepatitis, varying
from normal parenchymal architecture, to diffuse
increases (particularly if cirrhosis is present), or
Clinical signs decreases (especially in acute or suppurative inflamma-
tory disease) in echogenicity. Ultrasonography is help-
The most consistent clinical signs in these cases
ful to demonstrate:
are weight loss, variable anorexia, lethargy and
● Abnormalities of the biliary tract including biliary
depression.
stasis or sludging, cholecystitis, biliary tract disten-
Fever may occur, particularly in the acute or suppura- tion and obstruction.
tive form of the disease. ● Concurrent pancreatic or intestinal disease.
Vomiting, diarrhea and abdominal pain may also A definitive diagnosis requires histopathological
occur. examination of hepatic tissue. Although as a diffuse
disease, cholangiohepatitis should be amenable to diag-
Clinical signs more specific to hepatic disease such as
nosis by percutaneous fine-needle aspiration techniques,
hepatomegaly and jaundice are common, particularly
blood contamination and the inability to assess hepatic
in the early stages of the condition.
architecture make definitive diagnosis of inflammatory
Occasionally polyphagia or a normal appetite may disease difficult. Tissue core biopsy or surgical wedge
be seen, particularly associated with lymphocytic biopsy yield improved diagnostic accuracy.
cholangiohepatits. ● Surgical exploration and wedge biopsy are required if
there is evidence of extra-hepatic biliary stasis, severe
Ascites, hepatic encephalopathy and a generalized
biliary sludging or clinically significant choleliths.
lymphadenopathy are uncommon clinical signs.
● In addition, surgical exploration permits a complete
In some cats, cholangiohepatitis is associated with evaluation of the biliary tree and pancreas, aspira-
inflammatory bowel disease and pancreatitis. tion of bile for culture (although this may be carried
out percutaneously by ultrasound guidance), biopsy
of pancreas, and intestine and placement of feeding
Diagnosis tubes.
Routine serum biochemistry findings include mild to
severe elevations in hepatic enzymes (especially ala- Differential diagnosis
nine amino transferase (ALT)). Hyperbilirubinemia
Differential diagnoses for inappetence and weight loss
and elevated bile acids are often also present.
associated with suspicion of hepatic pathology includes
Elevated serum globulin concentrations are common hepatic lipidosis, hepatic neoplasia, feline infectious
in the chronic stage of the disease. peritonitis affecting the liver and hyperthyroidism.

A neutrophilia, often with left shift may be present in Feline infectious peritonitis is an important differen-
acute cases on routine hematology. More chronic cases tial diagnosis for cholangiohepatitis, as both may pres-
often have a lymphocytosis. ent with hyperglobulinemia or ascites.