Podcast
Questions and Answers
What is the proposed pathogenesis of neutrophilic cholangitis/cholangiohepatitis in cats?
What is the proposed pathogenesis of neutrophilic cholangitis/cholangiohepatitis in cats?
What is the common laboratory finding in cats with cholangitis?
What is the common laboratory finding in cats with cholangitis?
What is the preferred diagnostic method for cholangitis?
What is the preferred diagnostic method for cholangitis?
What is the most common complication of liver biopsy in cats?
What is the most common complication of liver biopsy in cats?
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What is the most common bacterial isolate in cats with hepatobiliary disease?
What is the most common bacterial isolate in cats with hepatobiliary disease?
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What is the preferred antibiotic for treating cholangitis in cats?
What is the preferred antibiotic for treating cholangitis in cats?
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What is the importance of anaerobic culture in cats with hepatobiliary disease?
What is the importance of anaerobic culture in cats with hepatobiliary disease?
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What is the significance of bile duct or gallbladder distension in cats with cholangitis?
What is the significance of bile duct or gallbladder distension in cats with cholangitis?
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What is the proposed mechanism for the pathogenesis of lymphocytic cholangitis?
What is the proposed mechanism for the pathogenesis of lymphocytic cholangitis?
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What is the characteristic histological feature of lymphocytic cholangitis?
What is the characteristic histological feature of lymphocytic cholangitis?
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What is the recommended treatment for lymphocytic cholangitis when infectious causes have been ruled out?
What is the recommended treatment for lymphocytic cholangitis when infectious causes have been ruled out?
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Which of the following bacteria is commonly associated with hepatic abscesses in cats?
Which of the following bacteria is commonly associated with hepatic abscesses in cats?
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What is the common intermediate host of Platynosomum, a liver fluke that infects cats?
What is the common intermediate host of Platynosomum, a liver fluke that infects cats?
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What is the treatment of choice for Platynosomum infections in cats?
What is the treatment of choice for Platynosomum infections in cats?
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Which viral infection is associated with hepatic neoplasia, fatty liver, and hepatic necrosis in cats?
Which viral infection is associated with hepatic neoplasia, fatty liver, and hepatic necrosis in cats?
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What is the treatment of choice for histoplasmosis, a common systemic fungal disease in cats?
What is the treatment of choice for histoplasmosis, a common systemic fungal disease in cats?
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Study Notes
Feline Inflammatory/Infectious Hepatic Disease
Neutrophilic Cholangitis/Cholangiohepatitis
- More common in cats than dogs
- Proposed pathogenesis is ascending bacterial infection
- Characterized by neutrophils within the bile duct lumen, associated with the bile duct or between biliary epithelial cells
- Inflammation extending beyond the limiting plate and into the hepatic parenchyma is diagnosed as cholangiohepatitis
- Many cats have normal liver enzyme values, but about 2/3 are hyperbilirubinemic
- Imaging findings: hyperechoic hepatomegaly, bile duct or gallbladder distension, gallbladder sludge, and GI tract abnormalities
- Consider AUS-guided FNA, but note the limitation of small sample size
- Preferred diagnostic method: 16-gauge US-guided needle bx or surgical wedge bx or laparoscopic liver bx
- Bleeding is a common complication of biopsy, regardless of coagulation status
- Anaerobic and aerobic culture is important in cats with hepatobiliary disease
- Common isolates: E. coli, Enterobacteriaceae, Streptococcus, Enterococcus, Actinomyces, Acinetobacter, Pasteurella, Clostridium, and Bacteroides species
- Treatment involves antibiotics active against aerobic and anaerobic bacteria, and nonspecific treatments for nausea, reduced appetite, dehydration, HE, and lowering gastric acid production
Lymphocytic Cholangitis
- Gradual weight loss, vomiting, lethargy, and decreased appetite are common symptoms
- Immune-mediated mechanism proposed, with possible role of Helicobacter and Bartonella
- Histologically characterized by dense aggregates of lymphocytes surrounding bile ducts
- When infectious causes are ruled out and/or cats fail to respond to antibiotics, immune suppressive therapy (prednisolone) is recommended
Infectious Hepatobiliary Diseases
- Bacterial component more common in neutrophilic cholangitis
- Hepatic abscesses with Klebsiella, Listeria, Salmonella, Brucella, Actinomyces, and Nocardia
- Mycobacterium infection: histopath reveals extensive granulomatous disease
- Platynosomum infection: chronic cholangitis associated with liver fluke infestation from the platynosomum group
- Tropical and subtropical regions are affected
- Adult flukes in the bile, liver, and gallbladder cause biliary obstruction
- Cats likely acquire the parasite by eating infected lizards
- Treatment: praziquantel
Viral Infections
- FeLV: associated with hepatic neoplasia, fatty liver, and hepatic necrosis
- Calicivirus: viral mutants can cause hepatic infections, with disseminated hepatocellular necrosis and mild inflammatory infiltration
- FIV (lentivirus): associated with cytopenias and cancer, rarely causes hepatic disease with general degradation or peribiliary fibrosis
- FIP: hyperbilirubinemia is common, but may be due to RBC destruction; livers frequently have histologic FIP, granulomatous lesions
Fungal Infections
- Histoplasmosis: the second most common systemic fungal disease in cats and the most common hepatic fungal disease
- Treatment: Itraconazole (5-10 mg/kg PO q12) for a minimum of 4-6 months
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Description
This quiz covers feline inflammatory and infectious hepatic diseases, including neutrophilic cholangitis and cholangiohepatitis. Learn about the proposed pathogenesis, histological features, and diagnosis of these diseases in cats.
