23. gall bladder and biliary tract diseases Flashcards
what to mention
types
neutrophilic cholangitis - types, clin sign, Diagnosis
lymphocytic cholangitis: general, patho, signs, Diagnosis
treatment of cholangitis
what types of cholangitis do we have
neutrophilic cholangitis
lymphocytic cholangitis
lymphocytic portal cholangitis
liver fluke cholangitis
types of neutrophil cholangitis
acute suppurative
chronic mixed
a common cause of neutrophilic cholangitis
triaditis: cholangitis + pancreatitis + IBD
what is acute neutrophilic cholangitis
neutrophilic infiltration of bile ducts and bile
ascending inflammation from intestines
E. coli, enterococcus, clostridium
what is chronic neutrophilic cholangitis
mixed infiltration: Neu, Ly, pl
inflammatory infiltration of epithelial cells of bile ducts
causes degeneration, necrosis, biliary hyperplasia, fibrosis
unknown etiology! bacteria or immune mediated
clinical signs of neutrophilic cholangitis
acute: look severely ill, fever, vomit, dehydration, icterus, abd pain
chronic: intermittent signs for months, weight loss, anorexia, icterus, vomit
neutrophilic cholangistis blood sample
leukocytosis - neutriphilia, left shift
ALT, AST, ALP, GGT, BA, Br increase
neutrophilic cholangitis diagnosis
US: distended thick gallbladder wall
bile culture, cytology
liver biopsy - histopath GOLD STANDARD
what is lymphocytic cholangitis
most common cholangitis in cat chronic, slow progression mainly portal area, around bile ducts lymphocytic infiltration inflam-biliary proliferation-hyperplasia, fibrosis- cholestais
pathogenesis of lymphocytic cholangitis
pathogeneis is unknown
immune mediated?
chronic bacterial infection? helicobacter like
genetic? person cat
signs of lymphocytic cholangitis
usually younger than in neutrophilic
don’t appear too sick, wavy appetite, weight loss
nausea, icterus, ascites
lymphocytic cholangitis blood work
mild non regenerative anemia increases ALT, ALP, AST, GGT BA, Br increase increased gammaglobulins decreased albumin
lymphocytic cholangitis diagnosis
US: thick wall of bile ducts
histopathology: GOLD. lymphocyte infiltration in portal area
treatment of cholangitis - steps
AB fluid-electrolyte balance analgesia anti inflammatory - immunosuppression UDCA supportive
what AB do we give in cholangitis
manily in acute suppurative form based on cytology amox-clav, amox cefazoline, cefalexine metronidazol
fluid- electrolyte balance in cholangitis
mainly in acute neutrophilic
Na poor, K rich
ringer + KCl + B-vitamin
what analgesia do we give in cholangitis
Butorphanol
fentanyl patch
antiinflammatory - immunesuppressive drugs in cholangitis
in chronic or immune mediated cholangitis with bacterial background
prednisolone
increase bile flow, decrease fibrosis and inflamm
UDCA why do we give it
ursodvsoxycholic acid
hepatoprotectant, antiinflammatory, antifibrotic
what supportive treatments do we have
NAC - n acetylcytsein
SAMe - s adenosylmethionine: antioxidant, glutathione precursor
