Cholangitis/cholangiohepatitis in cats

‘Cholangitis’ means inflammation of the bile system in the liver. This inflammation can spread to the liver itself and is sometimes termed ‘cholangiohepatitis’. It can cause a severe disease that comes on suddenly. However, many cats have episodes where their cholangitis flares up and they are unwell for a few days to weeks followed by periods where they appear to be completely normal. In cats it is common to have cholangitis alongside inflammation of the liver, pancreas and/or intestines which is known as triaditis. 

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In the normal animal the liver produces bile, which is a liquid used to digest fats. Bile is stored in a pouch called the ‘gall bladder’ which sits within the liver, and is transported to the intestine via the bile ducts which are narrow tubes.

Cholangitis means inflammation of the bile ducts, and cholangiohepatitis is inflammation of the bile ducts and the liver. Bile ducts are narrow and if swollen they can get blocked and bile is unable to flow out into the intestine which makes the animal severely unwell. Inflammation can be due to infection from bacteria in the gut escaping up into the bile ducts. This can occur if your cat vomits for any reason, or occur for other reasons. Obstruction to the ducts can also be caused by a tumor (cancerous lump) or a bile stone (cholelith). Inflammation can also be due to an autoimmune disease where the cat’s immune system attacks its own tissues.

In cats, the liver and bile ducts are very close to the pancreas, and both are connected to the intestine. Hence, disease in one organ often affects the other, and when all three are affected the term ‘triaditis’ is used. In some cases only two of the organs are involved.

The signs of cholangitis/cholangiohepatitis can be quite vague and intermittent and cats with mild disease are usually normal most of the time or show subtle signs of eating less and losing weight for example. During a flare-up of disease your cat may feel unwell (not wanting to eat and sleeping more), sometimes with a fever and abdominal pain (resenting being picked up for example). Cats often show pain in very subtle ways such as hiding, sleeping in unusual places, resting in abnormal positions, and interacting less with the family. Sometimes there will be vomiting and diarrhea and you may notice a yellowing of the membranes in your cat’s eyes and mouth which indicate jaundice. Cats with jaundice also produce very yellow colored urine which may be noticed in the litter tray.

The signs of cholangitis are sometimes vague and can be seen with many other conditions. Your veterinarian may find that your cat has pain on abdominal palpation, or they may spot signs of jaundice. Always ask for your cat to be weighed – weight loss may be the only sign of illness. Your veterinarian will need to run some tests to try to find out what is the causing your cat to be unwell. Results of blood tests may point your veterinarian towards thinking there is a problem with your cat’s liver but are unlikely to tell them exactly what is causing the problem.

Further investigations at the clinic may be needed, the most useful of which is an ultrasound. The bile ducts in particular can be difficult to find, so your cat may also need to visit a specialist clinic to have a more detailed scan. Samples can sometimes be taken from the liver and from the gall bladder guided by ultrasound, and sometimes surgery is needed to obtain larger samples.

If your cat is unwell the first step will be to stabilize your cat’s condition. If your cat is not eating your veterinarian will probably admit them to hospital and your cat may need to go onto a drip to provide fluids and may need a feeding tube to provide nutrition. They may need medications including antibiotics, pain relief, treatments for nausea (feeling sick) and other drugs and supplements. The treatment will depend on the underlying cause of the inflammation. If there is an infection then antibiotics can be quite successful, whereas for immune-mediated diseases immunosuppressive treatment will be required. For cats with a complete obstruction of the bile duct, surgery is likely to be required. This type of surgery can be very challenging and referral to a specialist veterinary hospital is recommended. Treatment may have to be continued for many months and is most commonly in the form of tablets, so it is important to discuss with your veterinarian if you might have trouble giving medication to your cats.

One of the main priorities is your cat start taking nutrition as soon as possible, as periods of not eating can be very detrimental for cats, even causing a more serious liver disease called hepatic lipidosis. Therefore, in many sick cats, a feeding tube will need to be placed. Your veterinarian will place a tube either through the nose, neck or through the body wall directly into the stomach. Cats generally tolerate these tubes quite well and they are important to ensure that regular liquidized nutrition can be given. Your cat might still have a feeding tube in place when they come out of hospital and you may need to feed them this way for several weeks after they have come home and although this can seem a daunting prospect, they are easy to manage with your veterinary clinic’s support. No cat should be ‘force fed’ with a syringe as this will rarely provide enough food and can cause serious complications.

Whilst your cat is being stabilized your veterinarian will continue to look for any underlying causes of the disease and other diseases like pancreatitis, and, if they find these, these will need to be treated as well.

The outlook for cats with cholangitis/cholangiohepatitis but no other complications is quite good, providing they can receive the correct treatment. In some cats the disease resolves completely, in others there will continue to be intermittent bouts of illness throughout your cat’s life but in most cases, these can be well-managed. For cats with complete obstruction of the bile duct treated with surgery, they can still make a good recovery, but the prognosis may be more guarded depending on the cause.

If your cat is unwell, you should always seek veterinary advice. Remember, cats show subtle signs of illness and rarely tell us they are in pain! If your cat’s behavior changes, they lose weight, eat less or sleep more, consult your veterinarian rather than waiting, as it is much easier to treat illness when it first occurs.