Cholangiohepatitis
Introduction: Cholangiohepatitis is
an inflammatory disease of bile ducts and adjacent hepatocytes. It should be thought of as
a group of disorders involving the biliary tract (cholangitis), which may extend to
periportal hepatocytes
(cholangiohepatitis) and biliary cirrhosis. Two forms of the disease are seen:
Suppurative (neutrophils) or non-suppurative
(lymphocytic/plasmocytic). Pathogenesis: The etiology of cholangiohepatitis is unknown,
though multiple factors contribute to the process. Both forms of cholangiohepatitis
are observed as sequelae to inflammatory bowel disease. Click
on the image to see a larger view. |
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Forms of Cholangiohepatitis:
- Suppurative Cholangiohepatitis:
Bacteria are thought to play a role in the suppurative
form of the disease. The source of the bacteria is probably gram negative
flora from the intestine (e.g. E. coli). Usually bile stasis, cholelithiasis, liver flukes, and anatomical
abnormalities are predisposing factors that contribute to the infection and the ability of
the bacteria to ascend the bile duct. However, it is unclear whether bacteria multiply due
to biliary stasis or if they instigate cholangitis.
- Non-suppurative Cholangitis:
Immune mediated mechanisms may have a function in the
non-suppurative disorder, though the exact means is unknown. Non-suppurative cholangiohepatitis is possibly a sequela to
suppurative cholangiohepatitis. But suppurative cholangiohepatitis, with proper treatment,
does not always progress to the non-suppurative form of the disease.
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Gross pathology: May see periportal fibrosis and
biliary hyperplasia.
 Click
on the image for a larger view and more information. |
A case of severe fibrosing cholangiohepatitis in a
cat.
This case is characterized by fibrosis of bile ducts
which are seen here in cross section. The liver is yellow-greeen due to marked
intra- and extrahepatic cholestasis. This degree of fibrosis is not typical and the
liver is often normal grossly.
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- Histopathology: |
Distinguishing
characteristics of non-suppurative cholangitis is a lymphocytic plasmocytic infiltrate
surrounding and within the bile ducts. Biliary hyperplasia and periportal fibrosis are
signs of chronic
disease and are seen more with non-suppurative cholangiohepatitis. The occasional neutrophil may be seen. |
Species affected:
Signalment: Appears to have a predilection for Persian
cats. Reported more frequently in male cats.
- Suppurative form:
Variable ages, but more common in very
young (3 months) or over 10 years.
- Non-suppurative
form: Age varies, but generally seen in young to middle aged.
Presenting clinical signs: Some cats may report with a
history of waxing and waning illness. With others it is an acute illness of less than one
months duration. Cats frequently present with:
 Anorexia |
Ascites |
Depression |
Diarrhea |
| Dehydration |
Hepatomegaly |
Icterus |
Pyrexia |
| Vomiting |
Weight loss |
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Clinical Pathology:
- Neutrophilia with a left shift (especially suppurative form)
- Mild non-regenerative anemia
- Hyperbilirubinemia is common.
- Serum hepatic enzyme levels are
all mildly to moderately increased. These include alanine amino
transferase (ALT)
(liver specific for small animal), alkaline phosphatase (ALP) (not as liver
specific), gamma glutamyl transferase (GGT) (seen commonly with
cholestasis). In some cats with cholangiohepatitis, the serum
liver enzymes will be normal.
- Other abnormalities may be seen depending upon how far the disease
has progressed.
A note about Chronic Interstitial Pancreatitis: This is a common finding in
cats
with either form of the disease. The anatomic arrangement of the common bile duct and
pancreatic ducts in cats is to anastomose just proximal to the duodenum.
This provides a possible explanation for the frequency of both diseases occurring
simultaneously.
For more information. . .
