By Dr. Becker
Cholangiohepatitis is a word that describes inflammation of the liver and bile ducts. This condition is seen less often in dogs than cats, and is a common cause of feline liver disease, especially in the Himalayan, Persian, and Siamese breeds.
Cholangiohepatitis and hepatic lipidosis (fatty liver disease) make up about two-thirds of all liver disease in cats.
The liver plays many important roles in the body, one of which is to help your pet digest the food she eats by manufacturing and secreting bile. Bile is a greenish brown fluid that travels from the liver through the biliary ducts to the gallbladder, where it’s stored until it’s needed by the intestines.
When called upon by the intestines (usually after a meal containing fat), the gallbladder contracts to push bile through a large duct called the common bile duct into the small intestine, where it aids the digestive process by breaking down dietary fats so they can be absorbed into the body.
Bile serves many other important functions in the body. It kills parasites, promotes peristalsis (the wave-like muscle contractions that move food through the digestive tract), and binds toxins produced by the liver so they can be transported into the intestine and eliminated from the body.
Types of Cholangiohepatitis
There are three forms of cholangiohepatitis:
- Suppurative, or pus forming, which often has a sudden onset with fever.
- Non-suppurative, which is recurrent and has a very poor prognosis.
- Lymphocytic-plasmacytic, in which lymphocytes and plasma cells invade and surround the liver’s portal vein and often also the bile duct and artery of the liver. This form is typically chronic and long lasting, and tends to progress to cirrhosis or scarring of the liver over time.
Regardless of the form it takes, the inflammation and swelling the disease causes inhibits the proper flow of bile, causing it to be retained in the liver and biliary ducts, creating a situation called “stagnant liver.”
Since bile is a highly acidic digestive fluid, it can cause irritation, congestion, and significant tissue damage when it doesn’t flow freely.
Most Cats With Cholangiohepatitis Have Concurrent Diseases
Most cats with cholangiohepatitis also have inflammatory bowel disease (IBD) — about 80 percent according to one study. Many also have pancreatitis, which is inflammation of the pancreas.
This is because the pancreatic duct that transports digestive enzymes to the intestine opens into the same port as the common bile duct. These two ducts share a common entryway to the intestine, which means if bacteria invade the entryway, both the liver and pancreas can become inflamed and infected.
In IBD, the cells in the intestinal lining become irritated and inflamed, which interferes with nutrient absorption, which in turn alters the populations of bacteria living in the intestine. An overgrowth of bacteria can occur, or more aggressive species of bacteria can take over and quickly invade the bile duct and pancreas.
This combination of cholangiohepatitis, inflammatory bowel disease, and pancreatitis is often referred to as triaditis, and all three conditions must be addressed if the patient is to recover.
Symptoms and Causes of Cholangiohepatitis
Typical signs of suppurative cholangiohepatitis include fever, a swollen and painful abdomen, jaundice (yellowing of the skin and the whites of the eyes), and dehydration. Pets with suppurative cholangiohepatitis look and feel very ill.
Causes of this form of the disease can be a bacterial infection or the result of a bile duct obstruction or gallbladder blockage. Non-suppurative cholangiohepatitis symptoms include an enlarged liver, lack of energy and appetite, and intermittent vomiting.
This form of the disease usually occurs in conjunction with a partial bile duct obstruction, inflammation of the gallbladder, gallstones, or gallbladder sludging. It can also occur with pancreatitis or IBD as well.
Since the symptoms of cholangiohepatitis are common in other serious liver disorders, often several diagnostic tests are necessary to confirm the diagnosis. These tests may include a complete blood count (CBC), blood chemistry profile, urinalysis, bile acid analysis, a blood-clotting test, and abdominal X-rays and/or ultrasound.
Often an ultrasound-guided liver biopsy is recommended to confirm the diagnosis and determine what form of cholangiohepatitis is present. However, I don’t recommend ultrasound-guided liver biopsies on patients who aren’t stable, because the risks can outweigh the benefits.
Treatment depends on the cause of your pet’s cholangiohepatitis. If there’s infection or inflammation present, it must be managed. Sometimes an autoimmune reaction occurs which requires special handling. In most cases, choleretics are prescribed to thin the bile so it can flow more easily out of the gallbladder.
Integrative veterinarians use a variety of excellent supportive therapies for cholangiohepatitis. I would recommend you consider investigating these if you have a pet with this condition. We use S-adenosylmethionine (SAMe), vitamin B and E supplements, and vitamin K. Foods rich in vitamin K are provided to address blood-clotting issues. Choline, glandular therapies, and milk thistle can also be very beneficial.
We also use homeopathic remedies based on your pet’s specific symptoms, and traditional Chinese medicine (TCM) as well, which is also customized to your pet’s individual needs.
In TCM, liver disharmony can negatively affect your pet’s behavior and contribute to a variety of other symptoms, including eye, bowel, skin, and neurologic symptoms. There are very good Chinese herbs that can be effective in reducing liver inflammation regardless of the cause.
Animals who are dehydrated or malnourished may require intravenous (IV) fluids for a period of time. Some pets require a feeding tube, especially kitty patients, who often stop eating, which is dangerous. Sometimes to save an animal’s life, a feeding tube is temporarily placed.
Treatment can take three to four months, and regular monitoring of your pet’s liver enzymes will be required. Animals with non-suppurative cholangiohepatitis typically require long-term therapy, sometimes for the rest of their lives. These are situations in which holistic modalities can be a tremendous blessing.
Often they can completely replace conventional drug protocols for maintenance therapy, or at the very least greatly reduce the amount of drugs needed on a long-term basis.
Pets who have a concurrent disease such as IBD, pancreatitis, ductopenia (an inherited lack of liver ducts), or small intestine absorption issues will need to be treated for those issues as well. Liver patients do best with an all-natural diet rich in food-based antioxidants, human-grade meats, and no synthetic preservatives. Reducing the amount of “extras” that go into your pet’s body means you’re reducing the workload on the liver, which is the goal.
The outlook for pets with cholangiohepatitis can be unpredictable. Many animals with the suppurative form of the disease who are diagnosed early and properly treated can make a full recovery. Long-term remission is possible in pets with the non-suppurative form of the disease that are diagnosed early and treated promptly.
Sadly, the prognosis is much less optimistic for pets who aren’t diagnosed until the disease is advanced. This can happen when pet parents don’t realize their cat or dog is sick, or they wait too long to make an appointment with their veterinarian. This is one of the reasons I recommend that you partner with a proactive veterinarian who will suggest regular routine bloodwork to monitor your pet’s overall internal health on a consistent basis.