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
What are the organisms associated with liver fluke?
Opisthorchiidae
Dicrocoeliidae families
How do you diagnose liver fluke?
Microscopic evaluation of liver/ bile or faeces may reveal fluke eves
Eosinophilic inflammation on histo
Chronic liver fluke leads to dilation and fibrosis of the bile ducts
How do you treat liver fluke?
Praziquantel
How does the GB appear on US with cholecystitis?
N.B no evidence that NC and cholecystitis are seperate entities in cats
Thick, double rimmed oedematous gall bladder wall in acute forms
Thinner, single layered wall in chronic forms/ mild forms
What are choleliths made of?
Ca carbonate or palmitate and amorphous plugs of bile salts and cholesterol
What are potential contributing factors to choleliths
Bile supersaturation Precipitation of a nucleus Mucin hypersecretion Aberrant pH of bile Biliary stasis or aberrant gallbladder moltility Altered bile composition Cholecystitis Cholangitis Dietary factors Biliary bacterial infections Haemolysis
What are most feline gall bladder stones classified as?
Black (bilirubin) or
Brown (bacterial degredation of biliary matter) AKA pigment gallstones
How do you treat choleliths?
Destolic for asymptomatic
Surgery normally indicated if symptomatic (cholecystoenterostomy first choice) - add a feeding tube
Outline mucocoeles in cats cf dogs
Less common on cats, possibly because cats have fewer mucous glands
Don’t get the typical kiwi fruit image on us with cats
How do you diagnose bile peritonitis?
Greater than 2 times value of bilirubin in an abdominal effusion compared with serum
What is more common in cats - hepatic of biliary neoplasia?
Biliary
cystadenomas or adenocarcinomas
Can remove large portions of the liver so this is the treatment of choice
What may be some of the clinical signs of biliary cysts?
N.B true cysts contain bile
Polyphagia
Weightloss
Nervousness
Abormal u+ (thought to be because of the cyst pushing on the bladder)
N.B if causing issues then surgical removal tx
Outline feline cystic liver disease
Multifocal
Often found in cats with polycystic kidney disease
PKD inheritited by persian cats as an autosomal dominant trait
Can see hepatic cysts and fibrosis
What are male cats predisposed to?
Lymphocytic cholangitis
choleliths
neoplasia
