Feline Inflammatory/ Infectious Hepatic Disease

Question 1

What’s the most common liver disease in the cat?

Answer 1

hepatic lipidosis

Question 2

What’s the etiology of feline neutrophilic cholangitis?

Answer 2

• Ascending infection from the intestines
• Neutrophils are noted in the bile lumen
• if passing the limiting plate, then it’s cholangiohepatitis
• progressive disease can lead to rupture of the bile duct

Question 3

What are some clinical signs of neutrophilic cholangitis?

Answer 3

• lethargy, vomiting, anorexia, weight loss
• PE abn not very common
• leukocytosis, left shift, anemia
• may have changes in liver enzymes, may have bilirubin changes
• may have changes with coagulation

Question 4

What are some common AUS findings for cats with neutrophilic cholangitis?

Answer 4

• hyperechoic liver parenchyma
• distended bile duct
• distended gallbladder
• sludge in the gallbladder

Question 5

What are some limitations with liver cytology?

Answer 5

Small sample size
- poor correlation (50/50), unless it’s vacuolar hepatopathy
- may be not as good for infiltrative disease
- still a good starting point

Question 6

What’s the recommended core biopsy method for liver sampling?

Answer 6

manual or semi-automatic needle core biopsy

Question 7

What are some potential complications with liver core biopsy?

Answer 7

• hemorrhage, thrombocytopenia and increased PTT at increased risk of bleeding; but has been shown to be independent of prior coagulation testing results
• pain
• sampling wrong tissue

Question 8

What’s the likelihood of a bacterial component to feline cholangitis? What’s the most common organims?

Answer 8

• 36% bile samples, 14% liver samples
• E. coli
• likely ascending from the GI tract

Question 9

What are some first line antibiotic options for infectious neutrophilic cholangitis/hepatitis?

Answer 9

Ampicillin, amoxicillin
Clavamox
metronidazole

Question 10

What clinical signs can be noted with lymphocytic cholangitis that’s not commonly noted in neutrophilic cholangitis?

Answer 10

gradual weight loss, jaundice

Question 11

What’s the most consistent biochemistry abnormality in lymphocytic cholangitis?

Answer 11

hypergammaglobulinemia

Question 12

What are some histological features of lymphocytic cholangitis?

Answer 12

• dense aggregates of lymphocytes surrounding the bile duct but not invading into the biliary epithelium
• lymphocytes may be detected in the bile lumen
  DDX = lymphoma

Question 13

What’s the treatment and prognosis for lymphocytic cholangitis?

Answer 13

• often start supportive therapy/ empirical antibiotics until histology comes back
• immunosuppressive therapy - prednisolone, or maybe methotrexate, cyclosporine
• if none responsive, consider treating for lymphoma
• prognosis often better than neutrophilic cholangitis

Question 14

What’s a common parasitic cause of lymphocytic cholangitis?

Answer 14

liver fluke - platynosomum infection
- cats get it from eating infected lizards
- can cause biliary tract obstruction and hepatic failure
- embryonate eggs are shed in the stool
- adult flukes can be found in the bile, liver, gallbladder, or bile ducts
- treat with praziquantel

Question 15

What are some potential viral causes of lymphocytic cholangitis?

Answer 15

• FeLV
• FCV: mutant FCV can lead to jaundice
• FIP: liver enzymes usually normal, but will have hyperbilirubinemia, hyperbilirubinuria; primary hepatic FIP not common
• FIV: rarely cause hepatic disease without concurrent conditions

Question 16

What’s the most common fungal cause of hepatitis?

Answer 16

histoplasma capsulatum
- demonstration of fungus on cytology or culture
- tx = intraconazole x 6m min