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Cholangitis, Feline 161

○ Liver fluke infestation associated DIAGNOSIS ○ Bacterial culture and sensitivity of liver
is low yield
○ Destructive Diagnostic Overview ○ Although minimally invasive, liver FNA
VetBooks.ir clinical picture (history, initial presentation, Lethargy and anorexia in a cat with elevated • Percutaneous ultrasound-guided cholecysto- Diseases and Disorders
• The different forms present with a similar
is frequently nondiagnostic or inaccurate
liver enzymes is consistent with cholangitis and
chief complaint, cause, progression, and
outcome).
diagnosis is confirmed histologically on liver
• Progressive lymphocytic cholangitis is a form with several other hepatobiliary disorders. The centesis
○ Minimally invasive; cytology, culture and
seen predominantly in Europe in young biopsy. sensitivity for bacterial isolates
cats presenting with ascites, icterus, and ○ Higher yield (up to 40%) and preferred
hyperglobulinemia. Differential Diagnosis culture sample over liver FNA
○ Some pathologists classify this as low-grade • Hepatic lipidosis ○ E. coli is the most common isolate; other
(well-differentiated) lymphoma. • Hepatic neoplasia (especially lymphoma) enteric organisms possible
• Lymphocytic portal hepatitis is a separate • Extrahepatic bile duct obstruction • Liver biopsy (wedge or ultrasound-guided
entity confined to portal triads and is often • Pancreatitis core [p. 1064]): as above for FNA plus
an incidental finding in older cats. • IBD ○ Periportal hepatocellular necrosis, bile duct
• Other systemic infections (e.g., cytauxzo- dilation and proliferation (neutrophilic)
HISTORY, CHIEF COMPLAINT onosis, tularemia) ○ Periductal fibrosis, diminished bile
• Patients with the neutrophilic form of chol- • FIP duct number, and sclerosing cholangitis
angitis usually present with an acute onset • Sepsis (lymphocytic)
of illness: anorexia, fever, and vomiting in • Laparoscopy (p. 1128):
an icteric cat with abdominal discomfort. Initial Database ○ Ability to obtain multiple biopsy samples
• Patients with the lymphocytic form of CBC: the following are variably present: from different lobes
cholangitis may present with a more chronic • Leukocytosis; neutrophilia with a left shift ○ Can visualize and biopsy the pancreas
condition with nonspecific signs (including and/or toxic neutrophils ○ Safest biopsy method
weight loss and chronic or intermittent • Lymphopenia • Laparotomy: as above for laparoscopy
vomiting and anorexia); a subset of patients • Mild nonregenerative anemia with poikilo- ○ Assess biliary system for extrahepatic
may present with acute signs. cytes and/or Heinz bodies biliary obstruction
• Patients with concurrent IBD (p. 543) and Serum biochemistry panel: ○ Feeding tube placement possible
pancreatitis (p. 740) (i.e., triaditis) may • Elevated liver enzyme activities (alanine ami-
present with a wide variety of signs and various notransferase, alkaline phosphatase, aspartate TREATMENT
degrees of severity, depending on the severity aminotransferase) in the majority of cases
of inflammation in these other organs. • Elevated serum total bilirubin Treatment Overview
• Patients with neutrophilic or lymphocytic • Hyperglobulinemia In addition to supportive care and specific
forms are usually icteric, and a few may have • Hyperglycemia, azotemia, electrolyte treatment, the treatment plan must address
ascites. abnormalities concurrent conditions (frequent) for optimal
• Patients with the chronic (typically lympho- Other: patient outcomes.
cytic) condition may rarely be polyphagic, • Increased serum bile acids concentrations
although usually they are presented for (redundant test in an icteric cat) Acute General Treatment
lethargy, anorexia, vomiting, and weight • High feline pancreatic lipase immunoreactiv- • Treatment should be tailored to the individual
loss. ity (fPLI) with pancreatitis patient.
• Low serum cobalamin concentration with • Crystalloid fluids (e.g., Normosol, lac-
PHYSICAL EXAM FINDINGS severe IBD tated Ringer’s solution) with potassium
• Neutrophilic cholangitis: fever, dehydration, • Clotting time abnormalities (prothrombin supplementation
and icterus are common; there may be signs time, activated partial thromboplastin time) • Antibiotics (based on culture and sensitivity
of abdominal discomfort with palpation or or portal vein thrombus (PVT) when possible) for all forms of cholangitis
ptyalism. • Hepatomegaly (radiographs) ○ Amoxicillin-clavulanate 15-20 mg/kg PO
• Lymphocytic cholangitis: findings range q 12h, 6-8 weeks, or
from minimal physical exam abnormalities Advanced or Confirmatory Testing ○ Amoxicillin 10-20 mg/kg PO q 12h, or
to icterus with weight loss. Hepatomegaly • Abdominal ultrasound: the following ○ Cephalexin or cefadroxil 22 mg/kg PO q
on abdominal palpation in ≈50% of cases. abnormalities are variably present: 8h, or
○ Hepatic parenchyma: nonspecific changes ○ Pradofloxacin 7.5 mg/kg PO q 24h
Etiology and Pathophysiology in echogenicity (preferred over enrofloxacin in cats for
• Bacterial infection (Escherichia coli, Strep- ○ Gallbladder distention, cholelithiasis, anaerobic efficacy and improved safety)
tococcus, Clostridium, Salmonella serovar biliary sludge, thickened gallbladder wall ○ Vancomycin has been reported for one case
Typhimurium, Enterococcus faecium, other ○ Cystic and common bile duct dilation of multidrug-resistant Enterococcus faecium.
enteric organisms, anaerobes); ascending and tortuosity • Ursodeoxycholic acid 10-15 mg/kg PO q 24h
infection of the biliary tract (acute neutro- ○ Evidence of pancreatic or intestinal for choleresis, unless physical obstruction to
philic cholangitis) inflammation gallbladder outflow exists
• In association with other infections (e.g., ○ Ascites (lymphocytic cholangitis; high • Vitamin K 1 5 mg/CAT PO q 24h in cases
toxoplasmosis, FIP) protein level, low cellularity) of coagulation abnormalities
• Immune-mediated disorder (chronic lym- • Fine-needle aspiration (FNA) of the liver • Surgery for extrahepatic biliary obstruction
phocytic cholangitis) ○ Be cognizant of clotting abnormalities • Necessary treatments for associated condi-
• Extrahepatic bile duct obstruction before FNA or biopsy. tions (especially pancreatitis, IBD, hepatic
• Secondary or concurrent pancreatitis, espe- ○ Inflammatory cell infiltration but difficult lipidosis)
cially with the suppurative form; pancreatic to distinguish whether from hepatic or
and bile ducts enter duodenum through a peripheral blood origin Chronic Treatment
common opening in the cat ○ Hepatocellular vacuolation (nonspecific: • Long-term management highly depends
• IBD concurrent lipidosis is possible) on an accurate diagnosis and requires

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