Neutrophilic cholangiohepatitis
This is a bacterial infection which enters the gallbladder from the intestines via the common bile duct. The bacteria causes a type of white blood cell, called neutrophils, to invade the gall bladder and liver to help fight the infection. Neutrophilic cholangiohepatitis can occur in cats of any age, breed or sex, and more than 50% of cats diagnosed with this disease are found to have inflammation of the intestines and/or pancreas as well.
Lymphocytic cholangiohepatitis
This is another common form of this disease and tends to be more chronic and progressive than the neutrophilic form. This is an immune-mediated disease, causing an infiltration of a different type of white blood cells (lymphocytes) without an underlying infection in the liver or gall bladder. Lymphocytic cholangiohepatitis can also occur in cats of any age, breed or sex, though Persian cats may have a genetic predisposition. Inflammatory bowel disease, or IBD, is a significant risk factor for the development of lymphocytic cholangiohepatitis in cats.
In tropical and sub-tropical areas, including Florida, Hawaii, Puerto Rico and Mexico, infestation of liver flukes can cause cholangiohepatitis. Free-roaming cats who ingest lizards, geckos and toads are most at risk for this parasitic infection, and many initially do not show clinical signs. Cats with this form of disease can often be diagnosed with a fecal exam and treated with anti-parasitic medication, though if extensive liver damage has already occurred by the time of diagnosis prognosis may be guarded.
Signs and Symptoms
Cats with cholangiohepatitis often have vague and non-specific signs of illness at home. The most common reported symptoms include vomiting, weight loss, loss of appetite, jaundice/icterus (yellow tint to skin or gums), and fever. Cats with neutrophilic cholangiohepatitis tend to have more acute, severe clinical signs at home, while cats with lymphocytic cholangiohepatitis may initially show no clinical signs, or slow progression of weight loss, episodic vomiting, and listlessness.
Cats with cholangiohepatitis often have concurrent inflammation in the pancreas (pancreatitis) and intestines (inflammatory bowel disease), a syndrome often called “triaditis”. Clinical signs of these diseases often overlap as they can all cause loss of appetite, vomiting, and weight loss, though diarrhea and abdominal pain are more common in cats with IBD and pancreatitis.
Treatment
Treatment for cholangiohepatitis will depend on severity of the illness and the form of disease diagnosed. For cats with severe disease, especially those with neutrophilic cholangiohepatitis, hospitalization may be required for initial treatment. Therapy for cats with lymphocytic cholangiohepatitis will include many of the treatments, though hospitalization may not be required in more chronic, mild cases. Because lymphocytic cholangiohepatitis is an immune-mediated disease, long-term treatment for this form of disease will involve immunosuppressive medications.
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