Liver Inflammation in Cats


Cholangitis-Cholangiohepatitis Syndrome in Cats

Cholangitis is the medical term given for inflammation of the bile ducts and intrahepatic ducts — the ducts that carry bile out of the liver. Bile, an essential component in the digestive process, begins in the liver and is then stored in the gallbladder until a meal is taken. The bitter fluid is then released into the cat’s small intestine, where it emulsifies fats in the food to be used as energy by the rest of the body.

Cholangiohepatitis, meanwhile, describes inflammation of the bile ducts and liver. Together, these diseases are referred to as Cholangitis-Cholangiohepatitis Syndrome (CCHS), a disease that most commonly occurs in cats (though it does occur in dogs).

The most common cat breeds affected with CCHS are the Himalayan, Persian, and Siamese

Symptoms and Types

Certain conditions often occur prior to or simultaneous to CCHS: inflammation or clogging of  the liver ducts running outside the liver (EHBDO), inflammation of the pancreas, inflammatory bowel disease (IBD), fatty liver disease, or long-term inflammation of kidney tissue. Symptoms may be sudden, intermittent, or long-term.

However, there are currently only three types of CCHS are recognized: suppurative, which has a discharge of fluid within the biliary canal and is often sudden onset, but generally has a good outcome; nonsuppurative, which is reoccurring and has a guarded to poor prognosis; and lymphocytic/lymphoplasmacytic, where lymphocytes and plasma cells invade and surround the liver’s portal vein or portal triad (the portal vein, bile duct and artery of the liver), and which has a poor outcome due to its longer lasting chronic nature and tendency to progress to cirrhosis of the liver.

Suppurative CCHS

  • Fever
  • Swollen painful abdomen – due to fluid crossing over into the abdomen (ascites)
  • Yellow skin and yellow whites of eyes
  • Dehydration
  • Shock

Nonsuppurative CCHS

  • Enlarged liver (hepatomegaly)
  • Lack of energy
  • Lack of appetite (anorexia)
  • Vomiting
  • Ductopenia – insufficient number of bile ducts
    • Very hearty appetite
    • Unkempt coat
    • Variable baldness on sides of chest
    • Variable white to gray feces
    • Often due to failing liver/cirrhosis

Causes

Suppurative CCHS

  • Infectious
    • E. coli
    • Enterobacter
    • Enterococcus
    • β-hemolytic Streptococcus
    • Klebsiella
    • Actinomyces
    • Clostridia
    • Bacteroides
    • Toxoplasmosis (rarely)
  • Non-infectious
    • Occurs after EHBDO (extra-hepatic bile duct obstruction)
    • Occurs after gall bladder blockage

Nonsuppurative CCHS

  • May not be directly causal, but concurrent with:
    • EHBDO
    • Inflammation of gallbladder
    • Gallstones
    • Inflammation of the pancreas
    • Inflammatory bowel disease
    • Long-term swelling of kidney tissue

malnutrition

A condition of poor health that results from poor feeding or no feeding at all

lymphoma

A term for a type of neoplasm that is made up of lymphoid tissue; these masses are usually malignant in nature

lymphocyte

A type of leukocyte in the body

pancreas

A gland that aids in both digestive and insulin functions

lymphocytosis

A heightened number of lymphocytic leukocytes in the blood of an animal

prognosis

The prediction of a disease’s outcome in advance

urinalysis

An in-depth examination of the properties of urine; used to determine the presence or absence of illness

thyroid gland

A gland found in the neck of humans and animals that secretes glands responsible for metabolic rate, calcitonin, and others.

suppurative

Something in which pus is discharged or formed

hepatomegaly

An enlargement of the liver to an abnormal size

pancreatitis

A medical condition in which the pancreas becomes inflamed

hepatic

Referring to the liver

bilirubin

A certain pigment that is produced when hemoglobin is destroyed.

bile

The fluid created by the liver that helps food in the stomach to be digested.

ascites

The collection of fluid in the peritoneal cavity.

artery

A large blood vessel that transports blood out of the heart.

biopsy

The process of removing tissue to examine it, usually for medical reasons.

dehydration

A medical condition in which the body has lost fluid or water in excessive amounts

hemolytic

The removal and destruction of red blood cells

enzyme

A substance that causes chemical change to another

ducts

A passage in the body with walls

anemia

A condition of the blood in which normal red blood cell counts or hemoglobin are lacking.

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