Symptoms and treatment of liver disease in cats. Feline cholangitis. Definition, diagnosis and treatment of cats with neutrophilic, bacterial, lymphocytic or chronic cholangitis

This is a syndrome of middle-aged and older cats. In this disease, lymphocytes infiltrate the structures of the liver, pancreas and intestines at the sites of excretion of the ducts of these organs. The reason for this is immune response organism on foreign body, bacterial agents or toxic components in the intestine. One or all of the organs may be involved in the process. Peculiarity this disease- possibility of transition pathological process from organ to organ, in view of the close anatomical communication. The affected organs become edematous and cannot function normally. When lymphocytes accumulate only in the submucosal layer of the intestine, the disease is called IBD - inflammatory bowel disease. If only the liver is affected - hepatitis, if the pancreas is affected - pancreatitis. All these diseases occur more often together, but in the early stages one may prevail.

Icteric skin

Symptoms is progressive anorexia (refusal to eat), cachexia (weight loss), vomiting, diarrhea, icterus.

Diagnostics: biochemical analysis blood, clinical analysis blood, ultrasound of the liver and intestines, biopsy. Pancreatitis is the most difficult to diagnose, so it always remains in differential diagnoses.

Treatment directed to the disease with the most striking symptoms. It is necessary to prescribe a diet in feeding, antibiotic therapy, immunosuppressive drugs.

Cholangitis can be divided into two subspecies: neutrophilic and lymphocytic.

Neutrophilic cholangitis usually occurs due to ascending infection from gastrointestinal tract. Often it is accompanied by pancreatitis. This pathology often occurs with biliary stasis occurring in the presence of inflammation rather than obstruction.

Symptoms: lethargy, anorexia, pyrexia, icterus, sometimes abdominal pain.

Treatment: antibiotic therapy, course of at least 4-6 weeks. At severe inflammation and biliary stasis - prednisolone.

Forecast favorable at early start treatment.

Lymphocytic cholangitis - a chronic condition lasting from a month to a year. It occurs in young cats, especially often recorded in the Persian breed. The etiology is not known. An immune-mediated mechanism of occurrence cannot be ruled out.

Symptoms: lethargy, lack of appetite, thirst, weight loss, abdominal wall flabby, palpable enlarged liver, icterus. A cat may not differ from its healthy compatriots and even show polyphagy.

Treatment: corticosteroids for 4-6 weeks antibiotic therapy, ursodeoxycholic acid.

Forecast: average duration life of cats with this diagnosis is 36 months. With the development of ascites, the prognosis is unfavorable.

Hepatitis treatment: intravenous therapy, vitamin K, methionine, silymarin, choleretics (ursodeoxycholic acid), diet and feeding, antiemetics (maropitant, metoclopramide), appetite stimulants (vitamin B12), diuretics with the threat of ascites.

Treatment of pancreatitis: intravenous therapy, antiemetics (maropitant, metoclopramide), H2 antagonists (ranitidine, famotidine), appetite stimulant (vitamin B12), antioxidants (methionine, selenium)

The liver is one of the most complex and important organs of a person and his pets. Any of her diseases have a bad effect on the health of the cat. Today we will consider cholangitis in cats, the causes and manifestations of this pathology.

That's what they call inflammation bile ducts . If in this case the entire liver is inflamed, the disease can be described as "cholangiohepatitis". The disease is quite serious, as it often leads to bile duct obstruction. Bile is essential for the digestion of fats, so a sick cat will quickly develop digestive problems. If nothing is done, cholemia will occur, which is fraught with death.

Causes and clinical manifestations

The acute neutrophilic form is caused by bacterial infection. Microorganisms enter the liver from the intestines, moving up the bile ducts. It is believed that the chronic neutrophilic form is a consequence acute variety. The cause of the lymphocytic form has not yet been accurately identified, but experts suggest that they are to blame autoimmune diseases when the body begins to attack itself.

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There is a group of factors called the "trinity", or "triad". In this case, cholangitis is accompanied by pancreatitis and inflammatory bowel disease. It is difficult to say which disease occurs first and "pushes" the development of other pathologies.

What are the symptoms of cholangitis in cats? Symptoms vary depending on the type of disease. Acute neutrophilic type causes a rapid deterioration in the condition of the animal, fraught with death. The cat, she has no appetite, develops profuse. Intermittent fever is possible. acute form diseases are more common in relatively young cats, cats get sick much less often.

Treatment for cholangitis in cats depends on the type of cholangitis. Because acute neutrophilic cholangitis is associated with bacterial infection, antibiotics are a key component of therapy. Alas, often the course of treatment reaches several weeks. In chronic neutrophilic and lymphocytic cholangitis, the goal is to reduce inflammation. Are used corticosteroids, sometimes use more powerful immunosuppressants. For cholangitis associated with liver flukes, use praziquantel and funds based on it.

Definition, terminology

Feline cholangitis- inflammation concentrated in the biliary tree (bile ducts), a common form of liver disease, and apparently the second most common after lipidosis. The new simplified classification scheme proposed by the WSAVA Liver Diseases and Pathologies Standardization Study Group proposes 3 various shapes cholangitis in cats

• Lymphocytic Cholangitis
• Chronic Cholangitis

The new proposed classification scheme also prefers the term "cholangitis" to "cholangiohepatitis" because inflammatory lesions parenchyma is not always present, and if present, it is a complication of primary cholangitis.

Neutrophilic (Bacterial) Cholangitis

Neutrophilic (bacterial) cholangitis characterized by infiltration of large numbers of neutrophils into the hilum of the liver and bile ducts, and is usually associated with ascending bacterial infection, although protozoa are sometimes the cause. Causative agents of feline cholangitis include E. coli, bacteroids, actinomycetes, clostridia, and alpha-hemolytic streptococcus. Bile thickening, which can cause partial or complete obstruction of the common bile duct, gallbladder, or intrahepatic bile ducts, often accompanies feline cholangitis and requires treatment to resolve the cholangitis itself.

Feline neutrophilic cholangitis can be divided into 2 categories:

• sharp
• chronic

Their histological distinction is based on the presence of a large number of plasma cells, lymphocytes, and sometimes macrophages in the chronic stage.

Lymphocytic cholangitis in cats

Lymphocytic cholangitis in domestic cats can be both a late stage of neutrophilic cholangitis, and an independent disease. Feline lymphocytic cholangitis is characterized by moderate to severe infiltration of the hilum region with small lymphocytes ± bile duct hyperplasia, portal or periductal fibrosis. Feline diseases often associated with lymphocytic cholangitis include inflammatory bowel disease and pancreatitis. Inflammatory bowel disease can lead to a retrograde introduction of bacteria into the common bile duct, resulting in pancreatitis and cholangitis. It is important that despite the pronounced inflammation in small intestine Cats with cholangitis will not always have diarrhea.

Chronic cholangitis in cats

Chronic cholangitis associated with liver fluke invasion (Amphimerus pseudofelineus, Platynosomum concinnum, etc.) represents the 3rd form of cholangitis. Chronic cholangitis in cats secondary to fluke infestation is characterized by prominent bile duct ectasia, moderate to severe ductal epithelial hyperplasia, severe concentric periductal fibrosis, and occasionally adult flukes and/or eggs can be found in the bile duct lumen.

Clinical signs of cholangitis in cats

The clinical signs of feline cholangitis associated with inflammatory liver disease are variable and nonspecific, and sometimes the same as those seen in hepatic lipidosis. The most common is partial or complete anorexia and sometimes this is the only symptom. Other less common symptoms include weight loss, lethargy, vomiting, diarrhea, and fever. Younger cats presenting with acute cholangitis ( average age 3 years) than cats with chronic cholangitis (mean age 9 years) or hepatic lipidosis (mean age 6.2 years). Males are more susceptible to acute neutrophilic cholangitis. Cats with acute cholangitis are more severely ill than cats with other liver diseases.

Diagnosis of cholangitis in cats

According to laboratory data, there will be a moderate or pronounced increase in serum bilirubin, alkaline phosphatase and ALT.

Most cats with acute or chronic cholangitis have no detectable echogenicity of the hepatic parenchyma. Conversely, cats with hepatic lipidosis will show diffusely hyperechoic parenchyma. Pathologies of the bile ducts can be seen with cholangitis. These pathologies include distension of the gallbladder and/or common bile duct, cholelithiasis, cholecystitis, and bile stasis. The common bile duct usually appears as an anechoic, tubular, tortuous structure, 2 to 4 mm in diameter, with an echogenic wall. Distension of the gallbladder and common bile duct (i.e., greater than 5 mm in diameter) occurs as a result of cholecystitis or duct obstruction. The gallbladder wall may become thickened due to inflammation or swelling. For the final diagnosis, a liver biopsy for histological examination is required, of course, after coagulation tests. Cultures of bile and/or liver parenchyma should be done, if possible.

Therapy for cholangitis in cats

Specific Treatment for Cats with Cholangitis based on liver biopsy results. Neutrophilic cholangitis in cats is treated with antibiotics. The antibiotics of choice must be excreted into the bile at active form, and should be active against aerobic and anaerobic intestinal bacteria of the group coli. Tetracycline, ampicillin, amoxicillin, erythromycin, chloramphenicol and metronidazole are excreted in active form; however, some of them have serious side effects. Erythromycin is not active against gram-negative bacteria, tetracycline is hepatotoxic, and chloramphenicol can cause anorexia. As a result, ampicillin or ampicillin with clavulanic acid is most often used for treatment. These drugs can be combined with enrofloxacin to expand the spectrum of action. Recommended treatment for 2 months or more. Cats with lymphocytic cholangitis are usually treated with immunomodulatory therapy, including a combination of prednisolone and chlorambucil.

Cholagogue drugs such as ursodeoxycholic acid (Actigall, Ursofalk) are recommended for any inflammatory diseases cat liver. It has anti-inflammatory, immunomodulatory and antifibrotic properties, as well as increases the flow and secretion of bile. Ursodeoxycholic acid can be given to cats at a dose of 10-15 mg/kg every 24 hours orally. Denamarin (adenosylmethionine, like our heptral) can be used as an antioxidant to reduce damage to hepatocytes. If hemorrhagic diathesis develops, injections of vitamin K1 (5 mg/cat every 1-2 days subcutaneously) are indicated. Nutritional support is of the utmost importance in a cat with cholangitis, and esophagostomy is often required. Surgery is recommended if cholelithiasis or obstruction of the common bile duct is found. If complete extrahepatic obstruction of the bile duct is found, surgical decompression is performed and a biliary-intestinal anastomosis (i.e., cholecystoduodenostomy or cholecystojejunostomy) is performed.

Cholangitis - inflammation of the bile ducts, manifested by indigestion and jaundice.

Cholangitis in cats is relatively common and very different from liver disease in dogs. It can be quite difficult to treat, especially if the cause of the disease is not exactly known.

There are three main types of cholangitis in cats:

Neutrophilic cholangitis caused by a bacterial infection in the liver, leading to inflammation. Usually develops as a result of migration of bacteria to the bile ducts from small intestine. The disease is sometimes observed simultaneously with inflammation of the pancreas and intestines.

Lymphocytic cholangitis It has non-infectious nature, although it also leads to inflammation. The exact cause is not known, but it is possible that the disease is associated with disorders in immune system cats (immune-mediated disease).

Lymphocytic cholangitis presents with typical chronic tissue changes that progress over months or years and may be asymptomatic at first. The disease is more common in younger and persian cats. Pathophysiological mechanisms its development is unknown, but it is assumed that they are immune-mediated.

Symptoms

Clinically, the disease can be manifested by drowsiness, loss of appetite, vomiting, weight loss, abdominal distension due to effusion in abdominal cavity. On palpation and percussion, severe pain in the liver. In most cases, there are signs of obstructive jaundice due to obstruction of the outflow of bile. However, sometimes the condition of the cat does not correspond to the diagnosis at all, and the appetite even increases.

Diagnostics

characteristic diagnostic features cholangitis - an increase in the level of alkaline phosphatase; hyperbilirubinemia; level up bile acids in blood serum. In some cases, neutrophilia with a shift to the left is possible.

At ultrasound examination it is possible to reveal a thickening of the wall of the gallbladder and stagnation of bile. However, sometimes the ultrasound picture is completely normal. In some cases, the liver tissue is hyperechoic. If bile stasis occurs, the echogenicity or size of the common bile duct may increase.

Differential Diagnosis

• liver lipidosis,
• Acute toxic hepatopathy,
• Feline infectious peritonitis
• hyperthyroidism,
• toxoplasmosis,
• bartonellosis,
• portosystemic shunting,
• Extrahepatic obstruction of the biliary tract,
• Neoplasms (cancer of the bile ducts, hepatocellular carcinoma, lymphoma), tumor metastases.

The basis of the treatment of cholangitis in cats is properly selected antibiotic therapy. Since infectious agents most often come from the gastrointestinal tract, the optimal choice would be powerful antibiotic a wide range, which has a bactericidal effect and is active against anaerobes. It is desirable that this antibiotic is excreted primarily in the bile.

Traditionally, treatment begins with the appointment corticosteroids , both to suppress inflammation and thus immune-mediated liver damage, and to protect against the development of fibrosis.

In addition to basic treatment for cholangitis in cats, maintenance or additional methods treatment:

• Intravenous hydration and electrolyte administration

Fluids and electrolytes should be selected according to the electrolyte profile. For rehydration and maintenance of the condition in the initial period, crystalloids should be prescribed. If the liver dysfunction in a cat is more pronounced, or cirrhosis has developed, hypoproteinemia may be present. In these cases (usually accompanied by ascites), treatment with colloids is recommended.

• Vitamin K

The liver produces blood clotting factors; when its function is impaired, there is a risk of developing coagulopathy (blood clotting disorder). With cholestasis (bile stasis), the absorption of vitamin K in the intestine is disrupted, which further aggravates the violation of blood clotting.

• Choleretics

Assign with stagnation of bile, not accompanied by obstruction of the extrahepatic biliary tract.

• Diet

Recommended balanced diet containing moderate amount high-quality protein, unless the cat develops symptoms of hepatic encephalopathy. The latter is rarely observed in cholangitis, although in severe chronic course it is taken into account in differential diagnosis if the cat develops behavioral or neurological disorders.

• Probe feeding

Prolonged fasting may require placement of a nasoesophageal or esophagostomy tube. If the cat refuses to eat within 3 days, you should start active supplementary feeding.

• Antiemetics

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Liver- vital important organ located in the abdominal cavity directly behind the diaphragm. The liver performs many functions that are important for maintaining normal state the cat's body and ensuring the metabolic processes occurring in it:

• Digestive support (especially fats);
• Synthesis of proteins and hormones;
• Setting up energy and protein metabolism;
• Delay and withdrawal toxic substances and products;
• Support of immune system functions;

Since blood flows directly from the intestines to the liver, part of the reason is that the liver is vulnerable to toxic and harmful substances, as anything a cat eats quickly reaches the liver. The cat's liver has hypersensitivity to poisoning, as it lacks some of the metabolic pathways that allow it to cope with certain toxins.

In addition, the cat's liver is prone to a number of diseases, including, for example, diabetes mellitus, hyperthyroidism, lymphoma, and others.

The cat's liver has a huge margin of safety, so liver failure rarely occurs in practice, since more than two-thirds of the entire liver must be seriously affected by the disease. The liver also has a good ability to regenerate, which makes it possible to hope for a cat's recovery even after severe liver diseases.

Symptoms of liver disease in cats.

Signs of liver dysfunction in cats are often very vague and vague. It can be:

• Loss of appetite;
• lethargy;
• Weight loss ;

Depending on the cause and degree of the disease, symptoms such as fever, increased thirst, and vomiting may occur. In some cases, liver disease can cause fluid to accumulate in the abdomen (ascites), and in more severe cases, jaundice (yellowing of the gums and skin) can occur.

Sometimes, with very serious illnesses liver or "shunt" formation (when blood from the intestine bypasses the liver due to the presence of an abnormal blood vessel- "shunt") toxins that are usually retained by the liver can reach the brain. This can cause abnormal cat behavior, disorientation, increased salivation, and even seizures or blindness.

Diagnosis of liver diseases in cats.

Because Clinical signs Liver disease in cats is often vague and nonspecific, and blood and urine tests are usually required to make a diagnosis and identify the underlying cause. Indicators of blood and urine tests that allow us to talk about violations in the liver, include:

Elevated bilirubin in cat urine and blood.

Level liver enzymes in blood(such enzymes are produced by liver cells) with diseases (or, possibly, obstruction of the outflow of bile) may increase. These enzymes can be:

• Alanine aminotransferase (ALT, alanine aminotransferase);
• Alkaline phosphatase (ALP, alkaline phosphatase);
• Aspartame aminotransferase (AST, aspartame aminotransferase);
• Gamma-glutamyltransferase (GGT, gammaglutamyl transferase);

Bile acids. These acids, produced by the cat's liver, are very important for the digestion of fats in the intestines. With liver diseases and obstruction and impaired bile outflow, an increase in the concentration of bile acids in the blood of a cat is possible. If elevated level enzymes can be a sign of liver disease, the level of bile acids can give information about the functions of the liver.

Hematology. Examination of red and white cells in the blood can give some indication of the potential presence of infection or inflammation in the liver.

Protein in the blood. Processing the results of blood tests can help identify liver diseases, although it is difficult to determine the severity and extent of the disease only from them. In addition, such tests do not allow to determine the cause of the disease. Some changes in a cat's blood can be caused by other diseases, such as diabetes or hyperthyroidism, so further research is needed to rule out other diseases.

Assessment of the liver (to determine its size) using x-ray and ultrasound(size and structure of the liver, possible violations bile flow) can also be very helpful in helping to narrow the circle possible causes diseases.

Liver biopsy at the cat. Often, finding the cause of a cat's liver disease and choosing the most appropriate treatment involves taking a sample of liver tissue for biopsy (and possibly culture to rule out bacterial infections). Obtaining samples for a liver biopsy is usually straightforward, but it is important to first ensure that the cat is clotting normally; the liver produces the proteins (or clotting factors) necessary for this. Obtaining specimens for liver biopsy in cats is usually done under anesthesia and is done with a simple surgical operation or with a biopsy needle.

Most common liver disease in cats.

Cats are prone to many liver diseases, which is why it is so important to determine the underlying cause of the disease and choose the most suitable treatment the biopsy is so important. Here are some of the diseases:

Neutrophilic cholangitis in cats.

This is a disease caused by a bacterial infection in the liver, leading to inflammation. It usually develops as a result of bacterial migration to the bile ducts and into the liver from the small intestine. The disease is sometimes observed simultaneously with pancreatic and intestinal diseases. Diagnosis requires a liver biopsy and cultures on the obtained samples (or on samples of bile from the gallbladder).

Treatment is with appropriate antibiotics. If treatment is started in a timely manner, the prognosis for recovery is usually favorable.

Lymphocytic cholangitis in cats.

Unlike the previous one, this liver disease is non-infectious in nature, although it also leads to inflammation. The exact cause is not known, but it may be due to an abnormality in the cat's immune system (immune-mediated disease). Lymphocytic cholangitis often causes enlargement of the liver and may also cause fluid to accumulate in the abdomen. Diagnosis is made by examining liver biopsy specimens.

Treatment is with anti-inflammatory and immune-boosting drugs—usually corticosteroids. The prospects for recovery depend on the severity of the disease and, although good, in some cases long-term or even lifelong treatment is required, and relapses are possible.

Hepatic lipidosis in cats.

In this disease, the liver cells accumulate a large number of fat, which leads to the formation of significant edema and damage to the liver, which can cause severe liver dysfunction. Hepatic lipidosis usually manifests itself in cats with a sharp refusal to eat, especially if the cat has previously had excess weight. The sudden change in metabolism in these cats is probably what causes fat accumulation. The diagnosis can be confirmed by a liver biopsy.

Treatment includes finding out the underlying cause of the disease or the circumstances that contributed to the development of hepatic lipidosis. The main way to treat the disease is to provide intensive nutritional support. The cat usually has to be hospitalized and fed according to special diet using a straw until she can feed on her own again. Although many cats eventually recover, the recovery process can take several months.

Toxic liver injury in cats.

Cats are very susceptible to liver disease, which is caused by exposure to a wide range of common medications or toxins that are not harmful to other animals. This is because the cat's metabolism lacks some of the processing abilities that other species have. This should be taken into account and when prescribing medication to a cat, be sure to consult a veterinarian.

Liver tumors in cats.

Many types of tumors can form in the liver of a cat. Some affect the liver itself (primary liver tumors), others invade the liver from outside ( secondary tumors liver). Unfortunately, many types of tumors are not treatable, although in the case of lymphoma, for example, chemotherapy can be effective. Tumors limited to one lobe of the liver are also amenable to surgical resection.

Amyloidosis and hepatic peliosis in cats.

Amyloidosis is a disease in which proteins certain type(amyloids) accumulate in the liver, causing liver dysfunction, and creating prerequisites for the occurrence of liver rupture and hemorrhage into the abdominal cavity. Some cats are genetically predisposed to this disease.

Hepatic peliosis- a rare disease in cats in which multiple cavities filled with blood develop in the liver. As with amyloidosis, the liver becomes very fragile and may spontaneous breaks and bleeding into the abdominal cavity.

Other liver diseases in cats.

Other liver diseases are possible in cats, including portosystemic shunts, toxoplasmosis, feline infectious peritonitis and many others.

Treatment of liver diseases in cats.

Treatment for a cat's liver mostly depends on the underlying cause of the disease, so additional tests, such as a biopsy, are usually required. Except special treatment, supportive care is usually prescribed, in many cases including intravenous infusions(to correct dehydration), nutritional support, and medications to help maintain liver function and blood clotting, such as:

• Vitamin K;
• Ursodeoxycholic acid (Ursodeoxycholic acid, UDCA);
• S-adenosylmethionine (s-adenosylmethionine, SAMe);
• Silybin/silymarin (Silybin/Silymarin);