DM3 Pt3-4 Feline Liver Disease Flashcards
What are the most common hepatic disorders in cats in the UK?
Inflammatory liver diseases are the most common hepatic disorders in cats in the UK. They are classified based on histopathological features, including the nature of the inflammatory infiltrate (neutrophilic vs lymphocytic) and the presence of bile duct proliferation and fibrosis.
What is neutrophilic cholangitis and hepatitis in cats?
Neutrophilic cholangitis/hepatitis is an acute inflammatory liver disease often associated with pancreatitis and inflammatory bowel disease (IBD). It typically affects middle-aged to older cats and presents with jaundice, pyrexia, anorexia, and abdominal pain. Blood tests show elevated ALT, ALP, GGT, bilirubin, and neutrophilia. It may involve ascending infection from the intestines and often requires antibiotic therapy.
How is neutrophilic cholangitis diagnosed in cats?
Diagnosis requires histopathology of liver biopsies and bacterial culture and sensitivity. Ultrasonography may show thickened gallbladder walls, bile duct distension, and liver changes. Blood work often shows elevated liver enzymes and neutrophilia.
What is the primary treatment for neutrophilic cholangitis in cats?
Antibiotic therapy is the primary treatment, often initiated with amoxicillin-clavulanate or cephalexin while awaiting culture results. Treatment continues for 4-6 weeks. Supportive care includes fluids, nutritional support, and potentially ursodeoxycholic acid and S-adenosyl-L-methionine (SAMe) to promote bile flow and reduce liver oxidative damage.
What is lymphocytic cholangitis in cats?
Lymphocytic cholangitis is a chronic liver disease with suspected immune-mediated mechanisms. It typically affects younger cats and is more common in Persians. Unlike neutrophilic cholangitis, these cats often remain bright, polyphagic, and are not febrile, but they are often jaundiced and may have ascites and hepatomegaly. Hyperglobulinemia is common, and neutrophilia is less frequent.
How is lymphocytic cholangitis treated in cats?
Treatment primarily involves corticosteroids (e.g., prednisolone at 1-2 mg/kg twice daily). Supportive treatments may include choleretics (e.g., ursodeoxycholic acid), nutritional support, and SAMe. The prednisolone dose is gradually reduced over 6-12 weeks if a good response is seen.
What are mixed inflammatory infiltrates in feline liver disease?
Mixed inflammatory infiltrates involve both neutrophilic and lymphocytic components. These cases may show initial acute illness followed by gradual loss of condition. Treatment typically starts with antibiotics while awaiting bacterial culture results. If there is no improvement or if cultures are negative, prednisolone (0.5-1 mg/kg daily) is added to the treatment regimen.
What role does SAMe play in treating feline liver disease?
S-adenosyl-L-methionine (SAMe) is a nutraceutical that may help restore glutathione levels in the liver, reducing oxidative damage. Though there is no definitive clinical evidence, it is often used as a supportive treatment in cats with liver disease.
What is the connection between liver disease, pancreatitis, and IBD in cats?
Cats often present with a combination of liver disease, pancreatitis, and inflammatory bowel disease (IBD), referred to as triaditis. In these cases, clinical signs of cholangitis/hepatitis usually predominate, though all three conditions can contribute to the illness.
What are the common clinical signs of neutrophilic cholangitis in cats?
Cats with neutrophilic cholangitis often present with acute jaundice, fever (pyrexia), anorexia, and abdominal pain. They may also show signs of triaditis (involving the liver, pancreas, and intestines).
What are the common clinical findings in lymphocytic cholangitis?
In cats with lymphocytic cholangitis, clinical findings include jaundice, ascites, hepatomegaly, and mild lymphadenopathy. Unlike neutrophilic cholangitis, cats with lymphocytic cholangitis tend to be bright, polyphagic, and afebrile, though they may experience significant weight loss.
What is ‘triaditis’ in cats?
Triaditis refers to the concurrent inflammation of the liver (neutrophilic cholangitis), pancreas (pancreatitis), and intestines (inflammatory bowel disease) in cats.
What causes the close association between cholangitis, pancreatitis, and IBD in cats?
The close anatomical and functional relationship between the common bile duct and pancreatic duct in cats. Most cats have only one pancreatic duct that enters the intestine at the major duodenal papilla, along with the bile duct. Inflammation or blockage in this area can easily spread between the liver, pancreas, and intestines.
Why are cats more susceptible to pancreatitis when they have biliary disease?
Cats are more susceptible to pancreatitis because any inflammation or blockage of the distal common bile duct can lead to pancreaticobiliary reflux, causing pancreatic secretions to back up into the pancreas, leading to inflammation and potential infection.
What role does vomiting play in the development of triaditis?
Vomiting increases the likelihood of pancreaticobiliary reflux, where a mix of bacteria, bile salts, and activated pancreatic enzymes can enter the pancreatic and biliary ducts, worsening inflammation.
