23. gall bladder and biliary tract diseases

Question 1

what to mention

Answer 1

types
neutrophilic cholangitis - types, clin sign, Diagnosis
lymphocytic cholangitis: general, patho, signs, Diagnosis
treatment of cholangitis

Question 2

what types of cholangitis do we have

Answer 2

neutrophilic cholangitis
lymphocytic cholangitis
lymphocytic portal cholangitis
liver fluke cholangitis

Question 3

types of neutrophil cholangitis

Answer 3

acute suppurative

chronic mixed

Question 4

a common cause of neutrophilic cholangitis

Answer 4

triaditis: cholangitis + pancreatitis + IBD

Question 5

what is acute neutrophilic cholangitis

Answer 5

neutrophilic infiltration of bile ducts and bile
ascending inflammation from intestines
E. coli, enterococcus, clostridium

Question 6

what is chronic neutrophilic cholangitis

Answer 6

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

Question 7

clinical signs of neutrophilic cholangitis

Answer 7

acute: look severely ill, fever, vomit, dehydration, icterus, abd pain
chronic: intermittent signs for months, weight loss, anorexia, icterus, vomit

Question 8

neutrophilic cholangistis blood sample

Answer 8

leukocytosis - neutriphilia, left shift

ALT, AST, ALP, GGT, BA, Br increase

Question 9

neutrophilic cholangitis diagnosis

Answer 9

US: distended thick gallbladder wall
bile culture, cytology
liver biopsy - histopath GOLD STANDARD

Question 10

what is lymphocytic cholangitis

Answer 10

most common cholangitis in cat 
chronic, slow progression 
mainly portal area, around bile ducts 
lymphocytic infiltration
inflam-biliary proliferation-hyperplasia, fibrosis- cholestais

Question 11

pathogenesis of lymphocytic cholangitis

Answer 11

pathogeneis is unknown
immune mediated?
chronic bacterial infection? helicobacter like
genetic? person cat

Question 12

signs of lymphocytic cholangitis

Answer 12

usually younger than in neutrophilic
don’t appear too sick, wavy appetite, weight loss
nausea, icterus, ascites

Question 13

lymphocytic cholangitis blood work

Answer 13

mild non regenerative anemia 
increases ALT, ALP, AST, GGT
BA, Br increase 
increased gammaglobulins 
decreased albumin

Question 14

lymphocytic cholangitis diagnosis

Answer 14

US: thick wall of bile ducts
histopathology: GOLD. lymphocyte infiltration in portal area

Question 15

treatment of cholangitis - steps

Answer 15

AB
fluid-electrolyte balance 
analgesia 
anti inflammatory - immunosuppression 
UDCA 
supportive

Question 16

what AB do we give in cholangitis

Answer 16

manily in acute suppurative form 
based on cytology 
amox-clav, amox
cefazoline, cefalexine
metronidazol

Question 17

fluid- electrolyte balance in cholangitis

Answer 17

mainly in acute neutrophilic
Na poor, K rich
ringer + KCl + B-vitamin

Question 18

what analgesia do we give in cholangitis

Answer 18

Butorphanol

fentanyl patch

Question 19

antiinflammatory - immunesuppressive drugs in cholangitis

Answer 19

in chronic or immune mediated cholangitis with bacterial background
prednisolone
increase bile flow, decrease fibrosis and inflamm

Question 20

UDCA why do we give it

Answer 20

ursodvsoxycholic acid

hepatoprotectant, antiinflammatory, antifibrotic

Question 21

what supportive treatments do we have

Answer 21

NAC - n acetylcytsein

SAMe - s adenosylmethionine: antioxidant, glutathione precursor