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162 Chole(cysto)lithiasis

histopathologic analysis of a liver biopsy. • Consider supplementation with L-carnitine an infectious process is a contributing factor
Continue supportive medications (see below) 250 mg/CAT PO q 24h; taurine has a critical bearing on treatment decisions.
VetBooks.ir • Continue antibiotics (see above) 3-6 months Possible Complications diagnostic steps in the workup of a cat
Following the appropriate and sufficient
250-500 mg/CAT PO q 24h; thiamine (B 1 )
for 3-6 months.
50-100 mg PO q 24h for 3 days
with inflammatory liver disease is critical
if neutrophilic cholangitis
• Prednisolone (for chronic neutrophilic or
for therapeutic success.
lymphocytic cholangitis) 2 mg/kg q 12h • Hepatic lipidosis with prolonged anorexia • Acute cholangitis is often infectious in
initially, gradual taper over 2-4 months or inadequate nutritional support nature (and therefore treated initially with
• Cobalamin 250 mcg SQ weekly for 6 weeks, • Diabetes mellitus with glucocorticoid treat- antibiotics), whereas chronic neutrophilic
then every 30 days if cobalamin deficient ment of lymphocytic form or treatment of or lymphocytic cholangitis may have an
• Refractory cases of lymphocytic cholangitis IBD immune-mediated basis (and therefore are
may require chemotherapeutics or aggres- • Advanced fibrosis/cirrhosis treated with immunosuppressive drugs).
sive immunosuppression: methotrexate • Progression of acute to chronic disease
0.13 mg/CAT PO q 8h for 3 doses at 7-day • Necrotizing cholecystitis, choleliths Prevention
intervals, if tolerated, cyclosporine 3-5 mg/ • Portal vein thrombosis Treat contributing or concurrent conditions
kg PO q 12h, or chlorambucil 2 mg (total such as chronic pancreatitis or IBD.
dose) PO q 48h for 2-4 weeks, then taper; Recommended Monitoring
or if < 4 kg, 2 mg (total dose) q 72h • Hepatic enzyme activity and total bilirubin Technician Tips
• Vitamin E (alpha-tocopherol acetate concentration (at 2-week intervals until • Nutritional support is a crucial component
10-30 IU/kg) for all forms of cholangitis stable, then monthly) of supportive care in these cats.
• S-adenosylmethionine 20 mg/kg PO q • Clotting times if abnormalities are present • The ability to medicate these cats may be
24h (enteric-coated tablet) for all forms of initially or to monitor vitamin K 1 therapy compromised, and consideration should be
cholangitis • Consider repeat bile acids measurement to given to placement of an esophagostomy
• Ursodeoxycholic acid (see above) monitor liver function. tube (p. 1106) to help the owner administer
• Continued treatment of concurrent condi- nutrition and medications. Pretreat with
tions such as pancreatitis and/or IBD PROGNOSIS & OUTCOME vitamin K 1 (3 doses) before esophagostomy
• Treatment for ascites if present: spirono- tube placement if a coagulopathy is present.
lactone 2 mg/kg PO q 12-24h ± hydro- • Acute neutrophilic cholangitis may be a single
chlorothiazide 0.5-2 mg/kg PO q 12h; curable event, or it may recur (especially if Client Education
angiotensin-converting enzyme inhibitors: antibiotic therapy is curtailed prematurely), • Vigilant monitoring is important for early
enalapril 0.5 mg/kg PO q 12-24h; salt but the prognosis is generally good with detection in the presence of anorexia,
restriction timely diagnosis and appropriate treatment. lethargy, vomiting, or abdominal discomfort
• For biliary cirrhosis (sclerosing cholangitis), • Lymphocytic cholangitis is a chronic condi- because suppurative cholangiohepatitis may
consider pulsatile therapy with methotrexate tion but carries a fair to good prognosis with recur.
0.13 mg/CAT PO q 8h for 3 doses at 7-day long-term therapy. • Compliance with medication administration
intervals if tolerated, being cognizant of • Concurrent pancreatitis and/or IBD may may be a lifelong commitment.
potential adverse side effects (gastrointestinal, affect the prognosis negatively. • Proper nutritional support is critical.
hepatic, renal, bone marrow toxicoses).
PEARLS & CONSIDERATIONS SUGGESTED READING
Nutrition/Diet Boland L, et al: Feline cholangitis. Vet Clin North
• Route determined by clinical condition Comments Am Small Anim Pract 47:703-724, 2017.
• Protein restriction in cats is problematic • Feline cholangitis is a constellation of
because they are strict carnivores; should clinical signs, biochemical abnormalities, and AUTHOR: Craig B. Webb, DVM, PhD, DACVIM
EDITOR: Keith P. Richter, DVM, MSEL, DACVIM
be avoided unless there is clear evidence of structural derangements. The cause may be
hepatic encephalopathy (rare) unclear initially, and determining whether

Chole(cysto)lithiasis Client Education
Sheet

Epidemiology
BASIC INFORMATION Dogs:
SPECIES, AGE, SEX • Cholecystitis
Definition • Dogs: older, small-breed, spayed females • Gallbladder perforation
Formation of stones in the extrahepatic bile appear to be predisposed. • Bile peritonitis due to gallbladder rupture
duct system (choleliths) and/or specifically in • Cats: middle-aged to older adults • Biliary adenocarcinoma (rare)
the gallbladder (cholecystoliths)
ASSOCIATED DISORDERS Clinical Presentation
Synonym Cats: DISEASE FORMS/SUBTYPES
Gallstones • In some cats, possible association with • Cholelithiasis without specific clinical signs
cholangitis, pancreatitis, inflammatory bowel ○ Incidental finding on abdominal radio-
disease (i.e., triaditis) graphs or ultrasound performed for
another reason

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