In cases of nonsuppurative cholangitis, response to treatment may be difficult to assess because of the slowly progressive
nature of the disease and subtle clinical signs. A cat is considered to be in remission if it is clinically doing well (good
appetite and activity level, good body condition score), its bilirubin and albumin concentrations normalize, and its serum
liver enzyme activities are no greater than twice the reference range upper limit. The goal is to taper immunosuppressive
therapy to the lowest dose required to maintain remission. Since long-term high-dose corticosteroid therapy predisposes patients
to glucose intolerance and diabetes mellitus, periodic blood glucose assessment is recommended. In cases of persistent or
progressive increases in serum hepatobiliary enzyme activities or serum bilirubin concentrations, look for potential complications
such as secondary hepatobiliary infection, hepatic lipidosis, extrahepatic bile duct obstruction, or hepatobiliary neoplasia.
Unfortunately, many cases may only partially respond to corticosteroids alone even when underlying conditions cannot be identified.
In these cats, adding SAMe, ursodeoxycholate, or vitamin E may be of some benefit.
PROGNOSIS
The prognosis in cases of suppurative cholangitis is good if the underlying infection is treated promptly and all predisposing
factors are corrected.1
The prognosis for cats with nonsuppurative cholangitis has not been well-described and is difficult to extrapolate from review
of the current veterinary literature. In one retrospective study involving 16 cases, the mean survival time was 29.3 months,
but in over half the cases a serious concurrent illness (e.g. feline infectious peritonitis, lymphosarcoma, chronic renal failure, diabetes mellitus) probably contributed to death.15 Some of the cases were subclinical for liver disease, but because suppurative and nonsuppurative cholangitis were combined
in this study, it is unclear what proportion of subclinical cases were nonsuppurative.15 In another study examining 21 cases of progressive lymphocytic cholangitis, survival ranged from five days in four cats
to more than six years in six cats.10 However, three of the cats that died within nine months of diagnosis died of conditions unrelated to their liver disease.10 So we can only say that full remission of disease is not obtained in most cases and that a waxing and waning course of illness
is likely.
The prognosis for cats with liver fluke infestation is variable and depends on the infective dose (number of flukes ingested)
and the risk of reinfection. Most cases are asymptomatic.11-13 The prognosis for severely affected cats is poor.
CONCLUSION
The clinical signs and clinicopathologic data of cats with inflammatory hepatobiliary disease help us suspect the disorder
but rarely help us differentiate the types of disease. Abdominal ultrasonography, hepatic biopsy, and bacterial culture and
antimicrobial sensitivity testing of liver and bile are necessary to obtain a definitive diagnosis and to rule out a treatable
underlying cause. While a predisposing cause is generally present in cases of suppurative cholangitis, the cause of the various
nonsuppurative cholangitis subtypes remains poorly understood.
Long-term antibiotic therapy is the treatment of choice for suppurative cholangitis. In nonsuppurative feline inflammatory
hepatobiliary disease, make every effort to rule out an underlying infectious cause before initiating immunosuppressive therapy.
Consider concurrent pancreatitis and inflammatory bowel disease in cases of nonsuppurative feline inflammatory hepatobiliary
disease. In all cases, monitoring serum liver enzyme activities and bilirubin and albumin concentrations will allow you to
assess response to therapy. Further research is required to investigate the roles of bacteria and immune stimulation in the
etiology of nonsuppurative cholangitis in order to improve the prognosis in these cases.
Johanna Cooper, DVM
Cynthia R.L. Webster, DVM, DACVIM
Department of Clinical Sciences
Cummings School of Veterinary Medicine
Tufts University
North Grafton, MA 01536
REFERENCES
1. Center S. Diseases of the gallbladder and biliary tree. In: Grant Guilford W, Center SA, Strombeck DR, et al, eds. Strombeck's small animal gastroenterology. 3rd ed. Philadelphia, Pa: WB Saunders Co, 1996;874-884.
2. Weiss DJ, Gagne J, Armstrong PJ. Inflammatory liver diseases in cats. Compend Contin Educ Pract Vet 2001;23:364-372.
3. van den Ingh T. Morphological classification of biliary disorders of the canine and feline liver, in Proceedings. Am Coll Vet Intern Med 2003.
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