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Liver Inflammation in Cats


Cholangitis-Cholangiohepatitis Syndrome in Cats


Cholangitis is the medical term given for inflammation of the bile ducts and intrahepatic ducts -- the ducts that carry bile out of the liver. Bile, an essential component in the digestive process, begins in the liver and is then stored in the gallbladder until a meal is taken. The bitter fluid is then released into the cat's small intestine, where it emulsifies fats in the food to be used as energy by the rest of the body.


Cholangiohepatitis, meanwhile, describes inflammation of the bile ducts and liver. Together, these diseases are referred to as Cholangitis-Cholangiohepatitis Syndrome (CCHS), a disease that most commonly occurs in cats (though it does occur in dogs).

The most common cat breeds affected with CCHS are the Himalayan, Persian, and Siamese


Symptoms and Types


Certain conditions often occur prior to or simultaneous to CCHS: inflammation or clogging of  the liver ducts running outside the liver (EHBDO), inflammation of the pancreas, inflammatory bowel disease (IBD), fatty liver disease, or long-term inflammation of kidney tissue. Symptoms may be sudden, intermittent, or long-term.


However, there are currently only three types of CCHS are recognized: suppurative, which has a discharge of fluid within the biliary canal and is often sudden onset, but generally has a good outcome; nonsuppurative, which is reoccurring and has a guarded to poor prognosis; and lymphocytic/lymphoplasmacytic, where lymphocytes and plasma cells invade and surround the liver's portal vein or portal triad (the portal vein, bile duct and artery of the liver), and which has a poor outcome due to its longer lasting chronic nature and tendency to progress to cirrhosis of the liver.


Suppurative CCHS

  • Fever
  • Swollen painful abdomen – due to fluid crossing over into the abdomen (ascites)
  • Yellow skin and yellow whites of eyes
  • Dehydration
  • Shock


Nonsuppurative CCHS

  • Enlarged liver (hepatomegaly)
  • Lack of energy
  • Lack of appetite (anorexia)
  • Vomiting
  • Ductopenia – insufficient number of bile ducts
    • Very hearty appetite
    • Unkempt coat
    • Variable baldness on sides of chest
    • Variable white to gray feces
    • Often due to failing liver/cirrhosis




Suppurative CCHS 

  • Infectious
    • E. coli
    • Enterobacter
    • Enterococcus
    • β-hemolytic Streptococcus
    • Klebsiella
    • Actinomyces
    • Clostridia
    • Bacteroides
    • Toxoplasmosis (rarely)
  • Non-infectious
    • Occurs after EHBDO (extra-hepatic bile duct obstruction)
    • Occurs after gall bladder blockage


Nonsuppurative CCHS

  • May not be directly causal, but concurrent with:
    • EHBDO
    • Inflammation of gallbladder
    • Gallstones
    • Inflammation of the pancreas
    • Inflammatory bowel disease
    • Long-term swelling of kidney tissue



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