Before beginning invasive procedures, assess the patient's coagulation status by determining the prothrombin time, partial
thromboplastin time, and platelet count. Vitamin K1 is routinely given, especially in hyperbilirubinemic animals, 24 to 36 hours before the coagulation profile is performed.
A hepatic biopsy may be obtained by ultrasound guidance (Tru-Cut biopsy with a 16- or 18-ga needle) or by laparoscopy or exploratory
surgery (wedge biopsy). Regardless of the technique, optimal evaluation in a relatively stable patient would consist of two
or three samples obtained from different liver lobes. Submit the biopsy samples in anaerobic culture medium (aerobes will
survive in low-oxygen states) for aerobic and anaerobic bacterial culture and antimicrobial sensitivity testing. In cases
in which surgical or laparoscopic sample collection is elected, perform concurrent pancreatic and intestinal biopsy because
of the high incidence of concurrent disease in these organs.8,9
Fine-needle aspiration
Fine-needle aspiration may be considered instead of hepatic biopsy in animals with coagulopathies or when hepatic lipidosis
or lymphoma is suspected.1 Lipid infiltration in greater than 80% of the hepatocytes or the presence of lymphoblasts can be used to diagnose hepatic
lipidosis (primary or secondary) and lymphoma, respectively. Cytologic examination of fine-needle aspirates may also reveal
infectious organisms that may be difficult to visualize on histologic sections.1 Keep in mind that fine-needle aspirates will consistently miss hepatobiliary inflammation, so they are inadequate for diagnosing
feline inflammatory hepatobiliary disease.
TREATMENT
Treating feline inflammatory hepatobiliary disease requires identifying and eliminating causative factors, providing supportive
care to promote hepatic recovery, and anticipating and controlling secondary complications.
Identifying and treating etiologic factors
Table 1: Treatment for Acute Suppurative and Chronic Nonsuppurative Feline Inflammatory Hepatobiliary Disease
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In cats with suppurative disease, promptly administer antibiotics that have broad-spectrum coverage for aerobic and anaerobic
intestinal coliforms (Table 1).1,2,5,6 In systemically ill animals, good choices include ticarcillin disodium-clavulanate potassium or enrofloxacin or amikacin
in combination with ampicillin. Some prefer to add metronidazole for its broad anaerobic spectrum and anti-inflammatory actions.1,2 Less systemically ill cats (lack of neutrophil toxicity, degenerative left shift, neutropenia, hypoglycemia, pyrexia, or
hypothermia) may be given either ampicillin or cefazolin alone. Long-term antibiotic therapy can be adjusted based on culture
and antimicrobial sensitivity results and should be continued for a minimum of three months.1 In cases of toxoplasmosis, administer clindamycin for four weeks (Table 1).
In addition to treating underlying bacterial infection, address other predisposing factors for suppurative disease. If abdominal
ultrasonography reveals cholelithiasis or extrahepatic bile duct obstruction, surgery for stone removal or decompression of
the biliary tract, respectively, is warranted. Survival rates are directly related to prompt definitive treatment and biliary
decompression.1
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