FELINE MEDICINE
TOP 5 Liver Presentations in Cats
1. Acute neutrophilic cholangitis (suppurative
cholangiohepatitis)
2. Chronic neutrophilic cholangitis (nonsuppurative or lymphoplasmacytic)
3. Lymphocytic cholangitis (nonsuppurative
cholangitis or cholangiohepatitis)
4. Triaditis
5. Hepatic lipidosis
onset anorexia, vomiting, lethargy, and diarrhoea;
they may be dehydrated, febrile, and jaundiced with
abdominal discomfort. Liver enzymes and total bilirubin are elevated while other biochemical abnormalities (eg, azotaemia, electrolyte imbalances) are nonspecific.
Ultrasonography may reveal bile duct distention (secondary to pancreatitis) or gallbladder sludge and may
help guide fine-needle liver aspiration and diagnosis
of cholecystitis. Laparoscopy can be used to examine
liver and biliary systems, procure samples for hepatic
histopathology, and guide spinal needle (22-gauge)
placement for gallbladder aspiration. Because of a
possible bacterial component, bile cytology and culture and sensitivity (both aerobic and anaerobic) of
the hepatic parenchyma and gallbladder contents are
important. Vitamin K1 at 0.5 to 1.5 mg/kg SC q12h for
3 doses is warranted before sample acquisition.
Antibiotic therapy is the cornerstone for ANF, based
either on culture and sensitivity test results or an
empiric choice to cover enteric organisms (usually
gram-negative, anaerobes) with good hepatobiliary
penetration. Cephalosporins, amoxicillin-clavulanic
acid, fluoroquinolones, or combination therapy (enrofloxacin 5 mg/kg q24h, metronidazole 7.5 mg/kg
q12h) are logical candidates (≥4–8 weeks). Supportive
care with fluids, electrolytes, and complete and balanced nutrition should also be considered. Ursodiol
at 10 to 15 mg/kg q24h and pain medications, such as
buprenorphine at 0.01 to 0.03 mg/kg OTM q8h, may
be indicated.
2. Chronic neutrophilic cholangitis (nonsuppura-
tive or lymphoplasmacytic)
Histopathology reflects a shift in the predominant
inflammatory cell type from neutrophils to a mixed
population, i