Cholangiohepatitis is a condition that occurs more commonly in the cat than in any other species.
It is a swelling of the liver caused by a reflux of bacteria passing from the gut up to the liver. Although cholangiohepatitis is often described as an infection, it is not “infectious,” and there is no risk of it spreading to other cats.
The signs are quite vague and nonspecific, such as a loss of appetite and vomiting. If the illness is caught in time, many cats respond well to treatment and go on to make a full recovery. However, some cases do deteriorate and become seriously ill.
It is therefore wise to always seek veterinary attention sooner rather than later if your cat is unwell.
Cats with cholangiohepatitis are likely to feel unwell and not want to eat. These cats tend to sleep a lot and seek solitude, so signs include a lack of interest in normal daily activities and withdrawing somewhere quiet to sleep.
Some cats vomit or have diarrhea; some stop drinking altogether while others become abnormally thirsty. The symptoms can come on suddenly or more gradually, including the cat’s appetite dropping off over a few days.
Some cats with cholangiohepatitis are feverish, which makes them sleepy. Plus, you may notice a warm nose and hot ears. If the liver is very swollen, it can compress the exit to the gall bladder, which results in the cat becoming jaundiced. You might notice this as a yellow tinge to the whites of the eye or to the normally pink gums.
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Cholangiohepatitis is a fascinating condition because it is almost certainly caused by a quirk in feline anatomy.
Other species have a more sophisticated method of plumbing the bile duct into the intestine. However, cats have a unique anatomy that means bile duct can unwittingly provide a passage for bacteria to reflux in the wrong direction from the duodenum up into the liver.
Cholangiohepatitis comes in 2 forms:
- Suppurative: the liver equivalent of an abscess, with infection in the tissue
- Non-suppurative: thought to be an inflammatory response generated by the immune system when presented with bacteria
Either way, if treatment is given promptly, the cat stands a good (but not guaranteed) chance of recovery.
Strictly speaking, a definitive diagnosis can only be made by liver biopsy. However, in the majority of cases, enough evidence can be gathered through less invasive means to justify starting treatment.
A thorough clinical exam gives the veterinarian lots of clues. A feverish cat with a swollen, sore liver and jaundice points heavily toward cholangiohepatitis. Blood tests can further back up these suspicions with things such as raised liver enzymes and bilirubin levels.
However, other conditions can also cause changes on the blood picture, so a logical step is to ultrasound the abdomen to troubleshoot other problems such as a tumor in the liver. A scan can also facilitate taking ultrasound-guided needle aspirates from the liver, which can give valuable clues about the cells types present in the liver.
Cats with cholangiohepatitis are often vomiting and not eating. If the condition is caught before the cat is dehydrated, then a course of antibiotics may be sufficient to settle things down. If, however, the cat presents worse symptoms, then hospitalization for an intravenous drip to reverse dehydration is likely needed.
Once the cat improves and starts eating, a bland, easy-to-digest diet is advisable so as not to overload the liver with toxic metabolites.
Because cholangiohepatitis in cats is caused by an error in internal plumbing, it is a difficult condition to prevent. However, cats treated in the early stages of sickness get better more quickly than those who become really unwell, so if in doubt, take your cat to the vet sooner rather than later.
- “Feline hepatic disorders: Update on diagnosis and management.” Marks. Proceedings of 51st BSAVA Congress, 201–205.
- “New developments in liver disease in cats.” Jackson. ESFM, 33rd WSAVA Congress.
This pet health content was written by a veterinarian, Dr. Pippa Elliott, BVMS, MRCVS. It was last reviewed Oct. 13, 2018.