23. Gallbladder and biliary tract diseases in dogs and cats Flashcards

1
Q

Info on gallbladder and biliary tract diseases in dogs and cats?

A

Group of diseases characterised by inflammation of the biliary

system & peribiliary hepatocyte

Inflammation of the biliary tract & surrounding liver

Cats > Dogs

Types of cholangitis:

§ Neutrophilic cholangitis:

Acute & suppurative form

Chronic & mixed form

§ Lymphocytic cholangitis

§ Lymphocytic portal hepatitis

§ Liver fluke-caused cholangitis

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2
Q

Acute Neutrophilic Cholangitis (ANC)?

A

Acute Neutrophilic Cholangitis (ANC)

Suppurative form

Neutrophilic infiltration within the bile ducts & portal triads

Essentially a septic inflammatory process

Aetiology

Ascending bacterial infection (translocation through GI wall/

haematogenous)

§ Bacteroides spp. § E.coli

§ Enterococcus spp. § Staphylococcus spp.

§ Streptococcus spp § Clostridium spp.

§ Helicobacter spp.

Triggering factors

§ Cholelitis

§ Anatomical abnormalities

§ Pancreatitis

§ Parasites

Triaditis (concurrent inflammation of the liver, pancreas & small

intestine) has been recorded in 40% of acute neutrophilic cholangitis

cases, and 76% of the chronic course of the disease.

Clinical signs

Severe; Acute onset; Short-period illness

§ Fever § Weight loss

§ Acute vomiting § Anorexia

§ Diarrhoea § Depression

§ Dehydration § Apathy

§ Icterus § Abdominal pain

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3
Q

Chronic Neutrophillic cholangitis (CNC)

A

Chronic Neutrophilic Cholangitis (CNC)

Mixed form (Because inflammation includes lymphocytes, plasma

cells & neutrophil granulocytes)

Old-age > Young age

Bile ducts & portal region

§ Inflammatory infiltration of bile duct epithelial cells

(leading to necrosis)

§ Portal area break through → Periportal parenchyma

§ Biliary hyperplasia

AETIOLOGY

Unknown causative factor; ANC → CNC

Often concurrent with pancreatitis & IBD

Persistent inflammation caused by bacteria

CLINICAL SIGNS

Intermittent signs

§ Weakness § Vomiting

§ Weight loss § Hepatomegaly

§ Anorexia § Ascites

§ Apathy § Icterus

LAB. D

§ Leucocytosis (Neutrophilia; Left-shift) Mostly in the acute

form

§ Intrahepatic Cholestasis

↑ALP; ↑ALT; ↑AST; ↑GGT; ↑BA (bile acid)

↑↑ Br

↑ Cholesterol in cases of EBDO (extrahepatic bile duct obstruction)

DIAGNOSIS

Liver biopsy → Histopathology: Gold standard

Laparoscopy is the best method of biopsy; Allows for biopsy of

multiple liver lobes

Laparotomy should always be done in cases of EBDO

Alternatively, US-guided biopsy may be performed

§ Intrahepatic cholestasis

Distended intrahepatic bile ducts; Exudate;

Neutrophil infiltration & necrosis of bile duct epithelium &

periportal hepatocytes

Oedema of the portal area; Necrosis

§ Chronic form

Bile duct proliferation; Fibrosis (depending on stage of disease);

Pseudolobule production

FNA (Cholecystocentesis)

Bacterial culture: E.coli; Helicobacter spp.

May be misleading (as the liver structure can’t be seen)

Bile cytology: Neutrophils; Bacteria (normal bile has Ø cells)

Ultrasound: Distended & thickened gall bladder wall; Oedema;

Sludging; Inspissation of bile; Normal liver size or hepatomegaly;

Swollen pancreatitis

Bacterial culture

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4
Q

Lymphocytic Cholangitis?

A

Lymphocytic Cholangitis

The most common form of cholangitis in cats

Young/middle-aged > Older; Persian cats

Chronic & slow-progressing; Develops over months to years

Bile ducts & portal region

§ Inflammatory infiltrate of lymphocytes in the portal areas

(plasma cells & eosinophils)

§ Bile ducts undergo inflammation → Cholestasis

AETIOLOGY

Unknown; Possibly immune-mediated; Chronic bacterial infection

CLINICAL SIGNS

§ Varying appetite § Nausea

§ Hepatomegaly § Icterus

§ Weight loss § Ascites

LAB. D

§ Neutrophilia § Lymphopenia

§ Non-regenerative anaemia § (Leucocytosis)

§ ↑ ALT; ↑AST; ↑AP § ↑ Ɣ-Globulin

§ ↑↑ BA § ↓ Albumin

§ ↑ Br § Coagulopathy
DIAGNOSIS

Liver biopsy → Histopathology: Gold standard

§ Small lymphocyte infiltration into the portal region

§ Periductal fibrosis; Bile duct proliferation; Hyperplasia

§ Disturbed liver structure

Ultrasound

Important for diagnosis

§ Wide, irregular distension of bile ducts; Wall thickening

§ Common bile duct: Narrowed & twisted → Obstruction

§ Cholelith; Sludge; Cholecystitis;

§ Liver: Hepatomegaly; Hyperechogenic

FNA: Not reliable

PROGNOSIS

§ Will not recover; Likely will survive for 1-3 years;

§ May lead to biliary cirrhosis & irreversible fibrosis of the

bile ducts

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5
Q

Lymphocytic portal hepatitis?

A

Lymphocytic Portal Hepatitis

Lymphocytic & plasmocytic

Non-specific lymphocytic infiltration of the portal region; Ø

Concurrent cholangitis

Old cats > Young cats

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6
Q

Treatment of cholangitis?

A

Treatment of Cholangitis

ANTIBIOTICS

Acute & suppurative cases

In lymphocytic cholangitis before glucocorticoid therapy to eliminate bacteria.

Suppurative inflammation: 6-week course is required

Amoxiclav; Cefazolin; Cephalexin; Metronidazole

Chronic, systemic & recurrent cases

Fluroquinolones – Marbofloxacin; Pradofloxacin; Amikacin

Course of 4 weeks is required

May be combined with other abx, Glucocorticoids & UDCA

(Ursodeoxycholic acid – A secondary bile acid)

ANALGESIA

Mostly used in cases of acute neutrophilic cholangitis

Buprenorphine; Butorphanol; Fentanyl patch; Hydromorphone

SURGERY

In cases of inspissated bile to restore bile flow

Cholecystectomy; Cholecystoduodenostomy; Antegrade flushing from gall bladder

ANTI-INFLAMMATORY & IMMUNOSUPPRESANTS

Non-suppurative; Chronic cases; Immunologically-caused cases

Prednisolone; UDCA

SUPPORTIVE THERAPY

§ Vit. K1

§ Vit. B12

§ Silymarin

§ SAMe (Methyl donor; Precursor of glutathione)

§ NAC

§ Diet – Avoid hepatic lipidosis

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7
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