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Q: Our cat is 2 1/2 years old and eats a little here and there - some times vomits (4 x month) and is quite thin - male cat. I rarely see him drink water. He had two ticks we removed from his neck area last year ( I am not sure this means anything). His bilirubin is 1.7, I understand normal is .5. His other liver function tests where elevated as well. He was diagnosed with choliangiohepatitis. What is this disease and is it preventable? The cat is now taking DAP.
A: Patricia- Cholangiohepatitis is a descriptive term for inflammation of the bile ducts and subsequent damage to the liver. Cholangitis (bile duct inflammation or infection) can occur without liver damage but due to the importance of the bile ducts to liver function there is usually a secondary hepatitis There are actually several causes of this condition in cats but they fall into three broad categories --
1) suppurative (usually bacterial infection) cholangitis/cholangiohepatitis
2) chronic lymphocytic cholangitis/cholangiohepatitis
3) lots of other primary diseases that can lead to secondary cholangiohepatitis or cause it as part of the overall disease process. These include toxoplasmosis, Tyzzer's disease, Hepatozoon protozoal infections, kidney failure and possibly immune mediated disease.
Suppurative cholangiohepatitis is probably the result of infectious agents such as E. coli invading the bile ducts from the digestive tract. Since this isn't a common occurrence it is possible that the body's natural defense mechanisms may be deficient in some way or that some pre-existing liver disease may be present making infection easier. This form of cholangiohepatitis usually has fever, inappetance, weight loss, depression, and sometimes jaundice associated with it. It is less likely to be an intermittent problem than lymphocytic cholangiohepatitis.
Chronic lymphocytic cholangiohepatitis causes weightloss, may cause an increase in appetite or less commonly a decrease in appetite, weight loss, fever, ascites (fluid accumulation in the abdomen), jaundice and sometimes neurologic signs. It is often an intermittent problem with a "waxing and waning" course.
Obviously, the signs of these disorders overlap since the damage that occurs is similar. It is probably impossible to tell them apart without a liver biopsy. Bloodwork, including checking liver values and white blood cell counts helps to identify the presence of cholangiohepatitis. Liver biopsy makes it possible to tell which type is present. In some instances biopsy of the liver doesn't look like a good idea after doing the labwork.
If suppurative cholangiohepatitis is present it is necessary to treat with antibiotics to control the infectious agent. It may take several months of antibiotics to eliminate the infection. At the same time it is necessary to support the liver function. If inappetance is present, using appetite stimulants may be necessary. Dehydrocholic acid (Decholin Rx) is used in cholangiohepatitis to help control the inflammation. Surgery may be necessary to correct bile duct obstruction in some patients.
If the diagnosis is chronic lymphocytic cholangiohepatitis it may be responsive to prednisone or other corticosteroids. Since the use of cortisones could be a problem if infectious agents are present it is pretty important to rule out suppurative cholangiohepatitis prior to using prednisone, if possible. If ascites is severe enough, diuretics may be necessary to control it or even drainage of the accumulated fluid (this must be done cautiously). Supportive care is necessary for this type of cholangiohepatitis as well.
Mike Richards, DVM
Hope this information might be of help.
God bless and good luck!