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How I approach… The cat with cholangitis
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A jaundiced cat is not a diagnosis, but rather the starting point for the clinician to investigate the possible underlying causes. Professor Craig Webb explains his approach to such cases.
Craig B. Webb
PhD, DVM, Dipl. ACVIM, Clinical Sciences Department, Colorado State University (CSU), CO, USA.
Craig Webb is currently a Professor of Small Animal Medicine and Interim Hospital Director at CSU. Qualifying from the University of Wisconsin-Madison, he did an Internship at Alameda East Veterinary Hospital and a Residency in Small Animal Medicine at CSU before gaining his Ph.D. in Neuroscience at Hahnemann University, Philadelphia. His clinical expertise is centered around gastroenterology and endocrinology. Awarded the Zoetis Distinguished Veterinary Teacher Award in 2013, he was voted the Colorado Veterinary Medical Association Outstanding Faculty member in 2014.
Key Points:
- Cats don’t actually present with cholangitis, they present as sick cats.
- Sick cats don’t present with cholangitis, they present with non-specific signs that could be almost anything.
- Yellow (icterus or jaundice) is a color, not a diagnosis.
- Feline cholangitis was the motivating disease behind the search for feline triaditis.
Introduction – a historical perspective
As early as 1996, veterinarian Dr. Sharon Center adeptly summarized the peculiarities of the feline hepatobiliary system and highlighted distinct disease differences between cats and dogs, stating that “cholangitis and cholangiohepatitis are more common in the cat than the dog. The anatomic difference in the biliary duct/pancreatic duct anatomy has long been considered an important predisposing factor in this species difference.” ( 1 ). Dr. Center collected, analyzed, and cited studies in cats going back to the 1980s that described suppurative cholangitis and chronic lymphocytic cholangitis ( 2 ) ( 3 ) and dug deep enough to uncover the description of 47 icteric cats from 1977 ( 4 ). She actually anticipated feline triaditis, noting that “although evaluation for inflammatory bowel disease and pancreatitis has not been thorough in every cat reported to date, they appear to be commonly associated [with cholangitis] conditions.”
1996 was also the year that the first study was published quantifying the association in cats between inflammatory hepatic disease, inflammatory bowel disease (IBD), pancreatitis, and nephritis (the condition that fell out of the equation, to leave “triaditis”) ( 5 ). This marked the beginning of a serious and fruitful effort to better understand liver disease in cats, or (as it was then referred to) the feline cholangiohepatitis complex, or feline cholangitis/cholangiohepatitis ( 6 ). Clinical research attempted to characterize feline inflammatory and lymphocytic liver disease using ultrasound, immunohistochemistry, and clinical presentation ( 7 ) ( 8 ) ( 9 ). Potential infectious etiologies, such as Bartonella, Enterococcus, and Helicobacter, were described, and the first report of an infectious organism ascending from the gastrointestinal tract to cause cholangitis in a kitten appeared in the literature ( 10 ) ( 11 ) ( 12 ) ( 13 ). [...]
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