Feline liver disease Flashcards
What are the three types of cholangitis in cats?
Neutrophilic (acute and chronic)
Lymphocytic
Liver fluke associated (not in UK)
What may predispose cats to neutrophilic cholangitis?
The common bile duct and pancreatic duct connect before entering the duodenum - this may predispose cats to a combination of NC and pancreatitis.
IBD may predispose to ascending infection
What is the aetiology of lymphocytic cholangitis?
Unknown - immune mediated mechanism thought to play a role in the pathogenesis
What are the clinical features of neutophilic cholangitis?
Milder aged to older cats normally (not always)
Presented as acutely sick
With the chronic form, there may be a more waxing/ waning history with milder clinical signs
What are the clinical features of lymphocytic cholangitis?
More common in younger ats Persians are predisposed Appetite is usually normal to increased Marked hepatomegaly Can see ascites More in males
What are the clinicopathological findings with either form of cholangitis
Both - Increased liver enzymes +/- bilirubin, anaemia of chronic disease
Neutrophilic - left shift neutrophilia common
Lymphocytic - lymphopaenia, often see a marked hyperglobulinaemia. If there is ascites, it may have similar characteristics to FIP fluid. Al:glob ratio normall higher than 0.45 though.
How can you distinguish between FIP and lymphocytic cholangitis?
Clinical features - similar, can both be jaundiced. FIP more likely to be pyrexic but can occur in both. FIP may have other inflammatory signs elsewhere
Demeanour - Normally sick with FIP but brightish with LC
Appetite reduced normally with FIP, increased with LC
Bloods - both can have raised liver enzymes, more common with LC, both can have high bili/ anaemia, alb glob ratio can help to distinguish but not always
Imaging - marked heptatomegaly less likely with FIP, mesenteric lymphadenopathy can occur with both but more likely with FIP, other effusions only occur with FIP
Other organs may be irregular with FIP
What is the US appearance of cholangitis?
For both - patchy echogenicity of the liver. May have a heterogenous appearance with irregular margins
If extensive cirrhosis occurs (as can happen with lymphocytic) then may be hyperechoic
Acute NC - thickening of the gall bladder, distension of the bile duct, sludging of bile, occasional cholelithiasis
LC - Just hepatomegaly
Is cytology useful with diagnosis liver disease
Not really, can’t distinguish between the forms or evaluate architecture
What does NC look like on histopath?
Neutrophilic infiltrate within bile duct lumen +/- epithelium.
In the acute form this may extend into the hepatic parenchyma
Commonly periportal necrosis
In the chronic form there may be fibrosis, bile duct proliferation, more mixed inflammatory infiltrate
What does lymphocytic cholangitis look like on histopath?
Mostly lymphocytic infiltrate, restricted to the portal areas
Variable portal fibrosis and biliary duct proliferation
Usually no epithelial degeneration or inflammatory infiltrate within the lumen of the bile ducts.
How do you treat acute neutrophilic cholangitis?
Treat the symptoms
AB (needs to be broad spec/ bacteriacidal, achieve theraputic levels in bile, not require hepatic metabolism for excretion/ metabolism
Best options are: Amox clav or cephalosporin, metronidazole with fluoroquinolone.
AB treatment for 4-8 weeks.
Cholecystectomy may be needed for removal of inspissated bile
How do you specifically treat chronic neutrophilic cholangitis?
Hard to say when ABs are best verus steroids. Ideally treat with ABs whilst awaiting bile/ histo culture results. Move to steroids if no improvement in a week, or culture comes back negative, although keep on ABs for 2-3 weeks still
0.5-1mg/kg SID
How do you treat lymphocytic cholangitis?
Steroids - immuno suppressive dose, taper over 6-12 weeks
Sometimes need to add in other immunosuppressive agents (chlorambuucil/ ciclosporin, methotrexate
What other treatments should be given for cholangitis treatment (both)
SAM-e - restores gluthathion, reduces oxidative damage. increases leels of cysteine and taurine which are needed for bile acid conjugation
Milk thistle
Vit K if clotting issues identified
Destolit - reduces the proportion of hydrophobic bile acids that have toxic effects on hepatocellular membranes, as well as anti-inflammatory and immunomodulatory and antibibrotic effects
