Page 725 - Clinical Small Animal Internal Medicine

P. 725

63 Feline Inflammatory Liver Disease 693

Vitamin supplementation is usually beneficial in ano- Development of fibrosis is seen with progression of the
VetBooks.ir rectic cats. B vitamins become rapidly depleted and thia- disease. While the use of colchicine to reduce fibrosis has
previously been advocated in dogs, there are no studies
mine deficiency can contribute to neurologic signs, while
cobalamin deficiency can exacerbate anorexia. Vitamin E
is an antioxidant that also has antiinflammatory proper- to demonstrate benefit. Moreover, its use can be associ-
ated with significant side‐effects. Current medical advice
ties. Vitamin K supplementation may be required to cor- suggests that it not be recommended, although silymarin
rect coagulopathies (Table 63.2). and UDCA may have potential antifibrotic effects.
Symptomatic therapy can include antiemetics (e.g., Our poor understanding of the etiopathogenesis of the
metoclopramide or maropitant) and gastroprotectants cholangitis‐cholangiohepatitis complex, and lack of con-
(e.g., H2 blockers, proton pump inhibitors, sucralfate). trolled clinical trials, combined with an inability on occa-
Control of vomiting is important for patient comfort and sions to obtain diagnostic samples before antibacterial
to reduce the risk of feeding tubes becoming dislodged. therapy, can often result in initiation of therapy with an
Gastroprotectants may be beneficial due to the presence antibacterial along with other supportive therapies as
of concurrent inflammatory bowel disease and to address indicated. If a diagnosis of NC has been made, and
gastritis induced by persistent vomiting (see Table 63.2). improvement has plateaued, prednisolone at antiinflam-
S‐adenosyl‐L‐methionine (SAM‐e) has a number of matory doses could be introduced as this may be benefi-
hepatoprotectant effects: it is a glutathione precursor cial in attenuating the inflammatory response.
(hence antioxidant properties), it stabilizes cell mem-
branes, and it modulates inflammatory cytokines. As low
glutathione levels are present in a high percentage of cats Prognosis
with hepatobiliary disease, administration of SAM‐e
should be beneficial, although no published data exist to Prognosis will depend on the severity of the disease.
support this claim (see Table 63.2). Obstruction of the bile duct, necessitating surgical inter-
Ursodeoxycholic acid (UDCA) is a hydrophilic bile vention, has a guarded prognosis, particularly where bil-
acid that has a number of benefits: choloresis, that is, iary diversion surgery is required. Cats with ascites
making the bile more liquid and promoting bile flow; similarly have a guarded prognosis as this is likely to rep-
replacement of more toxic, hydrophobic bile acids; antia- resent the presence of significant fibrosis. However, cats
poptosis; antioxidant; and immunomodulation (see that survive the initial acute phase of NC or that are diag-
Table 63.2). It has been used as the sole therapy for treat- nosed with LC often go on to live for several years.
ment of primary sclerosing cholangitis in people, but its Relapses are possible, especially if there is a concurrent
use as sole therapy for treatment of LC in cats did not condition such as pancreatitis that may be difficult to
compare favorably to prednisolone. control.
Immunosuppression is considered important for the Lymphocytic cholangitis is likely a progressive disease,
management of LC, but should only be commenced once and dilation of the bile ducts may be irreversible. This has
NC has been ruled out. Prednisolone is typically been proposed to increase the risk of these cats develop-
employed, starting at higher, immunosuppressive doses ing ascending infections and potentially cholecystitis,
and tapering to as low a dose as possible once in remis- therefore although recurrence is not inevitable, periodic
sion (see Table 63.2). Some authors have also advocated monitoring of liver parameters +/‐ ultrasonographic eval-
the use of methotrexate or chlorambucil. uation of the biliary system may be warranted.