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Cholangiohepatitis in Dogs

What Is Cholangiohepatitis in Dogs?

Cholangiohepatitis in dogs involves inflammation of the biliary system, which comprises ducts responsible for collecting and directing bile from the liver, along with the gall bladder, where bile is stored. Inflammation of the ducts and gall bladder is known as cholangitis, while inflammation of the liver is termed hepatitis. These inflammatory conditions may manifest independently or concurrently, culminating in what is referred to as cholangiohepatitis.

Symptoms

Symptoms of cholangiohepatitis in dogs may include the following clinical signs:

  • Reduced energy levels (lethargy)
  • Loss of appetite ranging from decreased to absent
  • Dehydration
  • Weight loss
  • Vomiting
  • Diarrhea
  • Jaundice, noticeable as yellow pigmentation in the skin and whites of the eyes
  • Fever
  • Painful, distended abdomen

Causes

Causes of cholangiohepatitis in dogs include conditions that disrupt the regular flow of bile through the liver and from the gall bladder. Although more common in cats, cholangiohepatitis can still affect dogs. Factors such as gall bladder stones (choleliths) and thickened bile material in the gall bladder (gall bladder mucocele) can predispose dogs to developing cholangiohepatitis. Additionally, infection from intestinal bacteria entering the biliary system or the spread of bacteria to the biliary system via the bloodstream can also lead to cholangiohepatitis.

Diagnosis

To diagnose cholangiohepatitis in dogs, veterinarians typically begin with a general lab panel consisting of blood and urine tests. This comprehensive evaluation allows for an assessment of organ systems, including detecting any changes associated with the liver. However, abnormalities in liver values on lab work aren’t exclusive to cholangiohepatitis, as other liver conditions can produce similar alterations.

Therefore, the next step involves recommending liver imaging using ultrasound. This procedure evaluates liver size, tissue appearance, gall bladder condition, and the state of biliary ducts. Ultrasound can also detect fluid accumulation in the abdomen (ascites), aiding in diagnosis.

While a combination of lab work and ultrasound findings may raise suspicion for cholangiohepatitis, a confirmed diagnosis requires liver and gall bladder biopsy, along with culture to check for bacterial involvement.

Liver biopsies and bile collection can be performed using ultrasound guidance, needle aspiration, laparoscopy, or surgery. Among these methods, ultrasound-guided procedures carry a higher risk of bile leakage into the abdomen.

Biopsy samples undergo evaluation to determine the type and extent of inflammation, whether it’s confined to the biliary system or affects surrounding liver tissue. Additionally, collected tissue and bile samples undergo bacterial culture to identify any present bacteria and determine appropriate antibiotic treatment.

Treatment

For dogs with cholangiohepatitis stemming from impaired bile flow due to issues like gallstones (choleliths) or a gall bladder mucocele, surgery is typically the recommended course of action to address the root cause. In cases where a dog exhibits severely diseased gall bladder walls leading to bile leakage and subsequent inflammation (bile peritonitis), surgical intervention becomes necessary. Dogs unresponsive to medication for cholangiohepatitis may also require surgery.

Medical management involves the use of antioxidant medications like S-Adenosylmethionine (SAMe) and possibly Vitamin E to support liver function. Ursodiol may be prescribed to enhance bile flow. Antibiotics are selected based on culture/sensitivity results, and treatment may extend from six to eight weeks, sometimes longer. Pain relief medication is administered if the dog shows signs of abdominal discomfort, and anti-inflammatory drugs like prednisolone/prednisone may be used in certain cases.

Supportive care varies based on the severity of the illness. Dogs experiencing symptoms such as vomiting, lethargy, jaundice, or fever require hospitalization and IV fluid support. Medications to manage nausea and pain are also administered. In severe cases, dogs may need specialized fluids or plasma transfusions if liver function is significantly compromised.

Cholangiohepatitis can be effectively treated through medical and/or surgical interventions. However, the condition can prove fatal in more severe cases, especially if complications like a ruptured gall bladder or bile peritonitis arise.

Living and Management

The treatment duration for cholangiohepatitis can span up to eight weeks or even longer. Depending on the extent of liver and gall bladder involvement, dogs may require long-term medication regimes such as SAMe, Vitamin E, or Ursodiol.

Veterinarians will monitor liver values and potentially other parameters routinely, perhaps every two to four weeks, or even more frequently for several months. Lifelong lab work checks, at least annually if not more frequently, are typically recommended.

Recovery from cholangiohepatitis can be a lengthy process, taking several weeks. In cases where the biliary tract and liver suffer extensive damage, scar tissue formation may impede complete recovery.

The prognosis hinges on the type of cholangiohepatitis identified through biopsy and the severity of the illness. Dogs treated early in the course of the disease generally have a better prognosis compared to those with advanced cholangiohepatitis. A dog with a ruptured gall bladder and bile peritonitis faces a guarded-to-poor prognosis.

Annual examinations with yearly blood/urine testing can aid in diagnosing the condition in its early stages, even if the dog isn’t showing signs of illness. Veterinarians can detect changes in liver values and may recommend an abdominal ultrasound to monitor the condition closely.

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