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Öberg J, Häggström J, Pelander L, Hillström A, Ljungvall I. The Diagnostic Value of Serum Amyloid A and Other Laboratory and Clinical Variables in Cats with Increased Liver Enzyme Activity. Vet Sci 2024; 11:298. [PMID: 39057982 PMCID: PMC11281469 DOI: 10.3390/vetsci11070298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/22/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
Distinguishing inflammatory from non-inflammatory liver disease in cats may impact management. The study aim was to evaluate if certain diagnostic variables, including Serum Amyloid A (SAA), differ (1) between various clinical disease categories (Primary liver disease, Extrahepatic, Trauma and Inconclusive) and (2) between cytological findings of severe hepatic lipidosis and other cytological findings in cats with increased liver enzymes. Medical records from 5042 cats, where SAA had been measured, were reviewed, and 566 cats fulfilled inclusion criteria consisting of increased liver enzymes and available biochemical panel results. SAA was higher in cats diagnosed with trauma compared to other diseases (p = 0.008). Cytology results were available in 85 cats, and cats with severe lipidosis had lower serum SAA concentration (p < 0.0001) and were younger (p < 0.0002) compared to cats with other cytological findings. The study shows that SAA was higher in cats diagnosed with trauma compared to cats with other causes of increased liver enzymes and that SAA may be useful to distinguish cats with cytologic evidence of hepatic lipidosis from cats with other liver pathologies. Serum Amyloid A may be a valuable complement to liver cytology when investigating cats with increased liver enzymes.
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Affiliation(s)
- Josefine Öberg
- AniCura Bagarmossen Animal Hospital, 128 48 Stockholm, Sweden
| | - Jens Häggström
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, The Swedish University of Agricultural Science, 750 07 Uppsala, Sweden; (J.H.); (L.P.); (I.L.)
| | - Lena Pelander
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, The Swedish University of Agricultural Science, 750 07 Uppsala, Sweden; (J.H.); (L.P.); (I.L.)
| | - Anna Hillström
- The University Animal Hospital, The Swedish University of Agricultural Science, 750 07 Uppsala, Sweden;
| | - Ingrid Ljungvall
- Department of Clinical Sciences, Faculty of Veterinary Medicine and Animal Science, The Swedish University of Agricultural Science, 750 07 Uppsala, Sweden; (J.H.); (L.P.); (I.L.)
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Wilson R, Barrs VR. Salmonella enterica subspecies enterica serotype Typhimurium induced pyelonephritis and suspected multifocal myositis in a cat. JFMS Open Rep 2024; 10:20551169231221951. [PMID: 38304754 PMCID: PMC10832421 DOI: 10.1177/20551169231221951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024] Open
Abstract
Case summary A 2-year-old male neutered domestic shorthair cat presented with an acute onset of muscular pain, ataxia and fever. Serological tests for Toxoplasma gondii IgM and IgG, cryptococcal antigen, feline immune deficiency virus antibody and feline leukaemia virus antigen were all negative. Brain and spinal MRI showed evidence of myositis and bilateral renal parenchymal abnormalities and pyelectasis. Salmonella enterica subspecies enterica serotype Typhimurium 1,4, [5],12:i:1,2 was isolated from urine and was susceptible to amoxycillin, amoxycillin-clavulanic acid, enrofloxacin and trimethoprim-sulfonamide. All clinical signs resolved after a 2-week treatment course with oral amoxycillin-clavulanate. A repeat urine culture 7 days after completing the antimicrobial course was negative. Relevance and novel information Infection with Salmonella species is uncommon in cats and has not previously been reported in association with pyelonephritis or generalised myositis. The importance of performing urine culture in the initial diagnostic investigation of cats with pyrexia is highlighted in this case report.
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Affiliation(s)
- Remon Wilson
- Queensland Veterinary Specialists, North Lakes, QLD, Australia
| | - Vanessa R Barrs
- Department of Veterinary Clinical Sciences, Jockey Club College of Veterinary Medicine and Life Sciences, and Centre for Animal Health and Welfare, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
- Centre for Animal Health and Welfare, City University of Hong Kong, Kowloon Tong, Hong Kong, SAR China
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Low D, Williams J. Surgical Management Of Feline Biliary Tract Disease: Decision-making and techniques. J Feline Med Surg 2023; 25:1098612X231206846. [PMID: 37933545 PMCID: PMC10812002 DOI: 10.1177/1098612x231206846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
PRACTICAL RELEVANCE Diseases of the hepatobiliary system are not uncommon in first-opinion practice. The anatomy of the feline hepatobiliary tract differs from that of dogs and may predispose cats to inflammatory hepatobiliary disease. Case management can be challenging, and the prognosis is variable and dependent on the underlying disease process. CLINICAL CHALLENGES Biliary tract disease in the cat has non-specific clinical signs that overlap with those of diseases of other body systems. Diagnostic tests of the hepatobiliary system are widely available, but interpretation of results can be challenging. Deciding on medical or surgical management can also be challenging; for example, various degrees of cholestasis may be seen with different diseases and disease severities, and will influence the decision to manage the patient medically or surgically. Surgery is indicated in cases of bile peritonitis, severe cholestasis, focal neoplasia or disease that is refractory to medical management. Intensive perioperative and postoperative management, with 24 h hospitalisation facilities, is essential. AUDIENCE This review article is written for the small animal general/primary care practitioner, with an emphasis on decision-making in the surgical management of feline hepatobiliary disease. EVIDENCE BASE Evidence available in the published literature is reviewed and presented, and the inherent limitations are discussed.
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Affiliation(s)
| | - John Williams
- Vets Now 24/7 Hospital Manchester, Whitefield, Manchester M45 6TQ, UK
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Rahmani V, Peltonen J, Amarilla SP, Spillmann T, Ruohoniemi M. Cholangiopancreatography in cats: a post-mortem comparison of MRI with fluoroscopy, corrosion casting and histopathology. Vet Radiol Ultrasound 2023. [PMID: 37133979 DOI: 10.1111/vru.13240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 03/25/2023] [Accepted: 03/25/2023] [Indexed: 05/04/2023] Open
Abstract
In human medicine, magnetic resonance cholangiopancreatography (MRCP) is a valuable diagnostic tool for hepatobiliary and pancreatic diseases. In veterinary medicine, however, data evaluating the diagnostic value of MRCP are limited. The primary objectives of this prospective, observational, analytical investigation were to assess whether MRCP reliably visualizes the biliary tract and pancreatic ducts in cats without and with related disorders, and whether MRCP images and measurements of the ducts agree with those of fluoroscopic retrograde cholangiopancreatography (FRCP), corrosion casting and histopathology. A secondary objective was to provide MRCP reference diameters for bile ducts, GB, and pancreatic ducts. Donated bodies of 12 euthanized adult cats underwent MRCP, FRCP, and autopsy with corrosion casting of the biliary tract and pancreatic ducts using vinyl polysiloxane. Diameters of the biliary ducts, gallbladder (GB), and pancreatic ducts were measured using MRCP, FRCP, corrosion casts and histopathologic slides. There was an agreement between MRCP and FRCP in measuring diameters of the GB body, GB neck, cystic duct, and common bile duct (CBD) at papilla. Strong positive correlations existed between MRCP and corrosion casting for measuring GB body and neck, cystic duct, and CBD at the extrahepatic ducts' junction. In contrast to the reference methods, post-mortem MRCP did not visualize right and left extrahepatic ducts, and pancreatic ducts in most cats. Based on this study, MRCP with 1.5 Tesla can be regarded as a contributory method to improve the assessment of feline biliary tract and pancreatic ducts when their diameter is >1 mm.
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Affiliation(s)
- Vahideh Rahmani
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Juha Peltonen
- HUS Medical Imaging Center, Radiology, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Shyrley Paola Amarilla
- Department of Veterinary Biosciences, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
- Department of Pathological Sciences, Faculty of Veterinary Sciences, National University of Asuncion, San Lorenzo, Paraguay
| | - Thomas Spillmann
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Mirja Ruohoniemi
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
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Jaffey JA. Feline cholangitis/cholangiohepatitis complex - what have we learned? J Small Anim Pract 2022; 63:573-589. [PMID: 35522164 DOI: 10.1111/jsap.13508] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 02/19/2022] [Accepted: 04/11/2022] [Indexed: 12/07/2022]
Abstract
Cholangitis/cholangiohepatitis complex in cats is commonly encountered in clinical practice worldwide. Diagnosis and management of cats with this complex is difficult because of the ambiguity of clinical signs, diagnostic test results and commonality of comorbid disorders. These impediments can delay disease identification and treatment, which can increase morbidity and mortality. In this narrative review, we aimed to provide a thorough review of the unique physioanatomic features of the biliary system as well as clinically relevant updates on cholangitis/cholangiohepatitis complex in cats.
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Affiliation(s)
- J A Jaffey
- Department of Specialty Medicine, College of Veterinary Medicine, Midwestern University, Glendale, Arizona, 85308, USA
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Center SA, Randolph JF, Warner KL, McDonough SP, Lucy JM, Sapa KC. Bacterial culture and immunohistochemical detection of bacteria and endotoxin in cats with suppurative cholangitis-cholangiohepatitis syndrome. J Am Vet Med Assoc 2021; 260:194-211. [PMID: 34936576 DOI: 10.2460/javma.20.10.0552] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To characterize the frequency and type of bacterial infection by culture- and immunohistochemical (IHC)-based methods and determine the impact of infection on clinical features and survival time in cats with suppurative cholangitis-cholangiohepatitis syndrome (S-CCHS). ANIMALS 168 client-owned cats with S-CCHS (cases). PROCEDURES Clinical features, bacterial culture results, culture-inoculate sources, and survival details were recorded. Cases were subcategorized by comorbidity (extrahepatic bile duct obstruction, cholelithiasis, cholecystitis, ductal plate malformation, biopsy-confirmed inflammatory bowel disease, and biopsy-confirmed pancreatitis) or treatment by cholecystectomy or cholecystoenterostomy. Culture results, bacterial isolates, Gram-stain characteristics, and IHC staining were compared among comorbidities. Lipoteichoic acid IHC staining detected gram-positive bacterial cell wall components, and toll-like receptor expression IHC reflected pathologic endotoxin (gram-negative bacteria) exposure. RESULTS Clinical features were similar among cases except for more frequent abdominal pain and lethargy in cats with positive culture results and pyrexia, abdominal pain, and hepatomegaly for cats with polymicrobial infections. Bacteria were cultured in 93 of 135 (69%) cats, with common isolates including Enterococcus spp and Escherichia coli. IHC staining was positive in 142 of 151 (94%) cats (lipoteichoic acid, 107/142 [75%]; toll-like receptor 4, 99/142 [70%]). With in-parallel interpretation of culture and IHC-based bacterial detection, 154 of 166 (93%) cats had bacterial infections (gram-positive, 118/154 [77%]; gram-negative, 111/154 [72%]; polymicrobial, 79/154 [51%]). Greater frequency of bacterial isolation occurred with combined tissue, bile, and crushed cholelith inoculates. Infection and gram-positive bacterial isolates were associated with significantly shorter long-term survival times. CLINICAL RELEVANCE S-CCHS was associated with bacterial infection, pathologic endotoxin exposure, and frequent polymicrobial infection in cats. Combined tissue inoculates improved culture detection of associated bacteria.
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Affiliation(s)
- Sharon A Center
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - John F Randolph
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - Karen L Warner
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | - Sean P McDonough
- Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
| | | | - Kirk C Sapa
- Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY
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Center SA, Randolph JF, Warner KL, Flanders JA, Harvey HJ. Clinical features, concurrent disorders, and survival time in cats with suppurative cholangitis-cholangiohepatitis syndrome. J Am Vet Med Assoc 2021; 260:212-227. [PMID: 34936575 DOI: 10.2460/javma.20.10.0555] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To characterize clinical features, comorbidities, frequency of bacterial isolation, and survival time in cats with suppurative cholangitis-cholangiohepatitis syndrome (S-CCHS). ANIMALS 168 client-owned cats with S-CCHS. PROCEDURES Data were prospectively (1980 to 2019) collected regarding clinical features, comorbidities, bacterial infection, illness duration, and treatments. Variables were evaluated for associations with survival time. RESULTS Median age of cats was 10.0 years, with no breed or sex predilection observed. Common clinical features included hyporexia (82%), hyperbilirubinemia (80%), lethargy (80%), vomiting (80%), jaundice (67%), weight loss (54%), and hypoalbuminemia (50%). Comorbidities included extrahepatic bile duct obstruction (53%), cholelithiasis (42%), cholecystitis (40%), and ductal plate malformation (44%) as well as biopsy-confirmed inflammatory bowel disease (60/68 [88%]) and pancreatitis (41/44 [93%]). Bacterial cultures were commonly positive (69%) despite prebiopsy antimicrobial administration in most cats. Of surgically confirmed choleliths, diagnostic imaging identified only 58%. Among 55 cats with "idiopathic pancreatitis," 28 (51%) were documented to have transiting choleliths, and 20 had pancreatic biopsies confirming pancreatitis. Cholelithiasis (with or without bile duct obstruction) and cholecystectomy were associated with survival advantages. Survival disadvantages were found for leukocytosis, ≥ 2-fold increased alkaline phosphatase, and hyperbilirubinemia. Cholecystoenterostomy had no survival impact. Cats with ductal plate malformations were significantly younger at diagnosis and death than other cats. Chronic treatments with antimicrobials, S-adenosylmethionine, and ursodeoxycholic acid were common postbiopsy. CLINICAL RELEVANCE S-CCHS in cats was associated with bacterial infection and various comorbidities and may be confused with pancreatitis. Surgically correctable morbidities (ie, cholecystitis, cholecystocholelithiasis) and cholecystectomy provided a significant survival advantage.
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Abstract
Case summary An 11-year-old female spayed Maine Coon cat was referred for assessment of hyporexia, weight loss, vomiting and diarrhoea. An abdominal ultrasound revealed an enlarged and hypoechoic pancreas containing two large fluid-filled structures. Fine-needle aspiration of the cyst-like structures was performed, and cytology revealed moderate-to-marked predominantly suppurative inflammation with yeast cells. Candida glabrata was cultured from the fluid. The patient was treated with oral itraconazole and the clinical signs resolved, although repeat abdominal ultrasound and cytology revealed persistence of the infected cyst-like structures. The patient remained asymptomatic for 8 months after the discontinuation of antifungal medications, despite the persistence of the pancreatic infection with C glabrata. Relevance and novel information To our knowledge, this is the first report of pancreatic infection with Candida species in a cat, followed by a chronic subclinical infection persisting for at least 8 months after treatment discontinuation.
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Affiliation(s)
- Kelsey Renner
- Animal Referral Centre, Department of Internal Medicine. Auckland, New Zealand
| | - Sarah Hill
- Animal Referral Centre, Department of Internal Medicine. Auckland, New Zealand
| | - Alex Grinberg
- Massey University, School of Veterinary Science, Palmerston North, New Zealand
| | - Amy Weeden
- Gribbles Veterinary Pathology New Zealand, Auckland, New Zealand
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Simpson M, Neville-Towle J, Lee K, Rossanese M. Cholecystectomy in 23 cats (2005-2021). Vet Surg 2021; 51:109-116. [PMID: 34669214 DOI: 10.1111/vsu.13741] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 09/04/2021] [Accepted: 09/29/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To describe the clinical presentation, treatments, and long-term outcomes following cholecystectomy in cats. STUDY DESIGN Clinical retrospective study. ANIMALS Twenty-three client-owned cats. METHODS Medical records of all cats undergoing cholecystectomy between 2005 and 2021 at a single referral hospital were retrospectively reviewed. No cats were excluded. An owner questionnaire assessed long-term outcomes. RESULTS Vomiting, jaundice, and abdominal pain were the most common clinical signs; median duration of signs was 4 days (range 1-21). Cholelithiasis was the major indication for cholecystectomy followed by cholecystitis. Intraoperative hypotension and postoperative anemia were commonly encountered. Nine cats required a postoperative blood product transfusion. Cardiopulmonary arrest and death occurred in five cats. Eighteen cats (78.3%) survived to discharge. Long-term follow up (>60 days) was available for 16 cats at a median of 1003 days (range 81-4995). Fifteen cats survived over 6 months with eight cats (44.4%) surviving over 3 years. The most common short-term and long-term postoperative complication was vomiting. Owners assessed postoperative outcome as excellent in all cats and quality of life as excellent or good. CONCLUSION The most common indication for cholecystectomy was cholelithiasis. Perioperative complications were commonly encountered. Perioperative mortality rate was 21.7%. Long-term owner evaluation of clinical outcome was considered excellent. CLINICAL SIGNIFICANCE Cats undergoing cholecystectomy for non-neoplastic causes can have a favorable prognosis for recovery and quality of life. Concurrent extrahepatic biliary duct obstruction is not a contraindication for cholecystectomy provided that patency of the common bile duct is restored.
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Affiliation(s)
- Matthew Simpson
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, UK
| | - Jack Neville-Towle
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, UK.,Sydney Veterinary Emergency and Specialists, Rosebery, New South Wales, Australia
| | - Karla Lee
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, UK
| | - Matteo Rossanese
- Queen Mother Hospital for Animals, Royal Veterinary College, Hatfield, UK
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Fujimoto S, Torisu S, Kaneko Y, Mizutani S, Yamamoto S, Naganobu K, Nakamura K. Pancreatic enzyme activity in the bile of healthy cats and its association with biliary morphology. J Vet Intern Med 2021; 35:1780-1788. [PMID: 34117814 PMCID: PMC8295664 DOI: 10.1111/jvim.16196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 05/25/2021] [Accepted: 05/27/2021] [Indexed: 11/29/2022] Open
Abstract
Background In human medicine, congenital maljunction of the common bile duct (CBD) and main pancreatic duct (MPD), or pancreatobiliary maljunction (PBM), is a known cause of cholecystitis. Objective Pancreatic enzyme activity in the bile (a diagnostic marker for PBM) of healthy cats was measured to determine normal values and evaluate its relationship with biliary morphology. Animals Fifty‐two healthy cats. Methods Cross‐sectional study of the biliary tracts of healthy cats during laparoscopic ovariohysterectomy and measurement of pancreatic enzyme activity in bile. The cats were divided into groups A and B based on the ratio of the diameter of the cystic duct (CD) to the CBD. The normal ratio was 3.4. Pancreatic enzyme activity in bile was compared between the groups. Results The CBDs were straight in all cases, whereas the CDs were variably tortuous or dilated. Amylase activity in the bile (median, <100 U/L; range, <100‐591 U/L) was lower than in serum in all cases, and group B, which had a CD/CBD ratio >3.4, had significantly higher amylase activity (median, 109 U/L; range, <100‐591 U/L) in the bile than did group A (median, <100 U/L; range, <100‐238 U/L), which had a CD/CBD ratio <3.4 (P = .0009). Conclusions and Clinical Importance The results suggest that a dilated CD is associated with reflux of pancreatic juice. In the future, it will be necessary to examine the clinical usefulness of these findings by measuring pancreatic enzyme activity in the bile of cats with cholangitis.
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Affiliation(s)
- Shinsuke Fujimoto
- Miyazaki University Veterinary Medical Teaching Hospital Laboratory, 1-1 Gakuenkibanadainishi, Miyazaki City, Miyazaki Prefecture, Japan.,Ozu Animal Clinic, 317 Ozumachimuro, Kikuchi-gun, Kumamoto Prefecture, Japan
| | - Shidow Torisu
- Laboratory of Companion Animal Surgery, Department of Companion Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan
| | - Yasuyuki Kaneko
- Miyazaki University Veterinary Medical Teaching Hospital Laboratory, 1-1 Gakuenkibanadainishi, Miyazaki City, Miyazaki Prefecture, Japan
| | - Shinya Mizutani
- Miyazaki University Veterinary Medical Teaching Hospital Laboratory, 1-1 Gakuenkibanadainishi, Miyazaki City, Miyazaki Prefecture, Japan
| | - Shushi Yamamoto
- Miyazaki University Veterinary Medical Teaching Hospital Laboratory, 1-1 Gakuenkibanadainishi, Miyazaki City, Miyazaki Prefecture, Japan
| | - Kiyokazu Naganobu
- Miyazaki University Veterinary Medical Teaching Hospital Laboratory, 1-1 Gakuenkibanadainishi, Miyazaki City, Miyazaki Prefecture, Japan
| | - Kensuke Nakamura
- Laboratory of Veterinary Internal Medicine, Department of Veterinary Clinical Sciences, Graduate School of Veterinary Medicine, Hokkaido University, 18-9 Kita, Kita Ward, Sapporo, Hokkaido, Japan
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Černá P, Kilpatrick S, Gunn-Moore DA. Feline comorbidities: What do we really know about feline triaditis? J Feline Med Surg 2020; 22:1047-1067. [PMID: 33100169 PMCID: PMC10814216 DOI: 10.1177/1098612x20965831] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PRACTICAL RELEVANCE Feline triaditis describes concurrent pancreatitis, cholangitis and inflammatory bowel disease (IBD). The reported prevalence is 17-39% in ill referral patients. While the aetiology is poorly understood, it is known to include infectious, autoimmune and physical components. What is not known is whether different organs are affected by different diseases, or the same process; indeed, triaditis may be part of a multiorgan inflammatory disease. Feline gastrointestinal tract anatomy plays its role too. Specifically, the short small intestine, high bacterial load and anatomic feature whereby the pancreatic duct joins the common bile duct before entering the duodenal papilla all increase the risk of bacterial reflux and parenchymal inflammation. Inflammation may also be a sequela of bowel bacterial translocation and systemic bacteraemia. DIAGNOSTIC CHALLENGES Cholangitis, pancreatitis and IBD manifest with overlapping, vague and non-specific clinical signs. Cholangitis may be accompanied by increased serum liver enzymes, total bilirubin and bile acid concentrations, and variable ultrasonographic changes. A presumptive diagnosis of pancreatitis is based on increased serum pancreatic lipase immunoreactivity or feline pancreas-specific lipase, and/or abnormal pancreatic changes on ultrasonography, though these tests have low sensitivity. Diagnosis of IBD is challenging without histopathology; ultrasound findings vary from normal to mucosal thickening or loss of layering. Triaditis may cause decreased serum folate or cobalamin (B12) concentrations due to intestinal disease and/or pancreatitis. Triaditis can only be confirmed with histopathology; hence, it remains a presumptive diagnosis in most cases. EVIDENCE BASE The literature on feline triaditis, pancreatitis, cholangitis and IBD is reviewed, focusing on histopathology, clinical significance and diagnostic challenges. Current management recommendations are provided. Further studies are needed to understand the complex pathophysiology, and in turn improve diagnosis and treatment.
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Affiliation(s)
- Petra Černá
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, and Small Animal Clinic, The University of Veterinary and Pharmaceutical Sciences, Brno, Czech Republic
| | | | - Danielle A Gunn-Moore
- The Royal (Dick) School of Veterinary Studies, and The Roslin Institute, University of Edinburgh, UK
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12
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Abstract
Clinical findings with triaditis and individual disease components overlap and may include hyporexia, weight loss, lethargy, vomiting, diarrhea, dehydration, icterus, abdominal pain, thickened bowel loops, pyrexia, dyspnea, and shock. A definitive diagnosis of triaditis requires histologic confirmation of inflammation in each organ, but this may not be possible because of financial or patient-related constraints. Evidence-based data indicate that histologic lesions of triaditis are present in 30% to 50% of cats diagnosed with pancreatitis and cholangitis/inflammatory liver disease. Treatment of triaditis is based on the overall health status of the patient and the type and severity of disease in component organs.
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Webb CB. Evidence-Based Medicine: Ultrasound-Guided Percutaneous Cholecystocentesis in the Cat. Vet Clin North Am Small Anim Pract 2020; 50:1123-1134. [PMID: 32680666 DOI: 10.1016/j.cvsm.2020.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Cholangitis is a common cause of hepatobiliary disease in the cat. Feline cholangitis is characterized as neutrophilic (acute or chronic), lymphocytic, or caused by liver flukes. The neutrophilic form is caused by bacterial infection of the biliary system, and identification of the specific bacterial agent guides treatment. Bile is the sample of choice for cytology and bacterial culture in these cases, and percutaneous ultrasound-guided cholecystocentesis is used to obtain that sample. This review covers the literature that provides evidence for safety and usefulness of percutaneous ultrasound-guided cholecystocentesis as part of the diagnostic work-up of cats suspected of having hepatobiliary disease.
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Affiliation(s)
- Craig B Webb
- Clinical Sciences Department, Colorado State University Veterinary Teaching Hospital, 300 West Drake Road, Fort Collins, CO 80523, USA.
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Palermo SM, Newman AW, Koch MW. Candida albicans cholecystitis with associated hepatitis in a cat. JFMS Open Rep 2019; 5:2055116919854165. [PMID: 31218075 PMCID: PMC6563395 DOI: 10.1177/2055116919854165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Case summary A 3-year-old male neutered domestic shorthair cat was presented for vomiting, inappetence and icterus. Biochemical results and ultrasonographic findings were consistent with cholestasis and possible biliary obstruction. A diagnosis of Candida albicans cholecystitis with associated hepatitis was made following cytologic examination and fungal culture. Progressive hyperbilirubinemia and hepatic encephalopathy were ultimately fatal. Relevance and novel information To our knowledge, this is the first report of biliary candidiasis diagnosed by cytologic examination of a cholecystocentesis sample in a domestic animal with no evidence of immunodeficiency. Additionally, this is the first reported case of fungal cholecystitis with associated white bile syndrome due to obstructive cholestasis, without an overt gall bladder mucocele.
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Affiliation(s)
| | | | - Michael W Koch
- Veterinary Specialists and Emergency Services, Rochester, NY, USA
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Dierks EA, Luk CE, Cai H, MacGuire J, Fox M, Smalley J, Fancher RM, Janovitz E, Foster K, Sun Q. Application of ultrasound-guided cholecystocentesis to the evaluation of the metabolite profiling in bile of dogs and cynomolgus monkeys. Pharmacol Res Perspect 2019; 7:e00488. [PMID: 31149343 PMCID: PMC6536413 DOI: 10.1002/prp2.488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 05/01/2019] [Accepted: 05/02/2019] [Indexed: 11/07/2022] Open
Abstract
In this study, we describe a novel approach for collecting bile from dogs and cynomolgus monkeys for metabolite profiling, ultrasound-guided cholecystocentesis (UCC). Sampling bile by UCC twice within 24 hours was well tolerated by dogs and monkeys. In studies with atorvastatin (ATV) the metabolite profiles were similar in bile obtained through UCC and from bile duct-cannulated (BDC) dogs. Similar results were observed in UCC and BDC monkeys as well. In both monkey and dog, the primary metabolic pathway observed for ATV was oxidative metabolism. The 2-hydroxy- and 4-hydroxyatorvastatin metabolites were the major oxidation products, which is consistent with previously published metabolite profiles. S-cysteine and glucuronide conjugates were also observed. UCC offers a viable alternative to bile duct cannulation for collection of bile for metabolite profiling of compounds that undergo biliary excretion, given the similar metabolite profiles in bile obtained via each method. Use of UCC for metabolite profiling may reduce the need for studies using BDC animals, a resource-intensive model.
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Affiliation(s)
- Elizabeth A. Dierks
- Pharmaceutical Candidate OptimizationBristol‐Myers SquibbPrincetonNew Jersey
| | - Chiuwa E. Luk
- Pharmaceutical Candidate OptimizationBristol‐Myers SquibbPrincetonNew Jersey
| | - Hong Cai
- Pharmaceutical Candidate OptimizationBristol‐Myers SquibbPrincetonNew Jersey
| | - Jamus MacGuire
- Veterinary SciencesBristol‐Myers SquibbPrincetonNew Jersey
| | - Maxine Fox
- Veterinary SciencesBristol‐Myers SquibbPrincetonNew Jersey
| | - James Smalley
- Pharmaceutical Candidate OptimizationBristol‐Myers SquibbPrincetonNew Jersey
| | - R. Marc Fancher
- Pharmaceutical Candidate OptimizationBristol‐Myers SquibbPrincetonNew Jersey
| | - Evan Janovitz
- Pharmaceutical Candidate OptimizationBristol‐Myers SquibbPrincetonNew Jersey
| | - Kimberly Foster
- Pharmaceutical Candidate OptimizationBristol‐Myers SquibbPrincetonNew Jersey
| | - Qin Sun
- Pharmaceutical Candidate OptimizationBristol‐Myers SquibbPrincetonNew Jersey
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Pilton JL, Chau J, Foo TS, Hall EJ, Martinez-Taboada F, Podadera JM, Makara MA. Hepatic computed tomography and cholangiography by use of gadoxetic acid in healthy cats. Am J Vet Res 2019; 80:385-395. [PMID: 30919679 DOI: 10.2460/ajvr.80.4.385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate 3 doses of gadoxetic acid (Gd-EOB-DPTA) for hepatic CT and cholangiography in cats and to determine optimal timing for hepatobiliary image acquisition and evaluation of the contrast-enhanced hepatobiliary anatomy. ANIMALS 6 healthy cats. PROCEDURES Cats were anesthetized; sequential CT scans were performed 0, 5, 25, 45, 65, and 85 minutes after IV administration of Gd-EOB-DTPA at low (0.0125 mmol/kg), medium (0.1 mmol/kg), and high (0.3 mmol/kg) doses. Hepatobiliary enhancement for each dose was objectively assessed over time and by use of a subjective semiquantitative visual assessment score. RESULTS No contrast-related adverse effects were detected. Each increase in dose of contrast medium resulted in a significant increase in HU across the hepatobiliary system. The liver had a significantly higher number of HU at 45 minutes, with homogenous enhancement at all doses of contrast medium. Contrast-enhanced cystic and bile duct HU were significantly higher and maximal at 65 minutes. Contrast-enhanced gallbladder HU did not plateau by 85 minutes. At a high dose of contrast medium, 12 of 60 (20%) biliary tract scores indicated no enhancement, 34 (57%) indicated poor enhancement, and 14 (23%) indicated moderate enhancement. No cat had excellent enhancement of the biliary tract at any dose. CONCLUSIONS AND CLINICAL RELEVANCE Gd-EOB-DTPA-enhanced hepatic CT and cholangiography in cats were safely performed and provided good hepatic enhancement but poor to moderate enhancement of the biliary tract. This technique may be useful for assessing the liver parenchyma in cats, but its value for assessing the biliary tract is questionable.
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Abstract
PRACTICAL RELEVANCE Abdominal ultrasound plays a vital role in the diagnostic work-up of many cats presenting to general and specialist practitioners. The biliary tree encompasses the liver, gall bladder and bile ducts, although only diseases affecting the latter two are discussed here. Diseases of the bile ducts and gall bladder are more common than those of the liver parenchyma and ultrasound plays an important role in their diagnosis. CLINICAL CHALLENGES Despite ultrasonography being a commonly used modality, many practitioners are not comfortable performing an ultrasound examination or interpreting the resulting images. Even differentiating between normal variation and pathological changes can be challenging for all but the most experienced. In addition, a lack of pathological change does not necessarily rule out disease; for example, absence of gall bladder and/or extrahepatic biliary distension is not sufficient to exclude the possibility of biliary obstruction, and in many cases of cholangitis the liver and biliary tree are unremarkable on ultrasound examination. EQUIPMENT Ultrasound facilities are readily available to most practitioners, although use of ultrasonography as a diagnostic tool is highly dependent on operator experience. AIM This review, part of an occasional series on feline abdominal ultrasonography, discusses the appearance of the normal and diseased biliary system. It is aimed at general practitioners who wish to improve their knowledge and confidence in feline abdominal ultrasound and is accompanied by high-resolution images. Percutaneous ultrasound-guided cholecystocentesis is also covered. Ultrasound examination of the liver was discussed in an article published in January 2019 and an upcoming article will cover hepatic vascular anomalies. EVIDENCE BASE Information provided in this article is drawn from the published literature and the author's own clinical experience.
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Affiliation(s)
- Sally Griffin
- Radiology Department, Willows Veterinary Centre and Referral Service, Highlands Road, Shirley, Solihull B90 4NH, UK
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Newton PL, Fry DR. Successful treatment of Providencia rettgeri cholecystitis and neutrophilic cholangitis in a cat. JFMS Open Rep 2018; 4:2055116917750763. [PMID: 29399368 PMCID: PMC5788108 DOI: 10.1177/2055116917750763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Abstract
Case summary A 15-year-old male neutered domestic shorthair cat was presented with a recent history of seizures, diarrhoea, lethargy, fever and jaundice. Marked elevation of liver enzyme activity was present and ultrasound examination was suggestive of cholecystitis and hepatitis. Neutrophilic cholangitis was confirmed on histopathology of liver biopsies. Bile culture identified a monomicrobial infection with Providencia rettgeri, which was resistant to multiple antimicrobial agents. The cat was treated with oral pradofloxacin for 4 weeks and remained well 4 months later. Relevance and novel information Providencia species are rarely reported in the veterinary literature and are an uncommon cause of disease in humans. The significance of this species in humans relates to the high prevalence of antimicrobial resistance. This is the first report of P rettgeri causing clinical illness in a cat and highlights the importance of bile cultures in hepatic disease.
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Affiliation(s)
| | - Darren R Fry
- Brisbane Veterinary Specialist Centre, Albany Creek, QLD, Australia
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Byfield VL, Callahan Clark JE, Turek BJ, Bradley CW, Rondeau MP. Percutaneous cholecystocentesis in cats with suspected hepatobiliary disease. J Feline Med Surg 2017; 19:1254-1260. [PMID: 28128682 PMCID: PMC11104171 DOI: 10.1177/1098612x16689335] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
Objectives The objective was to evaluate the safety and diagnostic utility of percutaneous ultrasound-guided cholecystocentesis (PUC) in cats with suspected hepatobiliary disease. Methods Medical records of 83 cats with suspected hepatobiliary disease that underwent PUC were retrospectively reviewed. Results At the time of PUC, at least one additional procedure was performed in 79/83 cats, including hepatic aspiration and/or biopsy (n = 75) and splenic aspiration (n = 18). Complications were noted in 14/83 cases, including increased abdominal fluid (n = 11), needle-tip occlusion (n = 1), failed first attempt to penetrate the gall bladder wall (n = 1) and pneumoperitoneum (n = 1). There were no reports of gall bladder rupture, bile peritonitis or hypotension necessitating treatment with vasopressor medication. Blood products were administered to 7/83 (8%) cats. Seventy-two cats (87%) survived to discharge. Of the cats that were euthanized (9/83) or died (2/83), none were reported as a definitive consequence of PUC. Bacteria were identified cytologically in 10/71 samples (14%); all 10 had a positive aerobic bacterial culture. Bile culture was positive in 11/80 samples (14%). Of the cases with a positive bile culture, cytological description of bacteria corresponded to the organism cultured in fewer than 50% of cases. The most common cytologic diagnosis was hepatic lipidosis (49/66). The most common histopathologic diagnosis was cholangitis (10/21). Conclusions and relevance PUC was safe in this group of cats with suspected hepatobiliary disease. Complications were likely associated with ancillary procedures performed at the time of PUC. Bile analysis yielded an abnormal result in nearly one-third of cats with suspected hepatobiliary disease. Complete agreement between bile cytology and culture was lacking. Further evaluation of the correlation between bile cytology and bile culture is warranted.
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Affiliation(s)
- Victoria L Byfield
- Department of Clinical Studies, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA, USA
- Current address: Mount Laurel Animal Hospital, Mount Laurel, NJ, USA
| | - Julie E Callahan Clark
- Department of Clinical Studies, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA, USA
- Current address: New England Animal Medical Center, West Bridgewater, MA, USA
| | - Bradley J Turek
- Department of Anatomic Pathobiology, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA, USA
- Current address: Antech Diagnostics, Irvine, CA, USA
| | - Charles W Bradley
- Department of Anatomic Pathobiology, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA, USA
| | - Mark P Rondeau
- Department of Clinical Studies, University of Pennsylvania, School of Veterinary Medicine, Philadelphia, PA, USA
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Harrison JL, Turek BJ, Brown DC, Bradley C, Callahan Clark J. Cholangitis and Cholangiohepatitis in Dogs: A Descriptive Study of 54 Cases Based on Histopathologic Diagnosis (2004-2014). J Vet Intern Med 2017; 32:172-180. [PMID: 29131399 PMCID: PMC5787197 DOI: 10.1111/jvim.14866] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 08/10/2017] [Accepted: 10/11/2017] [Indexed: 12/15/2022] Open
Abstract
Background Cholangitis in dogs appears to be more common than previously thought, but understanding of the disease remains incomplete. Objective To describe a population of dogs with cholangitis or cholangiohepatitis. Animals Fifty‐four client‐owned dogs with cholangitis or cholangiohepatitis. Methods Medical records of dogs with cholangitis or cholangiohepatitis confirmed by histopathology between January 2004 and December 2014 were identified using a computer‐based search and retrospectively reviewed. Results Clinical signs included vomiting (72.2%), lethargy (70.4%), and inappetence (64.8%). Most dogs (49/50) had increased liver enzyme activities, hyperbilirubinemia (32/50), and hypercholesterolemia (24/43). Ultrasonographic abnormalities of the hepatobiliary system were seen in 84% of cases. On histopathology, 53 of 54 affected dogs had neutrophilic cholangitis (NC) or cholangiohepatitis, whereas 1 dog had lymphocytic cholangitis. Most cases (42/54) were chronic. Evidence of concurrent biliary disease (46.2%) and biliary tract obstruction (42.6%) was common. Seventeen of 36 biliary and 11 of 25 liver cultures were positive for bacterial growth; Escherichia coli and Enterococcus spp. were most common. Median patient survival was 671 days (95% confidence interval [CI]: 114–1,426). On Cox regression, dogs that did not have a cholecystectomy performed had a 2.1 greater hazard for death (P = 0.037; 95% CI: 1.0–4.3) compared to cholecystectomized dogs. Dogs >13 years old had a 5.0 greater hazard for death (P = 0.001; 95% CI: 1.9–13.2) compared to younger dogs. Conclusions and Clinical Significance Chronic NC or cholangiohepatitis was most common. Cholecystitis and biliary tract obstruction often occurred in conjunction with cholangitis. Cholecystectomized dogs had decreased risk of death; thus, cholecystectomy may improve patient outcome.
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Affiliation(s)
- J L Harrison
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - B J Turek
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - D C Brown
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - C Bradley
- Department of Pathobiology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
| | - J Callahan Clark
- Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, PA
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21
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Meichner K, Li CF, Harrell K, Neel JA, Tarigo JL. Pathology in Practice. J Am Vet Med Assoc 2017; 251:793-796. [PMID: 28967820 DOI: 10.2460/javma.251.7.793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Policelli Smith R, Gookin JL, Smolski W, Di Cicco MF, Correa M, Seiler GS. Association between Gallbladder Ultrasound Findings and Bacterial Culture of Bile in 70 Cats and 202 Dogs. J Vet Intern Med 2017; 31:1451-1458. [PMID: 28755468 PMCID: PMC5598895 DOI: 10.1111/jvim.14792] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Revised: 05/05/2017] [Accepted: 06/22/2017] [Indexed: 12/03/2022] Open
Abstract
Background Bacterial cholecystitis often is diagnosed by combination of gallbladder ultrasound (US) findings and positive results of bile culture. The value of gallbladder US in determining the likelihood of bile bacterial infection in cats and dogs with suspected biliary disease is unknown. Hypothesis/Objectives To determine the value of gallbladder US in predicting bile bacterial culture results, identify most common bacterial isolates from bile, and describe complications after cholecystocentesis in cats and dogs with suspected hepatobiliary disease. Animals Cats (70) and dogs (202) that underwent an abdominal US and submission of bile for culture were included in the study. Methods A cross‐sectional study design was used to determine the association of gallbladder US abnormalities and the results of bile cultures, and complications of cholecystocentesis. Results Abnormal gallbladder US had high sensitivity (96%) but low specificity (49%) in cats with positive and negative results of bile bacterial culture, respectively. Cats with normal gallbladder US findings were unlikely to have positive bile bacterial culture (negative predictive value of 96%). Gallbladder US had lower sensitivity (81%), specificity (31%), positive predictive value (20%), and negative predictive value (88%) in dogs. The most common bacterial isolates were of enteric origin, the prevalence being higher in cats. Incidence of complications after cholecystocentesis was 3.4%. Conclusions and clinical importance Gallbladder US has a high negative predictive value for bile culture results in cats. This modality is less predictive of infection in dogs. Percutaneous US‐guided cholecystocentesis has a low complication rate.
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Affiliation(s)
- R Policelli Smith
- Departments of Molecular Biomedical Sciences, Clinical Sciences, and Population Health and Pathobiology, North Carolina State University, Raleigh, NC
| | - J L Gookin
- Departments of Molecular Biomedical Sciences, Clinical Sciences, and Population Health and Pathobiology, North Carolina State University, Raleigh, NC
| | - W Smolski
- Departments of Molecular Biomedical Sciences, Clinical Sciences, and Population Health and Pathobiology, North Carolina State University, Raleigh, NC
| | - M F Di Cicco
- Departments of Molecular Biomedical Sciences, Clinical Sciences, and Population Health and Pathobiology, North Carolina State University, Raleigh, NC
| | - M Correa
- Departments of Molecular Biomedical Sciences, Clinical Sciences, and Population Health and Pathobiology, North Carolina State University, Raleigh, NC
| | - G S Seiler
- Departments of Molecular Biomedical Sciences, Clinical Sciences, and Population Health and Pathobiology, North Carolina State University, Raleigh, NC
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Affiliation(s)
| | - Vera Geisen
- Ludwig Maximilian University, Munich, Germany
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24
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Schiborra F, McConnell JF, Maddox TW. Percutaneous ultrasound-guided cholecystocentesis: complications and association of ultrasonographic findings with bile culture results. J Small Anim Pract 2017; 58:389-394. [DOI: 10.1111/jsap.12697] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/06/2017] [Accepted: 04/11/2017] [Indexed: 11/30/2022]
Affiliation(s)
- F. Schiborra
- Small Animal Teaching Hospital; University of Liverpool; Neston Cheshire CH64 7TE UK
| | - J. F. McConnell
- Small Animal Teaching Hospital; University of Liverpool; Neston Cheshire CH64 7TE UK
| | - T. W. Maddox
- Small Animal Teaching Hospital; University of Liverpool; Neston Cheshire CH64 7TE UK
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Otte CMA, Penning LC, Rothuizen J. Feline biliary tree and gallbladder disease: Aetiology, diagnosis and treatment. J Feline Med Surg 2017; 19:514-528. [PMID: 28438089 PMCID: PMC10816526 DOI: 10.1177/1098612x17706465] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Practical relevance Diseases of the biliary tree and gallbladder are more common in cats than diseases of the liver parenchyma. The parenchyma is usually affected secondarily to systemic illnesses, while the biliary system is the prime target for infectious agents (eg, bacteria and flukes) and non-infectious conditions (eg, neoplasia and cysts). Clinical approaches Cats with biliary disease are evaluated because of common feline clinical signs such as anorexia, nausea, vomiting and lethargy. Icterus may or may not be obvious. Biopsies for histological evaluation, and bile aspirates for culture and cytological evaluation are helpful diagnostically. Antibiotics and immunosuppressive drugs have been used successfully. Hepatosupportive drugs may help in liquefying thick bile and protecting hepatic tissue from damage. Ultrasound is a noninvasive diagnostic tool that may help in identifying dilated bile ducts, liver cysts and choleliths. It is also used to guide percutaneous bile aspiration. Audience This review, written for all veterinarians who treat cats, describes the various conditions that can affect the feline biliary tree and gallbladder. Treatment options are discussed, and brief summaries provided of surgical techniques and diagnostic approaches. Evidence base The veterinary literature pertaining to feline biliary disease is comprehensively reviewed. When appropriate, data on dogs and humans has been included to provide background information. Based on the available literature, more research into feline biliary diseases is needed.
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Affiliation(s)
- Corma MA Otte
- Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Utrecht, The Netherlands
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Fragkou FC, Adamama-Moraitou KK, Poutahidis T, Prassinos NN, Kritsepi-Konstantinou M, Xenoulis PG, Steiner JM, Lidbury JA, Suchodolski JS, Rallis TS. Prevalence and Clinicopathological Features of Triaditis in a Prospective Case Series of Symptomatic and Asymptomatic Cats. J Vet Intern Med 2016; 30:1031-45. [PMID: 27296565 PMCID: PMC5089651 DOI: 10.1111/jvim.14356] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 04/26/2016] [Accepted: 05/16/2016] [Indexed: 12/25/2022] Open
Abstract
Background The term triaditis designates the concurrent presence of idiopathic inflammatory bowel disease (IBD), cholangitis, and pancreatitis in cats. Hypothesis/Objectives The histopathology of concurrent, but often subclinical, inflammatory processes in the small intestine, liver, and pancreas of cats is poorly described. We aimed to investigate the frequency of enteritis, cholangitis, pancreatitis, or some combination of these in symptomatic and asymptomatic cats, compare clinicopathological features, and correlate histopathological with laboratory findings. Animals Domestic cats (27 symptomatic, 20 asymptomatic, and 8 normal). Methods Prospective study. Physical examination, laboratory variables (CBC, serum biochemistry profile, serum thyroxine concentration, serum feline trypsin‐like immunoreactivity [fTLI], feline lipase immunoreactivity [fPLI, as measured by Spec fPL®], urinalysis, and fecal analysis), imaging, and histopathological examinations were conducted. Feline liver, pancreas, and small intestine were biopsied during laparotomy. Results Inflammatory lesions were detected in 47 cats (27 symptomatic, 20 asymptomatic). In total, 20 cats had histopathologic lesions of IBD (13/47, 27.7%), cholangitis (6/47, 12.8%), or pancreatitis (1/47, 2.1%) alone, or inflammation involving >1 organ (27/47, 57.4%). More specifically, 16/47 cats (34.0%) had concurrent lesions of IBD and cholangitis, 3/47 (6.4%) of IBD and pancreatitis, and 8/47 cats (17%) of triaditis. Triaditis was identified only in symptomatic cats (8/27, 29.6%). A mild, positive correlation was detected between the severity (score) of IBD lesions and the number of comorbidities (rho = +0.367, P = .022). Conclusions and Clinical Importance Histopathological evidence of IBD or IBD with comorbidities was detected in both symptomatic and asymptomatic cats. The possibility of triaditis should be considered in symptomatic cats with severe IBD.
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Affiliation(s)
- F C Fragkou
- Medicine Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - K K Adamama-Moraitou
- Medicine Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - T Poutahidis
- Laboratory of Pathology, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - N N Prassinos
- Surgery and Obstetrics Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - M Kritsepi-Konstantinou
- Diagnostic Laboratory, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - P G Xenoulis
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX, USA
| | - J M Steiner
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX, USA
| | - J A Lidbury
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX, USA
| | - J S Suchodolski
- Gastrointestinal Laboratory, Texas A&M University, College Station, TX, USA
| | - T S Rallis
- Medicine Unit, Companion Animal Clinic, School of Veterinary Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Ultrasound Imaging of the Hepatobiliary System and Pancreas. Vet Clin North Am Small Anim Pract 2016; 46:453-80, v-vi. [DOI: 10.1016/j.cvsm.2015.12.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Köster L, Shell L, Illanes O, Lathroum C, Neuville K, Ketzis J. Percutaneous Ultrasound-guided Cholecystocentesis and Bile Analysis for the Detection of Platynosomum spp.-Induced Cholangitis in Cats. J Vet Intern Med 2016; 30:787-93. [PMID: 27059933 PMCID: PMC4913578 DOI: 10.1111/jvim.13943] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 02/15/2016] [Accepted: 03/10/2016] [Indexed: 11/30/2022] Open
Abstract
Background Examination of bile could be useful to diagnose Platynosomum spp.‐induced cholangitis in cats. Obtaining bile via percutaneous ultrasound‐guided cholecystocentesis (PUC) is possible but raises safety concerns in cats with severe cholecystitis. Objectives The objectives of this study were to investigate the use of PUC to collect bile samples from cats with known platynosomosis and to determine if bile analysis could be a diagnostic test. Animals Twenty‐seven free‐roaming cats positive for Platynosomum spp. eggs via fecal examination. Methods In this prospective study, fecal egg counts were performed by double centrifugation with Sheather's solution. Bile was collected using PUC from anesthetized cats. Egg counts in bile were performed with a stereoscope. Euthanasia and postmortem examination were performed immediately after PUC. Results All cats had ultrasound (US) evidence of cholangitis or cholecystitis. Thirty‐nine PUCs were performed with 14 cats having 2 PUCs 12 or 24 days apart. Postmortem examinations showed no overt gallbladder damage or leakage but fresh blood was noted in the gallbladder lumen of 3 cats. Median Platynosomum spp. egg counts were higher in bile (1450 eggs/mL; IQR, 400; 5138 eggs/mL) as compared to feces (46 eggs/mL; IQR, 10; 107 eggs/mL) (P < .001). Conclusion and Clinical Importance Bile egg count analysis is an alternative method with higher egg counts as compared to fecal egg count analysis for the diagnosis of platynosomosis. Obtaining bile via US guidance is technically feasible and safe in cats with cholangitis/cholecystitis. Cholecystocentesis and bile analysis are especially relevant for those cats with chronic cholangitis/cholecystitis and negative fecal egg counts for Platynosomum.
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Affiliation(s)
- L Köster
- One Health Center for Zoonosis and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, St Kitts, West Indies
| | - L Shell
- One Health Center for Zoonosis and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, St Kitts, West Indies
| | - O Illanes
- One Health Center for Zoonosis and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, St Kitts, West Indies
| | - C Lathroum
- One Health Center for Zoonosis and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, St Kitts, West Indies
| | - K Neuville
- One Health Center for Zoonosis and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, St Kitts, West Indies
| | - J Ketzis
- One Health Center for Zoonosis and Tropical Veterinary Medicine, Ross University School of Veterinary Medicine, Basseterre, St Kitts, West Indies
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Freiche V, Faucher MR, German AJ. Can clinical signs, clinicopathological findings and abdominal ultrasonography predict the site of histopathological abnormalities of the alimentary tract in cats? J Feline Med Surg 2016; 18:118-28. [PMID: 25722348 PMCID: PMC11149018 DOI: 10.1177/1098612x15573091] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/27/2024]
Abstract
OBJECTIVES Many cats with gastrointestinal signs have coexisting abnormalities in the intestine, liver and pancreas. Investigations typically involve clinicopathological tests, diagnostic imaging and biopsy, either at coeliotomy or by non-invasive means. While exploratory coeliotomy enables all organs to be sampled simultaneously, it is invasive and might not be necessary. The aim of the current study was to assess the performance of preliminary clinical information in predicting the histopathological presence of abnormalities in alimentary tract organs in cats. METHODS The records of 38 cats with alimentary tract signs, which had ultimately undergone exploratory coeliotomy and surgical biopsy, were reviewed. The clinical signs, clinicopathological findings, diagnostic imaging findings and histopathology results were reviewed. RESULTS On histopathological analysis, lesions were detected in 29/37 (78%) liver biopsies, in 29/35 (83%) gastrointestinal biopsies and in 17/37 (46%) pancreatic samples, the majority of which were inflammatory in nature. Clinical signs were generally poor markers of the presence of lesions in the alimentary tract. Further, while liver enzyme activity was relatively specific (88-100%) for detecting histopathological abnormalities in the liver, sensitivity was poor (11-50%). Pancreatic histopathological abnormalities were present in 1/3 of the cats with a positive pancreas-specific lipase result, and in 6/8 cats with a negative result. While relatively specific (57-100%) for both intestinal (57-100%) and hepatic (71-80%) histopathological abnormalities, abdominal ultrasonography lacked sensitivity for both organs (intestine 50-80%; liver 20-25%). In contrast, ultrasonography was relatively sensitive (50-80%), but not specific (17-22%) for detecting pancreatic lesions. CONCLUSIONS AND RELEVANCE Clinical signs, and clinicopathological and ultrasonographic abnormalities lack precision for hepatic and pancreatic histopathological lesions in cats with alimentary tract signs, and cannot reliably predict from which organs biopsies should be collected. Arguably, therefore, exploratory coeliotomy is necessary to determine the site of histopathological abnormalities in feline alimentary tract disorders.
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Affiliation(s)
- Valerie Freiche
- Internal Medicine Unit, National Veterinary School of Alfort, Maisons-Alfort, France
| | | | - Alexander J German
- Department of Obesity and Endocrinology, University of Liverpool, Neston, UK
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Peters LM, Glanemann B, Garden OA, Szladovits B. Cytological Findings of 140 Bile Samples from Dogs and Cats and Associated Clinical Pathological Data. J Vet Intern Med 2015; 30:123-31. [PMID: 26566964 PMCID: PMC4913648 DOI: 10.1111/jvim.13645] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/17/2015] [Accepted: 09/16/2015] [Indexed: 11/30/2022] Open
Abstract
Background Cholecystocentesis can be part of the diagnostic workup of hepatobiliary disease in small animals, but literature on cytological evaluation of bile is scant. Objectives To determine the diagnostic utility of cytological assessment of bile aspirates. Animals Fifty‐six and 78 client‐owned dogs and cats, respectively, with bile collected by cholecystocentesis and submitted to our diagnostic laboratory between 1999 and 2014. Methods Retrospective study describing cytological findings of bile, concurrent bacterial culture results, hematological and serum biochemical data, gallbladder biopsy results, as well as final diagnosis and complications after cholecystocentesis. Results Infectious agents were found in 30% of canine and 22% of feline bile aspirates, and inflammation in 5% and 19% respectively. Presence of microorganisms was more often detected on cytological examination (24%) than by culture (21%). The most common bacterial isolates were Escherichia coli and Enterococcus spp., isolated from 14.8% and 6.7% of cultured samples respectively. Only increased canine pancreatic lipase immunoreactivity concentration (cPLI) was significantly associated with the presence of microorganisms, inflammatory cells, or both in bile. Clinically relevant complications of cholecystocentesis occurred in 2 dogs. The majority of the animals undergoing cholecystocentesis suffered from hepatic, pancreatic, gastrointestinal disease, or a combination thereof. Conclusions and Clinical Importance Cytological examination of bile is inexpensive and straightforward, and yields diagnostically relevant information that precedes and complements bacterial culture.
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Affiliation(s)
- L M Peters
- Departments of Pathology and Pathogen Biology, The Royal Veterinary College, Hertfordshire, UK
| | - B Glanemann
- Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, UK
| | - O A Garden
- Clinical Sciences and Services, The Royal Veterinary College, Hertfordshire, UK
| | - B Szladovits
- Departments of Pathology and Pathogen Biology, The Royal Veterinary College, Hertfordshire, UK
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Makara M, Chau J, Hall E, Kloeppel H, Podadera J, Barrs V. EFFECTS OF TWO CONTRAST INJECTION PROTOCOLS ON FELINE AORTIC AND HEPATIC ENHANCEMENT USING DYNAMIC COMPUTED TOMOGRAPHY. Vet Radiol Ultrasound 2015; 56:367-73. [PMID: 25640846 DOI: 10.1111/vru.12239] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 11/19/2014] [Indexed: 11/28/2022] Open
Abstract
This prospective study compared aortic and hepatic enhancement achieved using a contrast injection protocol with a fixed rate of 5 ml/s vs. that achieved using a protocol with fixed injection duration of 20 s in eight cats. Cats were assigned into two groups (Group 1, rate 5 ml/s; Group 2, duration 20 s). The dose of contrast was the same in both groups (740 mgI/kg). Regions of interest (ROI) were drawn in the aorta and liver for transverse scans acquired at the hepatic hilus. Time to peak aortic enhancement occurred significantly earlier in Group 1 (M = 11s, SD = 1.63) than in Group 2 (M = 25.5 s, SD = 2.51). Peak aortic enhancement was significantly higher in Group 1 (M = 1906.51 HU, SD = 368.64) than in Group 2 (M = 745.08 HU, SD = 201.84). Duration of aortic enhancement equal to or above 300 HU was statistically longer in Group 2 (M = 24.5 s, SD = 8.39) than in Group 1 (M = 10 s, SD = 1.63). There were no significant differences in time to peak liver enhancement, peak liver enhancement, or duration of hepatic arterial phase between groups. Findings supported the hypothesis that longer injection duration results in a broader bolus geometry with a longer time to peak and a lower peak aortic enhancement in cat. This strong influence of injection duration on timing of aortic enhancement may help future users optimize protocols for CT angiography of the aorta and multiphasic evaluation of the liver, pancreas, and small intestine.
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Affiliation(s)
- Mariano Makara
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
| | - Jennifer Chau
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
| | - Evelyn Hall
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
| | - Heide Kloeppel
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
| | - Juan Podadera
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
| | - Vanessa Barrs
- Faculty of Veterinary Science, University of Sydney, NSW, 2006, Sydney, Australia
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33
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Simpson KW. Pancreatitis and triaditis in cats: causes and treatment. J Small Anim Pract 2015; 56:40-9. [DOI: 10.1111/jsap.12313] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 09/12/2014] [Accepted: 10/28/2014] [Indexed: 01/16/2023]
Affiliation(s)
- K. W. Simpson
- College of Veterinary Medicine; Cornell University; Ithaca NY 14850 USA
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34
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Huynh M, Guillaumot P, Hernandez J, Ragetly G. Gall bladder rupture associated with cholecystitis in a domestic ferret (Mustela putorius). J Small Anim Pract 2014; 55:479-82. [PMID: 25168742 PMCID: PMC7166623 DOI: 10.1111/jsap.12230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Revised: 02/11/2014] [Accepted: 03/24/2014] [Indexed: 12/22/2022]
Abstract
A six‐year‐old neutered female albino ferret was presented with an acute episode of lethargy and anorexia. Clinical examination revealed marked cranial abdominal pain. A severe neutrophilic leukocytosis was present. Abdominal ultrasound was consistent with a diffuse peritonitis and severe bile duct inflammation. Cytology of the abdominal effusion revealed bile peritonitis. An exploratory laparotomy was performed and the gall bladder appeared inflamed with multiple perforations. A cholecystectomy was performed. The ferret recovered without complication. Bacteriological culture of the bile and gall bladder yielded a pure growth of Pseudomonas aeruginosa. Histopathological analysis of the gall bladder and liver was consistent with a marked cholecystitis and cholangiohepatitis. On the basis of sensitivity testing, the ferret was treated with marbofloxacin for one month. No complications or reoccurrence were seen up to 1 year after the diagnosis. To the author's knowledge, this is the first report of bile peritonitis secondary to gall bladder rupture in a ferret.
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Affiliation(s)
- M Huynh
- Centre Hospitalier Vétérinaire Frégis, 94110, Arcueil, France
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36
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Spillmann T, Willard MD, Ruhnke I, Suchodolski JS, Steiner JM. Feasibility of endoscopic retrograde cholangiopancreatography in healthy cats. Vet Radiol Ultrasound 2013; 55:85-91. [PMID: 23919246 DOI: 10.1111/vru.12086] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 06/01/2013] [Indexed: 11/27/2022] Open
Abstract
Cats are predisposed to diseases of the biliary tract and the exocrine pancreas and these can be challenging to diagnose. In humans and dogs > 10 kg, endoscopic retrograde cholangiopancreatography (ERCP) has been successfully used to diagnose some of these disorders. The purpose of our study was to determine whether ERCP would also be feasible in cats using a pediatric duodenoscope. Four purpose-bred, clinically healthy, castrated domestic shorthair cats participated in two studies. Study 1 compared standard white light endoscopy with chromoendoscopy for localizing the major duodenal papilla. In Study 2 ERCP was performed. Repeated clinical examinations and measurements of serum feline pancreatic lipase immunoreactivity (fPLI) were performed before and up to 18 hours after interventions on all cats. Chromoendoscopy was subjectively judged to be superior for localizing the major papilla. Insertion of the ERCP catheter was best accomplished when cats were in dorsal recumbency. Complete ERCP was successful in two cats. In the other cats, either retrograde cholangiography or pancreatography was possible. Serum fPLI concentrations increased temporarily in two cats during Study 2 when measured immediately, 2, 4, and 18 h after ERCP. Peak fPLI concentrations were detected either immediately after ERCP or 2 h later. No clinical signs of complications were observed within 18 h after the procedures. Findings indicated that ERCP is technically demanding but feasible in healthy cats. Future studies need to determine whether the temporary increases in serum fPLI concentrations are clinically important and to investigate the utility of ERCP in feline patients.
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Affiliation(s)
- Thomas Spillmann
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, Helsinki University, P.O. Box 57, Finland
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37
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Twedt DC, Cullen J, McCord K, Janeczko S, Dudak J, Simpson K. Evaluation of fluorescence in situ hybridization for the detection of bacteria in feline inflammatory liver disease. J Feline Med Surg 2013; 16:109-17. [DOI: 10.1177/1098612x13498249] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The etiopathogenesis of feline inflammatory liver disease (ILD) is unclear. Therefore, we sought to determine the presence and distribution of bacteria within the livers of cats with ILD using eubacterial fluorescence in situ hybridization (FISH). Histopathology from 39 cats with ILD and 19 with histologically normal livers (C) were classified using World Small Animal Veterinary Association guidelines. Hepatic sections were examined by 16 and 23S ribosomal RNA FISH. Antibodies against cytokeratins and factor VIIIa were used to distinguish bile ducts and vascular structures. Histopathologic findings included non-specific reactive hepatitis (12), neutrophilic cholangitis (NC; 12), lymphocytic cholangitis (seven), cholestasis/obstruction (three), probable lymphoma (three) and acute hepatitis (two). Bacteria were observed in 21/39 ILD and 3/19 C ( P = 0.0054). In 8/39 ILD and 2/19 C bacteria were restricted to the outer liver capsule ( P = 0.29) and may represent contaminants. The prevalence of intrahepatic bacteria was higher ( P = 0.008) in ILD (13/31) than C (1/17). Bacteria in ILD were more frequently ( P <0.0001) localized to portal vessels, venous sinusoids and parenchyma (12/13) than bile duct (1/13). Bacterial colonization was highest in Escherichia coli-positive NC cats. Concurrent non-hepatic disease, predominantly pancreatic and intestinal (8/10 cats biopsied), was present in all 13 cats with intrahepatic bacteria. Bacterial culture was positive (predominantly E coli and Enterococcus species) in 11/23 (48%) samples, and concurred with FISH in 15/23 cases. The presence of intrahepatic bacteria in 13/31 (41%) cats with ILD suggests a role in etiopathogenesis. The distribution of bacteria within the liver supports the possibility of colonization via either enteric translocation or hematogenous seeding.
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Affiliation(s)
| | - John Cullen
- North Carolina State University, Raleigh, NC, USA
| | | | | | - Julie Dudak
- Reidsville Veterinary Hospital, Reidsville, NC, USA
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Batchelor DJ, Devauchelle P, Elliott J, Elwood CM, Freiche V, Gualtieri M, Hall EJ, Den Hertog E, Neiger R, Peeters D, Roura X, Savary-Bataille K, German AJ. Mechanisms, causes, investigation and management of vomiting disorders in cats: a literature review. J Feline Med Surg 2013; 15:237-65. [PMID: 23403690 PMCID: PMC10816764 DOI: 10.1177/1098612x12473466] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Vomiting is a common presenting complaint in feline practice. This article differs from previous reviews in that it is an evidence-based review of the mechanisms, causes, investigation and management of vomiting in the domestic cat. Published evidence was reviewed, and then used to make recommendations for clinical assessment, diagnosis, antiemetic drug treatment, dietary management and monitoring of cats presenting with vomiting. The strength of the evidence on which recommendations are made (and areas where evidence is lacking for cats) has been highlighted throughout.
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Abstract
Pancreatitis was considered a rare disease in the cat until a couple of decades ago when several retrospective studies of severe acute pancreatitis were published. It was apparent that few of the diagnostic tests of value in the dog were helpful in cats. With increasing clinical suspicion, availability of abdominal ultrasonography, and introduction of pancreas-specific blood tests of increasing utility, it is now accepted that acute pancreatitis is probably almost as common in cats as it is in dogs, although the etiology(s) remain more obscure. Pancreatitis in cats often co-exists with inflammatory bowel disease, less commonly with cholangitis, and sometimes with both. Additionally, pancreatitis may trigger hepatic lipidosis, while other diseases, such as diabetes mellitus, may be complicated by pancreatitis. Therapy is similar to that used in dogs, with added emphasis on early nutritional support to prevent hepatic lipidosis. Less is known about chronic pancreatitis than the acute form, but chronic pancreatitis is more common in cats than it is in dogs and may respond positively to treatment with corticosteroids.
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Affiliation(s)
- P Jane Armstrong
- Veterinary Clinical Sciences Department, College of Veterinary Medicine, University of Minnesota St. Paul, MN 55108, USA.
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40
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Diana A, Guglielmini C, Specchi S, Di Tommaso M, Pietra M, Baron Toaldo M, Cipone M. Ultrasonographic evaluation of preprandial and postprandial gallbladder volume in healthy cats. Am J Vet Res 2012; 73:1583-8. [DOI: 10.2460/ajvr.73.10.1583] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Marolf AJ, Leach L, Gibbons DS, Bachand A, Twedt D. Ultrasonographic Findings of Feline Cholangitis. J Am Anim Hosp Assoc 2012; 48:36-42. [DOI: 10.5326/jaaha-ms-5671] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cholangitis is a common inflammatory disorder of the biliary system in cats. There are two major forms based on the predominate type of inflammatory cell infiltrates: lymphocytic or neutrophilic. Ultrasound is a common imaging modality used in these patients. This retrospective study evaluated the ultrasound examinations of 26 cats with a histologic diagnosis of cholangitis. Most cats with cholangitis had sonographically normal liver size, echogenicity, and normal biliary systems. Statistically significant sonographic changes for cats with cholangitis included hyperechoic liver parenchyma, hyperechoic gallbladder contents, and increased pancreatic size. No statistically significant changes were noted to distinguish lymphocytic and neutrophilic forms of cholangitis. Cats with the sonographic features of diffuse liver hyperechogenicity, gallbladder contents and enlarged pancreas may suggest cholangitis.
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Affiliation(s)
- Angela J. Marolf
- Department of Environmental and Radiological Health Sciences (A.M., D.G., A.B.) and Department of Clinical Sciences (D.T.), James L. Voss Veterinary Medical Center, Colorado State University, Fort Collins, CO; and Moore Animal Hospital, Fort Collins, CO (L.L.)
| | - Lesley Leach
- Department of Environmental and Radiological Health Sciences (A.M., D.G., A.B.) and Department of Clinical Sciences (D.T.), James L. Voss Veterinary Medical Center, Colorado State University, Fort Collins, CO; and Moore Animal Hospital, Fort Collins, CO (L.L.)
| | - Debra S. Gibbons
- Department of Environmental and Radiological Health Sciences (A.M., D.G., A.B.) and Department of Clinical Sciences (D.T.), James L. Voss Veterinary Medical Center, Colorado State University, Fort Collins, CO; and Moore Animal Hospital, Fort Collins, CO (L.L.)
| | - Annette Bachand
- Department of Environmental and Radiological Health Sciences (A.M., D.G., A.B.) and Department of Clinical Sciences (D.T.), James L. Voss Veterinary Medical Center, Colorado State University, Fort Collins, CO; and Moore Animal Hospital, Fort Collins, CO (L.L.)
| | - David Twedt
- Department of Environmental and Radiological Health Sciences (A.M., D.G., A.B.) and Department of Clinical Sciences (D.T.), James L. Voss Veterinary Medical Center, Colorado State University, Fort Collins, CO; and Moore Animal Hospital, Fort Collins, CO (L.L.)
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Digestive System, Liver, and Abdominal Cavity. THE CAT 2012. [PMCID: PMC7158306 DOI: 10.1016/b978-1-4377-0660-4.00023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Sjödin S, Trowald-Wigh G, Fredriksson M. Identification of Helicobacter DNA in feline pancreas, liver, stomach, and duodenum: Comparison between findings in fresh and formalin-fixed paraffin-embedded tissue samples. Res Vet Sci 2011; 91:e28-30. [DOI: 10.1016/j.rvsc.2011.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 11/29/2010] [Accepted: 02/01/2011] [Indexed: 11/16/2022]
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Callahan Clark JE, Haddad JL, Brown DC, Morgan MJ, Van Winkle TJ, Rondeau MP. Feline cholangitis: a necropsy study of 44 cats (1986-2008). J Feline Med Surg 2011; 13:570-6. [PMID: 21719332 DOI: 10.1016/j.jfms.2011.05.002] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2011] [Indexed: 11/18/2022]
Abstract
Forty-four cats diagnosed with moderate to severe cholangitis at necropsy are described. The population comprised 0.86% of all feline necropsies performed during the 22-year study period. Liver specimens were classified as acute neutrophilic cholangitis (ANC), chronic neutrophilic cholangitis (CNC), lymphocytic cholangitis (LC) or chronic cholangitis associated with liver fluke infestation (CC) based on the World Small Animal Veterinary Association (WSAVA) classification scheme. ANC (seven) and CNC (33) comprised the majority of cases. In contrast to previous descriptions, overlap was seen in clinical findings between ANC and CNC subtypes. Results suggest that liver enzyme activity may not predict degree of inflammation. Severity of inflammation varied between liver sections in individual cats, underscoring the need to obtain biopsy samples from multiple sites. Inflammatory bowel disease (50%), pancreatitis (60%), or both (32%) commonly accompanied cholagitis. We conclude that cholangitis is not a common cause of feline mortality. Most cats that succumb to cholangitis have ANC or CNC, and concurrent disease contributes to death in many.
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Affiliation(s)
- Julie E Callahan Clark
- Department of Clinical Studies, University of Pennsylvania, School of Veterinary Medicine, 3800 Spruce St, PA 19104, USA.
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Geigy CA, Dandrieux J, Miclard J, Kircher P, Howard J. Extranodal B-cell lymphoma in the urinary bladder with cytological evidence of concurrent involvement of the gall bladder in a cat. J Small Anim Pract 2010; 51:280-7. [DOI: 10.1111/j.1748-5827.2010.00911.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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46
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Wagner KA, Hartmann FA, Trepanier LA. Bacterial Culture Results from Liver, Gallbladder, or Bile in 248 Dogs and Cats Evaluated for Hepatobiliary Disease: 1998-2003. J Vet Intern Med 2007. [DOI: 10.1111/j.1939-1676.2007.tb02984.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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