Feline triaditis

Question 1

what is feline triaditis?

Answer 1

Triad of conditions Chorinic Enteropathy/IBD, pancreatitis, cholangiohepatitis

Question 2

what is the signalment if feline triaditis?
what are the clinical signs of feline triaditis?

Answer 2

• No gender, age, or breed predisposition (may see more in Siamese)
• Middle to old-aged cats (some young)
• SI or LI signs - vomiting and diarrhoea
• Lethargy, anorexia or ravenous appetite.
• Jaundice/palpable hepatomegaly
• abdo pain
• Signs are variable and depend on which of the triad is predominating on each occasion

Question 3

how is feline triadits diagnosed?

Answer 3

Diagnosis – gold standard is imaging plus histopathology
* exclude other causes of diarrhoea/weight loss

Baseline tests:
* complete blood count
◦ Inflammatory/eosinophilia, anaemia
* serum biochemistry panel
◦ Liver disease, pancreatic serology
◦ cobalamin
◦ Note different sensitivity and specificity of liver parameters in cats vs. dogs
* urinalysis
* Serum T4 concentration
* FeLV/FIV test

Radiography - rule out other conditions/confirm liver enlargement.
Ultrasound
* GI tract anatomy
* Liver/pancreas involvement
* Involvement of biliary system – ascending cholangitis/cholangiohepatitis
Specific diagnosis requires biopsies from all sites – ex lap vs. endo

Question 4

why are cats presisposed to feline triaditis?

Answer 4

The aetiology of feline triaditis is poorly understood. The disease may occur because of an infectious or an autoimmune process, or a physical problem such as duct obstruction.

anatomical differences:
* Pancreatic duct joins the CBD before reaching the duodenum in most cats. - bacterial reflux from the GIT into the pancreases

metabolic differences:
Ineffective glucuronidation pathway reduces ability to metabolise drugs and toxins.
* More susceptible to toxic damage
* Sensitive to many hepatotoxic drugs

Cats must eat and they must eat high quality protein.
* In cats hepatic gluconeogenesis relies on protein.
* Protein calorie malnutrition occurs if they are fed a low protein diet

Cats rely on dietary taurine and arginine.
* Arginine deficient diet –> increased ammonia (ie compromises urea cycle)
* Taurine essential for conjugation of bile salts

Memory T lymphocytes that arise as a consequence of IBD have been shown to express homing receptors that lead them to migrate to the liver and pancreas. These memory lymphocytes can then be activated within these organs, producing inflammation and tissue damage.

Question 5

what are the main categories/types of feline liver disease?

Answer 5

The pathological processes in the liver are different:
Cats rarely get severe fibrosis and cirrhosis; portal hypertension and acquired portosystemic shunts are uncommon

Cats are prone to infiltrative diseases.
1. Neutrophilic cholangitis –infiltration of neutrophils. Is a septic inflammatory disease.
2. Lymphocytic cholangitis – infiltration of lymphocytes. This is usually a chronic disease, suspected to be immune mediated.
3. Hepatic lipidosis – is the result of peripheral fat mobilisation, overwhelming the liver. Severe cholestasis is caused by compression secondary to hepatocyte triglyceride vacuolar distension. Underlying diseases can include: DM, pancreatitis, IBD/FCE; anything that stops food intake

Question 6

how is neutrophilic cholangitis managed in cats?
what is the prognosis?

Answer 6

• Appropriate antibiotic
  ◦ 4-6 week course
  ◦ amoxicillin is a good 1st choice or if no diagnostics
• Ursodeoxycholic acid
  ◦ choleretic effects
  ◦ anti inflammatory/immune modulating properties
• Anti oxidants (SAMe, silymarin)
• Supportive care if sick (can be septic –> SIRS –> MODS)
  ◦ IVFT +/- potassium, glucose
  ◦ analgesia especially if triaditis
• Enteral nutrition to avoid hepatic lipidosis as a complication
  ◦ “IBD/FCE diet” or high protein critical care diet
  ◦ don’t protein restrict
  prognosis can be excellent –> full recovery

Question 7

how is lymphocytic cholangitis managed in cats?
what is the prognosis?

Answer 7

Best treatment not clear because underlying cause not known
* Corticosteroid (+/- chlorambucil as 2nd immune suppressant agent in cats)
◦ Immunosuppressive doses
◦ Manage acute flare ups but tends to recur
◦ Doesn’t interfere with biochemical monitoring (Is this different to dogs?)
* Antibiotic treatment
◦ Rule out infection if you can do diagnostics?
◦ If not, perhaps a treatment trial is justified….
* Ursodeoxycholic acid
* Antioxidants (bile is a potent oxidising toxin in the liver)
◦ SAMe
◦ Vitamin E
* Enteral nutrition
* Supportive care
Prognosis: waxing and waning disease continues but rarely fatal
(Cats don’t tend to develop fibrosis the way dogs with chronic liver disease do)

Question 8

what is the management of hepatic lipidosis in cats?
what is the manageement?

Answer 8

• Enteral feeding ASAP
  ◦ continue for 4-6 weeks
• Anti emetics +/- prokinetics
  ◦ maropitant, metoclopramide
  ◦ ranitidine
• IVFT
  ◦ monitor potassium and glucose
• Antioxidants
• Vitamin K
  ◦ if any evidence of coagulopathy
• Treat the underlying cause/concurrent disease
  Prognosis: can be good but others will be guarded