If your cat has cholangiohepatitis, you may have a lot of questions; after all, this inflammatory condition is complex with vague symptoms. As an owner, it's natural to worry about the health and well-being of your cat; luckily, understanding what causes cholangiohepatitis in cats as well as how to manage it in light of proper treatments can ensure a favourable prognosis. This blog post will provide comprehensive insight into cholangiohepatitis in cats – from identifying common signs and symptoms to exploring diverse treatment options. Let's explore through one of the many gastrointestinal diseases affecting cats!

What is cholangiohepatitis in cats?

Cholangiohepatitis in cats is an umbrella term used to describe inflammation of the liver and bile ducts and can affect any cat at any age. This condition is very common in cats and ranks as the second most frequent liver disease, following hepatic lipidosis (fatty liver syndrome).

What causes cholangiohepatitis in cats?

The precise cause of cholangiohepatitis in cats is not always easy to pinpoint, but there are several potential causes we typically consider.

  1. Bacterial Infections: Bacteria from the intestines can sometimes 'backflow' into the liver via the bile ducts. These bacteria can cause an infection, leading to inflammation. This often causes the acute, neutrophilic form of cholangiohepatitis in cats.
  2. Immune-mediated Disease: This means that the cat's own immune system is inappropriately attacking its liver tissue. It's not entirely clear why this happens, but it's often associated with other immune-related conditions.
  3. Pancreatitis: Pancreatitis, or inflammation of the pancreas, is often seen in conjunction with cholangiohepatitis. It's believed that a similar backflow mechanism, this time from the pancreas to the liver, can lead to inflammation.
  4. Inflammatory bowel disease: Cats with inflammatory bowel disease (IBD) have chronic inflammation of their intestines. This condition often co-exists with cholangiohepatitis, whereas studies have shown that 83% of cats with cholangiohepatitis have concurrent IBD. The reason behind this is that the liver, pancreas, and intestines are interconnected both structurally and functionally, so a disease process affecting one organ can often impact the others.
  5. Liver Flukes: This is much less common but can be seen in cats that reside or have travelled to the topics or subtopics. These are trematode parasites that can infest the liver and bile ducts, causing inflammation. Cats get the parasite by eating secondary intermediate hosts that are infected, such as lizards or toads.
  6. Idiopathic: In some cases, despite our best efforts, we cannot find a specific cause. This is known as 'idiopathic' cholangiohepatitis.

What are the symptoms of cholangiohepatitis in cats?

The symptoms of cholangiohepatitis in cats can change depending on the specific type of this condition. If a cat is suffering from an acute, or sudden, form of cholangiohepatitis, it will likely show signs such as fever, loss of appetite, vomiting, diarrhea, and an overall lack of energy. They may also seem to be in abdominal discomfort and might display a yellowing of the skin and eyes, known as jaundice. These symptoms typically appear suddenly, within about five to seven days.

If a cat has a chronic, or long-term, form of cholangiohepatitis, the symptoms might come and go over time. They may lose their appetite, vomit occasionally, lose weight, and may not eat as much as usual.

Some cats with cholangiohepatitis might also show signs such as drinking and urinating more than usual, a condition known as polydipsia and polyuria. If you notice any of these signs in your cat, it's important to get them checked by your veterinarian.

How is cholangiohepatitis diagnosed in cats?

The type of diagnostic approach used will depend on the individual symptoms and health condition of your cat. Here's a general overview of how we typically approach the diagnosis of cholangiohepatitis in cats:

  1. Detailed History and Physical Examination: First, we take a detailed history of your cat's health, including the onset and nature of symptoms, diet, lifestyle, and any previous health issues. The physical examination may reveal signs such as jaundice, abdominal discomfort, or enlarged liver.
  2. Blood Tests: A complete blood count and biochemistry profile can provide clues about the presence of liver disease. We may see changes in certain liver enzymes or bilirubin levels. In some cases, a blood clotting test might be necessary, as liver disease can sometimes affect the blood's ability to clot.
  3. Urine Analysis: A urine test can help evaluate kidney function and check for bilirubin in the urine, another potential sign of liver disease.
  4. Imaging: Ultrasound of the abdomen can help us visualize the liver and bile ducts, and identify any abnormalities such as enlargement, changes in texture, or the presence of any abnormal material within the gall bladder.
  5. Liver Biopsy: In some cases, we may recommend a liver biopsy, which involves taking a small sample of liver tissue for examination under a microscope. This is the most definitive way to diagnose cholangiohepatitis, as it allows us to see the specific changes in the liver tissue associated with this disease.

What are the treatment options for cholangiohepatitis in cats?

The course of treatment largely depends on the underlying cause of the disease and the severity of the symptoms. Here's an overview of potential treatments:

  1. Antibiotics: If a bacterial infection is suspected as the cause of the inflammation, a course of antibiotics will be prescribed to eliminate the bacteria. It's important to complete the entire course of antibiotics even if your cat seems to improve before the medication is finished.
  2. Corticosteroids: If cholangiohepatitis is believed to be immune-mediated, meaning the cat's own immune system is causing the inflammation, prednisolone may be used to suppress the immune system and reduce the inflammation.
  3. Fluid Therapy: If your cat is dehydrated due to vomiting or not eating, we might administer fluids either intravenously or subcutaneously (under the skin) to rehydrate them.
  4. Ursodeoxycholic Acid (Ursodiol): This medication can help promote the flow of bile, reduce inflammation, and protect liver cells. It's often used in cats with cholangiohepatitis.
  5. Antioxidants: Supplements such as S-adenosylmethionine (SAMe) can be beneficial. SAMe is a naturally occurring antioxidant that can help support liver function in cats and combat oxidative stress that can further damage the liver.
  6. Nutritional Support: This is essential for cats with cholangiohepatitis and we recommend that cats consume at least 40 kcal/kg/day. If your cat is anorexic (loss of appetite), your veterinarian may recommend a feeding tube.
  7. Pain Management: If your cat is in pain, we'll administer appropriate pain relief to ensure they're comfortable. Buprenorphine is a common medication used to help alleviate pain in cats.
  8. Treating Underlying Conditions: If your cat has concurrent conditions like pancreatitis or inflammatory bowel disease, these will need to be treated concurrently to manage the overall health of your cat effectively.

What is the prognosis for cats with cholangiohepatitis?

The prognosis of cholangiohepatitis in cats can vary greatly and largely depends on the specific type as well as any other health issues they may be dealing with.

If your cat has the acute form of cholangiohepatitis - meaning it has come on suddenly - the prognosis is generally positive, especially if we're able to start aggressive treatment quickly. In fact, one study showed that five out of six cats with this acute form survived.

For the chronic, or long-term, form of cholangiohepatitis, the prognosis is also typically good, but it's important to understand that it may require ongoing management. This could include long-term use of medications like steroids to manage inflammation or ursodiol to promote bile flow and protect the liver. The disease tends to progress slowly, and your cat may have periods where symptoms flare up and then subside.

Approximately half of the cats diagnosed with chronic cholangiohepatitis can have prolonged survival, but it's also crucial to understand that there's a risk the disease could progress to liver failure or cirrhosis over time.

In closing, cholangiohepatitis in cats is a liver condition characterized by inflammation of the bile ducts and surrounding liver tissue. Causes range from bacterial infections to immune system issues and it can be linked to conditions like pancreatitis or inflammatory bowel disease (IBD). Symptoms may include appetite loss, lethargy, jaundice, vomiting, and abdominal discomfort. Diagnosing this disease involves a comprehensive veterinary examination, blood tests, and sometimes a liver biopsy. Treatment options are diverse and can include antibiotics, steroids, dietary adjustments, fluid therapy, liver-protecting medications like ursodiol, and antioxidant supplements like SAMe.

While cholangiohepatitis can be serious, with timely diagnosis and proper treatment, many affected cats can continue to lead fulfilling lives. As a cat owner, your role in observing any changes in your pet and seeking regular veterinary care is vital to managing this condition effectively.

If you have any questions or are concerned about cholangiohepatitis affecting your cat, please contact your veterinarian.