Chronic Liver Inflammation in Cats

CCHS is usually associated with another condition, such as bacterial infection or pancreatitis. CCHS may be suppurative, meaning that it is directly caused by another condition, or nonsuppurative, meaning that it is caused by immune-mediated disease. Chronic CCHS is considered “mixed” because it has the potential to be suppurative or nonsuppurative.

Chronic inflammatory liver disorders are difficult to diagnose and treat because they are not fully understood by veterinary professionals. Chronic liver inflammation is also known as mixed feline cholangitis/cholangiohepatitis syndrome. This syndrome is made up of two separate liver disorders. Cholangitis occurs when the bile ducts become inflamed. Cholangiohepatitis occurs when the bile ducts, gallbladder, and liver tissue become inflamed.

Symptoms may be sudden or may not manifest at all in some cats. Early detection and treatment of CCHS is imperative to secure the best prognosis possible. Seek immediate veterinary attention as soon as you notice any of the following symptoms:

• Loss of appetite
• Weight loss
• Fever
• Jaundice
• Vomiting
• Discoloration of the feces
• Pale gums and mucous membranes
• Lethargy and weakness

The exact cause of CCHS is unknown. Some veterinary literature suggests the disease is a progression of the acute form of inflammatory liver disease. However, this has not been confirmed by any studies. Some literature also suggests that cats with gallbladder abnormalities have a higher risk of developing CCHS, though there are no current studies supporting this theory.

Many other diseases may be seen concurrently with CCHS, including, but not limited to:

• Bacterial infection, particularly in the gastrointestinal tract
• Toxoplasmosis
• Inflammatory bowel disease
• Cancer
• Pancreatitis

In order to make a definitive diagnosis, your vet will first need to conduct tests to rule out other liver conditions. These tests may include blood and urinalysis, pancreatic tests, x-rays, ultrasounds, and fine-needle aspiration of the gallbladder or liver. Your vet will also be looking for obstructions within the bile duct. If these tests do not confirm CCHS but the disease is still suspected, your vet may recommend exploratory surgery.

Your vet will make a thorough physical examination and evaluate your cat’s symptoms. However, for many cats with CCHS, the physical examination may not show signs of illness. Be sure to inform your vet of the extent and duration of your cat’s symptoms, as well as any previous history of liver problems. Your vet will ask for your cat’s complete medical history, so be prepared to provide this information.

Treatment may vary, depending on the underlying cause. Your vet will be able to advise you on a treatment plan based on your cat’s specific needs.

Appropriate treatment for suppurative CCHS may be completely curative of the condition. Nonsuppurative CCHS will require long-term treatment. The primary objective of treatment for nonsuppurative cases of CCHS is to maintain remission rather than cure the disease.

Treatment methods may include intravenous fluid and nutritional therapy, oral medication, and surgery. Antibiotics may be prescribed to treat underlying bacterial infection. Immunosuppressive drugs may be effective in treating non-suppurative forms of CCHS. Surgery may be required for cats with obstructions in the bile duct. Additional treatment methods may be recommended based on the cat’s individual situation.

Recovery and prognosis may vary depending on the underlying condition, but are generally good as long as the condition is caught and treated early. Always follow your vet’s post-treatment and/or post-operative instructions carefully. Always administer any medications, particularly antibiotics, exactly as directed for the full duration of the recovery period. Failure to do so may result in aggressive recurrence.

If your cat has had surgery, ensure they have a warm place to rest on the return home. Do not allow them to irritate the surgery site. An Elizabethan collar may help with this. Check the surgery site daily to ensure there is no swelling or discharge.

It is important to note that advanced forms of CCHS may lead to further liver complications, particularly biliary cirrhosis. This condition occurs when healthy bile duct tissue is replaced by connective tissue. This is an extremely life-threatening condition and is considered the final stage of cholangiohepatitis. If your cat’s condition begins to get worse following treatment, take it to the vet immediately to secure the best prognosis.

Your vet may schedule follow-up appointments as needed to monitor the condition. Some mild cases caused by bacterial infection may not warrant follow-up appointments. If you have any questions, or if the condition has recurred or does not seem to be improving despite treatment, contact your vet immediately.