Triaditis in cats. Types of cholangitis in cats. Lymphocytic cholangitis in cats

Cholangiohepatitis is an inflammation of the liver and bile ducts.

The prevalence of cholangiohepatitis in cats is associated with the peculiarities of their anatomy: the pancreatic duct and the gallbladder ducts are connected before flowing into the duodenum. Therefore, inflammation of the small intestine or pancreatitis(inflammation of the pancreas) also leads to inflammation of the bile ducts ( cholangitis).

Cholangiohepatitis can manifest itself in acute and chronic forms.

acute form more common in young cats. It begins with a sudden refusal to feed and lethargy. Vomiting appears, body temperature often rises, the abdominal area is painful. With acute hepatitis, dehydration quickly sets in. After that, the so-called. "jaundice" or icterus(yellowish tint of the skin and mucous membranes), which is noticeable on the sclera of the eyes and gums. During this period, the activity of liver enzymes, bilirubin and the number of leukocytes increase in the blood of the animal.

Chronic form cholangiohepatitis is more common acute, older cats are prone to it. Symptoms in this course appear and disappear in periods, while periods of exacerbation are often associated with stress.

Depending on the type of cells found on microscopy of liver specimens, chronic cholangiohepatitis may have different names. If lymphocytes predominate, then this is called lymphocytic cholangiohepatitis; if neutrophils - then neutrophilic; if other defense cells (macrophages, plasma cells) - then granulomatous.

All forms of cholangiohepatitis can eventually lead to liver atrophy ( cirrhosis).

The causes of acute cholangiohepatitis are more often bacterial infections that pass into the liver from the small intestine (duodenum), pancreas. In addition, acute cholangiohepatitis can be caused by coronavirus infection, intoxication, or feeding poor-quality or unbalanced feed.

Among the causes of chronic cholangiohepatitis in the first place is a genetic predisposition, it may also be due to autoimmune disease, helminthiases, cystoisosporosis, feeding disorders.

Complications of hepatitis:

• Hepatic lipidosis. Cats do not tolerate periods of no food intake (anorexia). At this time, their liver often begins to store fat, which leads to lipidosis, while the functional tissue of the liver is irreversibly replaced by fatty tissue. At risk are cats with anorexia due to cholangiohepatitis.
• Hepatic encephalopathy. Due to the increase in the level of ammonia and other undesirable blood components, brain damage occurs.
• portal hypertension and the formation of free fluid in the abdominal cavity (ascites).
• Sometimes chronic cholangiohepatitis progresses to cancer. In humans, a link has been established between chronic stimulation of lymphocytes and the occurrence of malignant lymphoma. Therefore, it is likely that chronic lymphocytic cholangiohepatitis in cats can provoke lymphoma and malignant anomalies of lymphocytes.

Diagnosis of hepatitis

• General clinical study of the animal.
• General clinical and biochemical blood test. The presence of hepatitis or chronic inflammation of the intestine, pancreas is indicated by a high GGT rate, an increase in ALT and alkaline phosphatase with a normal content of thyroid hormones. They also increase the level of bilirubin, globulins, decrease cobalamin, folic acid.
• Serological studies. Used for suspected viral infections (feline leukemia, feline immunodeficiency, feline viral peritonitis), as well as toxoplasmosis.
• X-ray study.
• Ultrasound of the abdominal cavity (is important in the diagnosis of cholangiohepatitis or obstruction (blockage) of the bile duct).
• Liver biopsy. A needle is inserted through the abdominal wall into the liver of the animal and the material is taken for further research. The best way to diagnose hepatitis is by examining small fragments of the animal's liver. They are obtained by exploratory laparotomy ( surgically) or by biopsy. Both procedures represent a certain risk and should be carried out with the utmost care, because. in severe cases disease, the affected organs may bleed during the puncture, and anesthesia poses a risk to the sick animal.
• Bakpose culture of the liver and bile. If it is possible to obtain liver and bile samples for pathological examination, it is possible to test them for the presence of bacteria.

Treatment

• stabilization of the state of the body in critical cases (intravenous therapy with electrolyte solutions). If necessary, artificial or parenteral nutrition, antiemetics;
• antibiotics;
• choleretics and hydrocholeretics (substances that help the passage of bile from the liver to the intestines). They are prescribed to prevent stagnation of bile, tk. this is one of the main phenomena of cholangiohepatitis;
• anti-inflammatory drugs;
• immunosuppressive agents (prescribed for lymphocytic portal hepatitis);
• vitamins K, E, B12. With cholangiohepatitis, the ability to absorb these vitamins through the intestines is reduced. In some cases, the use of taurine, folic acid and L-carnitine is also indicated.

Diet

The cat should be switched to a diet containing reduced amount sodium, carbohydrates and an increased amount of protein. It is undesirable to feed the animal with feed containing sucrose or fructose.

In order to avoid hepatic encephalopathy, with an increased level of ammonia in the blood of a particular animal, the amount of protein in its diet should be limited, because. Protein is the main source of ammonia in the body. It is very important to feed your cat several small meals throughout the day.

Prognosis for Hepatitis in Cats

Liver is an organ that recovers well during a sudden crisis, provided that part of its cells (hepatocytes) remained intact. Therefore, a cat with an acute form of hepatitis is easy to cure. However, in chronic hepatitis, the situation is different. Diet and proper treatment contribute to the improvement of the animal's condition, although the chronic form of the disease is not completely cured. The animal can live a normal life if the conditions of keeping and therapeutic feeding are observed, although the disease may worsen under any stressful effect. The prognosis is less favorable in cats with advanced stages of hepatitis, when many systems are susceptible to inflammation and the disease has approached the early stages of leukemia (lymphoma).

This is a syndrome of middle-aged and older cats. In this disease, lymphocytes infiltrate the structures of the liver, pancreas and intestines at the sites of excretion of the ducts of these organs. The reason for this is the body's immune response to a foreign body, bacterial agents or toxic components in the intestine. One or all of the organs may be involved in the process. A feature of this disease is the possibility of the transition of the pathological process from organ to organ, due to the close anatomical communication. The affected organs become edematous and cannot function normally. When lymphocytes accumulate only in the submucosal layer of the intestine, the disease is called IBD - inflammatory bowel disease. If only the liver is affected - hepatitis, if the pancreas is affected - pancreatitis. All these diseases occur more often together, but in the early stages one may prevail.

Icteric skin

Symptoms is progressive anorexia (refusal to eat), cachexia (weight loss), vomiting, diarrhea, icterus.

Diagnostics: biochemical blood test, clinical blood test, ultrasound of the liver and intestines, biopsy. Pancreatitis is the most difficult to diagnose, so it always remains in differential diagnoses.

Treatment directed to the disease with the most striking symptoms. It is necessary to prescribe a diet in feeding, antibiotic therapy, immunosuppressive drugs.

Cholangitis can be divided into two subspecies: neutrophilic and lymphocytic.

Neutrophilic cholangitis usually occurs due to ascending infection from gastrointestinal tract. Often it is accompanied by pancreatitis. This pathology often occurs along with stagnation of bile, which occurs against the background of inflammation, and not obstruction.

Symptoms: lethargy, anorexia, pyrexia, icterus, sometimes abdominal pain.

Treatment: antibiotic therapy, course of at least 4-6 weeks. With severe inflammation and biliary stasis - prednisolone.

Forecast favorable for early treatment.

Lymphocytic cholangitis — chronic condition lasting from a month to a year. It occurs in young cats, especially often recorded in the Persian breed. The etiology is not known. An immune-mediated mechanism of occurrence cannot be ruled out.

Symptoms: lethargy, lack of appetite, thirst, weight loss, flabby abdominal wall, enlarged liver palpated, icterus. A cat may not differ from its healthy compatriots and even show polyphagy.

Treatment: corticosteroids for 4-6 weeks antibiotic therapy, ursodeoxycholic acid.

Forecast: the average life expectancy of cats with this diagnosis is 36 months. With the development of ascites, the prognosis is unfavorable.

Hepatitis treatment: intravenous therapy, vitamin K, methionine, silymarin, choleretics (ursodeoxycholic acid), diet and feeding, antiemetics (maropitant, metoclopramide), appetite stimulants (vitamin B12), diuretics with the threat of ascites.

Treatment of pancreatitis: intravenous therapy, antiemetics (maropitant, metoclopramide), H2 antagonists (ranitidine, famotidine), appetite stimulant (vitamin B12), antioxidants (methionine, selenium)

Cholangiohepatitis in cats is an inflammatory process that affects the bile ducts and liver of the animal. Often cholangiohepatitis is accompanied by pancreatitis or intestinal inflammation, which is due to the structural features of the pancreatic ducts and gallbladder in cats. Without proper treatment, cholangiohepatitis can eventually lead to cirrhosis of the liver.

Cholangiohepatitis in cats is an inflammatory process that affects the bile ducts and liver of the animal. Often cholangiohepatitis is accompanied by pancreatitis or intestinal inflammation, which is due to the structural features of the pancreatic ducts and gallbladder in cats. Without proper treatment, cholangiohepatitis can eventually lead to cirrhosis of the liver.

Cholangiohepatitis in cats can occur in two forms: chronic and acute.

Acute cholangiohepatitis

Symptoms of the acute form of cholangiohepatitis appear quickly, within a short period of time. Initially, the cat refuses food, looks weakened. Then vomiting opens, the body temperature rises, the animal suffers from pain in the abdomen, due to dehydration, the animal loses weight. The last symptom is "jaundice" - yellowness of the skin and mucous membranes (gums, sclera of the eyes).

When treating a cat for cholangiohepatitis, dehydration is eliminated with a dropper and a long course of antibiotics is prescribed. If the biliary tract is obstructed, surgery may be necessary.

Chronic cholangiohepatitis

Depending on the type of cells attacking the liver, there are 3 forms of chronic cholangiohepatitis: lymphocytic (lymphocytes), neutrophilic (neutrophils) and granulomatous (plasmocytes, macrophages). The manifestations of the chronic form of cholangiohepatitis are similar to the acute form, but they are accompanied by a swollen abdomen and enlarged lymph nodes. Treatment is similar to that of the acute form with the addition of corticosteroids. The treatment process is long and complicated, since chronic cholangiohepatitis is a recurrent disease.

To help your pet cope with cholangiohepatitis and other liver diseases, specialists from the Vega veterinary clinic network will help. Each clinic is a veterinary center equipped with modern medical and diagnostic equipment, where the latest scientific developments are combined with rich experience in successful practical veterinary activities. Our veterinarians provide veterinary care every day, including weekends and holidays.

K. W. Simpson,College of Veterinary Medicine, Cornell University, Ithaca, NY 14850, USA

Pancreatitis in cats is often accompanied by concomitant diseases of other organs and systems. Pathological disorders include liver lipidosis, inflammatory diseases liver, obstruction of the biliary tract, diabetes mellitus, inflammatory diseases of the gastrointestinal tract, hypovitaminosis (B12, folate, vitamin K), intestinal lymphoma, nephritis, pulmonary thromboembolism and pleural or peritoneal effusion. The term triaditis is used in the complex inflammatory diseases pancreas, liver and small intestine. Triaditis is found in 50–56% of cats diagnosed with pancreatitis and 32–50% in cats diagnosed with cholangitis/inflammatory liver disease. Differential diagnosis of triaditis is based on histopathological studies of these organs. However, the individual condition of each organ determines the diagnosis of triaditis among other differential diagnoses. While the etiopathogenesis of pancreatitis and its relation to inflammation of other organ systems is ambiguous, the first stage of differential diagnosis includes the study of the causes of inflammation, the immune response, and intestinal microflora.

Introduction

Pancreatitis in cats is often accompanied by concomitant diseases of other organs and systems. Pathological disorders include hepatic lipidosis, inflammatory liver diseases, biliary tract obstruction, diabetes mellitus, inflammatory diseases of the gastrointestinal tract, hypovitaminosis (B 12 , folate, vitamin K), intestinal lymphoma, nephritis, pulmonary thromboembolism, and pleural or peritoneal effusion. The term triaditis is used for a complex of inflammatory diseases of the pancreas, liver and small intestine. Triaditis is found in 50–56% of cats diagnosed with pancreatitis and 32–50% in cats diagnosed with cholangitis/inflammatory liver disease. This article provides an overview of the causes and treatment of pancreatitis and triaditis in cats, and an in-depth look at the etiopathogenesis of triaditis.

Differential diagnosis of triaditis is based on histopathological examination a separate body. However, the diagnosis of triaditis includes a combination inflammatory changes such as chronic pancreatitis, chronic cholangitis/cholangiohepatitis and IBD. Care must be taken when making a diagnosis when drawing conclusions about the causes of triaditis, since intravital diagnosis is difficult, and the final diagnosis is made postmortem. Diagnosis is hampered by the difference in the histological classification and assessment of feline pancreatitis, inflammatory diseases of the liver and intestines, which can be complicated by the staging and correlation of specific subtypes of diseases of these organs, with triaditis. Standardization of criteria for histopathological studies of the liver and intestines can be difficult.

Table number 1. Symptoms suggestive of triaditis

Diagnosis of pancreatitis and triaditis

The diagnosis of triaditis, the symptoms of which are described in Table 1, is made in the presence of a complex of inflammatory diseases of the intestine, liver and pancreas. Clinical findings are variable and include: anorexia, weight loss, muscle loss, diarrhea, vomiting, jaundice, hepatomegaly, bowel wall thickening, pancreatic enlargement, abdominal pain, abdominal effusion, fever, hypothermia, tachypnea, and shock. Hematological and biochemical changes associated with liver diseases - an increase in the concentration of ALT, AST, GGT, alkaline phosphatase and bilirubin; with diseases of the pancreas - an increase in pancreatic lipase and immunoreactive pancreatic lipase, a decrease in calcium levels; with IBD or alimentary lymphoma - lack of cobalamin, folate and albumin. In an ultrasound examination of the pancreas, the following are noted: a change in the size, echogenicity of tissues and the pancreatic duct; liver: changes in the size and contour of the organ, tissue echogenicity, the state of the biliary system; small intestine: thickening of the intestinal wall and hypertrophy of the muscular layer. The final diagnosis requires a biopsy and histopathological examination of the tissues of each organ.

Scheme No. 1

What are the causes of pancreatitis?

The etiopathogenesis of pancreatitis and its complications is described in Scheme 1. The causes that trigger the development of feline pancreatitis (Table 2) are usually not obvious. In this case, acute pancreatitis can flow into chronic, which in turn can be accompanied by exocrine pancreatic insufficiency; it is likely that each of the causes can provoke the development independent disease. Acute pancreatitis is accompanied by edema and necrosis, with hypoperfusion and thrombosis, which in turn can exacerbate pancreatic necrosis. Often pancreatitis is accompanied by inflammation of the small intestine. A particularly poor prognosis for purulent pancreatitis. Abscesses (sterile and infected) and pseudocysts (due to local accumulation of pancreatic secretions) are rare. The combination of these factors may be accompanied by bacterial infection and biliary obstruction. A bacterial infection can enter the pancreas through its duct along the ascending path or through the hematogenous route from the intestine. FISH study (fluorescence in situ hybridization) detects bacteria in the pancreas of 13/46 cats with pancreatitis. Bacterial infection provokes more severe pancreatitis in relation to cases occurring without it. Bacterial colonies are more often found in the tissues surrounding the pancreatic duct, the parenchyma of the organ, the surrounding omentum, areas of necrosis, and excretory ducts. Chronic pancreatitis can lead to obstruction of the pancreatic duct and biliary system, which in turn impairs the elimination of bacteria in the liver.

Table 2. Possible Causes of Pancreatitis, Inflammatory Liver Disease, and IBD

How is pancreatitis related to triaditis?

Inflammation in the intestines, liver and pancreas may be due to a separate pathological process at each site or have common cause. Most probable causes inflammation of the pancreas, liver, and intestines are indicated in Figure 2. Bacterial infection, immune-mediated response, and idiopathic mechanisms may also be potential causes of inflammation in each organ or provoke triaditis. When considering the causes of triaditis, several models of the development of the disease are possible.

Acute pancreatitis as a cause of triaditis?

Acute inflammation of the pancreas is one of the triggers of triaditis, and also affects the state of the liver and intestines (Scheme 2 A). In this scenario, pancreatitis provokes intestinal inflammation through contact with the duodenum and colon and/or associated systemic inflammatory response syndrome, which also promotes dysbiosis and migration of bacteria into the pancreas, bypassing the inflamed intestinal wall or through the pancreo-biliary duct. The combination of pancreatitis and migration of intestinal bacteria leads to the development of hepatopathy, neutrophilic cholangitis or hepatitis and septicemia. Cultures more frequently detect intestinal bacteria in liver and bile tissues in cats with cholangitis and cholangiohepatitis. FISH testing detects bacteria (predominantly E. coli and Streptococcus spp.) in formalin-fixed tissues in cats with inflammatory liver disease and pancreatitis. 6-7% of "FISH-positive" cats with liver disease and 79% of "FISH-positive" cats with pancreatitis have inflammation of the pancreas, liver, and small intestine. In addition, in animals with experimental pancreatitis, it has been demonstrated that E. coli can move into the small intestine. The appearance of hypoglycemia and worsening prognosis may be associated with the development of purulent pancreatitis, due to the development of infection and sepsis.

Scheme No. 2

intestinal inflammation and autoimmune causes triadite

An alternative etiological factor for triaditis may be in the gut. This scenario is based on lymphocytic-plasmacytic inflammation or small cell lymphoma, which may be accompanied by dysbiosis and migration of intestinal bacteria into the pancreas, bypassing the inflamed intestinal wall or pancreobiliary papilla.

An increase in intraduodenal pressure leads not only to vomiting, but also to reflux of intestinal contents into the pancreobiliary duct, leading to bacterial infection of the liver and pancreas (Scheme 2 B). We can detect bacteria in the bile and pankereobiliary tract. However, bacteria infectious diseases of the liver are more commonly located in the portal vein, venous sinuses, and parenchyma (12/13) than in the biliary tract (1/13), and only 3 of 13 cats with pancreatitis have infection in the pancreatic duct. It is assumed that the hematogenous route of infection is more likely than tissue infection along the ascending path of the pancreobiliary ducts.

The patterns described in Figure 2 A, B are most applicable to cats with triaditis, moderate to severe pancreatitis, and inflammatory liver disease (subdivided into reactive hepatopathy, neutrophilic or obstructive cholangitis). These cats are more likely to have active bacterial colonization than cats with milder disease.

Cats with chronic lymphocytic pancreatitis or cholangitis are rarely found to have a bacterial infection, as well as the presence of DNA from Helicobacter species that cause disease in other animal species (this has not been proven in cats). Therefore, the combination of lymphocytic (chronic) pancreatitis, lymphocytic or mixed lymphocytic and neutrophilic cholangitis, and lymphocytic-plasmacytic enteritis is more likely to be caused by an immune-mediated response than by bacterial infection (Figure 2C). In humans and experimental animals, autoimmune pancreatitis and cholangitis occurs as a complication of IBD with an immune attack on the pancreobiliary tract. Several experimental studies support the possibility that an immune response to gut bacteria is associated with immune-mediated pancreatitis and cholangitis. For example, C57BL/6 mice intraperitoneally injected with heat-inactivated E. coli weekly for 8 weeks show marked cellular infiltration and pancreatic fibrosis, accompanied by an increase in serum gamma globulin concentration and the formation of autoantibodies against carbonic anhydrase and lactoferrin. More recent studies have identified a single-celled flagellar organism, FliC from E. coli, which is an antigenic stimulus and causes elevated serum antibody titers in patients with immune-mediated pancreatitis. Expression of host antigens can generate an immune response. Mucin 1 (MUC1) is overexpressed in a pathogenic, hyperglycosylated form on the colonic epithelium of humans with IBD, where it induces inflammation. MUC1 also acts on the epithelium of the pancreatic duct. MUC1-specific T cells migrating to the colon and pancreas have been identified in mice with IBD. This suggests that the extraintestinal part of the ICZ is initially characterized by pro-inflammatory pathogenic expression of MUC1.

The immune response of cells in the bile ducts of cats with lymphocytic cholangitis is similar to that observed in humans with primary sclerosing cholangitis (PSC). PSC is characterized by progressive inflammation, fibrosis, and destruction of intra- and extrahepatic bile ducts, resulting in biliary fibrosis, cirrhosis, leading to liver failure.

PSC is a complex disease based on genetics, innate and adaptive immunity and the influence environment. It is often associated with IBD and involves an immune attack against cells in the biliary tract and can cause homing of memory lymphocytes, which increase in number as a consequence of IBD in the liver. The discovery of a cell adhesion molecule (MAdCAM-1) and chemokines (C-C motif) of a ligand (CCL25) thought to be localized only to the gut that are activated in the liver under inflammatory conditions supports the general concept that this mechanism can recruit lymphocytes to the affected liver and gut. . Expression of MadCAM-1 can also cause lymphocytic inflammation islet cells in diabetes mellitus, but this is not always associated with immune-mediated pancreatitis. A variety of antigens may be involved in PSC. Recently, the identification of B-tubulin isotype 5 (TBB5), which has a high correspondence with the bacterial cell division protein FtsZ, as an anti-neutrophil cytoplasmic autoantibody (ANCA), suggests that an immune response to bacterial migration is possible in the presence of impaired intestinal mucosal porosity, which contributes to inflammation in a susceptible person. While PSC contributes to autoimmune pancreatitis, biliary obstruction is increasingly considered to be a subtype of PSC, immunoglobulin (Ig) G4-associated cholangitis. This disease is associated with an increase in serum IgG4/IgE, profuse infiltration of IgG4-positive plasma cells and lymphocytes, self-antigens, and steroid susceptibility. It is believed that autoantigens, autoantibodies (such as lactoferrin, carbonic anhydrases) and potential pathogens may drive IgG4-mediated inflammation, but this remains to be determined. A number of other organs may also be involved in this process: salivary glands (Sjögren's syndrome), biliary strictures, lung nodules, autoimmune thyroiditis, interstitial nephritis (due to infiltration of IgG4-positive plasma cells and deposition of IgG4 on the tubular basement membrane). Notably, nephritis, which is considered an age-related comorbidity, is often diagnosed in cats with cholangitis and/or pancreatitis.

Treatment of triaditis

The term triaditis is applied to a syndrome that covers a spectrum of inflammatory diseases of the liver, pancreas and intestines, therefore, in order to choose treatment tactics, a particularly thorough assessment of the patient's general health and determination of the specific type and severity of changes in each of these organs is required. Drugs for the treatment of each of the diseases must be considered comprehensively, in order to assess the possibility of negative consequences with their simultaneous use, therefore, an individual approach to each patient is necessary.

Treatment priorities in cats with triaditis

Treatment of triaditis begins with obtaining the results of a clinical examination, clinicopathological tests that are aimed at differentiating the disease (cytology of liver tissues, pancreas, mesenteric lymph nodes, cultural studies of bile). In cats with persistent vomiting, abdominal pain, jaundice, anorexia, hypovolemia, signs of shock, sepsis, hypothermia, or fever, the primary goal of treatment is to maintain general condition and look for possible causes of illness. Symptomatic treatment includes fluid therapy, analgesia, antiemetics and antibiotics (if sepsis is suspected, if neutrophilia with a left shift is present) (Table 3). Anorexic animals are prescribed enteral nutrition (liquid feed through naso-pharyngeal tubes). In cats with confirmed triaditis, the main treatment is directed to the more affected organ. For example: acute pancreatitis, with suspected cholangitis, cholecystitis, obstruction of the biliary tract and possible intestinal perforation. In this case, it is necessary to determine the need for immediate surgical intervention.

Differential diagnosis of triaditis is based on the assessment of the histopathological material of each organ and the detection of a bacterial infection in them (cultural studies of bile and liver tissues, and FISH - examination of the liver and pancreas), for which a diagnostic laparotomy is performed. This is also a good opportunity to place an esophagostomy tube. If exploratory laparotomy is not possible or feasible, minimally invasive investigations such as endoscopy and ultrasound-guided fine-needle biopsy of affected organs are performed. Follow-up therapy is based on the presence of a bacterial infection in the biliary tract, pancreas or intestines (neutrophilic or granulomatous enteritis) and the sensitivity of this microflora to antibacterial drugs(tab. 3.).

Table 3 Treatment of triaditis: pancreatitis, inflammatory diseases of the liver and intestines

Corticosteroids are often used in the treatment of specific triaditis conditions that include lymphocytic cholangitis or LPE that are resistant to dietary and antibiotic therapy. Treatment with immunosuppressive drugs (steroids, chlorambucil) is started only if the diagnosis is confirmed and a bacterial infection is completely excluded.

Aspects of the treatment of pancreatitis, inflammatory diseases of the liver and intestines

Pancreatitis

Symptomatic treatment of pancreatitis is indicated in tab. 3. Infusion therapy is carried out to restore the acid-base state, electrolyte composition, colloidal and oncotic blood pressure. Buprenorphine and fentonyl are used to treat abdominal pain, although most cats with pancreatitis pain syndrome not expressed. Antiemetics(maropitant, ondansetron) are used to combat vomiting and nausea. Maropitant may also exert analgesic effects by inhibiting visceral NK1 receptors. For enteral nutrition, ready-made commercial feeds are used, which are administered through a naso-pharyngeal tube or through an esophagostomy.

Antibacterial therapy is considered warranted in patients with left-sided shift, signs of shock, or generalized bacterial infection. Failure to adequately respond to maintenance therapy is considered as a possible complication of the disease by the presence of pancreatic necrosis and DIC, septicemia or bacterial infection of the pancreas, the presence of pancreatic neoplasia and concomitant diseases other organs and systems. PTIA of the affected areas of the pancreas, followed by cytology and culture of tissues and bile, can help identify these conditions. Persistent biliary obstruction and secondary pancreatitis are another indication for surgery with possible stenting or cholecystostomy. It should be noted that corticosteroids or immunosuppressants are not commonly used in the treatment of pancreatitis in cats. They are used in cases with biopsy-proven immune-mediated pancreatitis or in cats with an identified IgG4 syndrome. However, these drugs should be used with caution, weighing the potential harm and benefit in long-term therapy of lymphocytic pancreatitis with corticosteroids.

Inflammatory Liver Disease (ILD)

The initial treatment for cats with ILD is the same as for pancreatitis. An additional focus is the treatment of vitamin K-dependent coagulopathy and oxidative stress. Antioxidants such as acetylcysteine ​​and S-adenosylmethionine (SAMe) are used to combat oxidative stress associated with changes in red blood cell morphology, anemia, and depletion of glutathione in the liver. Most specific treatment used after obtaining the results of a liver biopsy, followed by a cytological and cultural study of bile and tissues. Most forms of ILD are associated with intestinal microflora Therefore, antibiotic therapy begins with broad-spectrum drugs and is adjusted according to the results of a culture study. In the absence of bacterial infection, cats with lymphocytic cholangitis may have liver lymphoma and respond to treatment with corticosteroids and immunosuppressive drugs. Ursodil may not be effective in cats with lymphocytic cholangitis.

Inflammatory Bowel Disease

Treatment of IBD (Table 3) is best done after biopsy, when the type of disease (lymphocytic, eosinophilic, neutrophilic, granulomatous) and the degree of structural changes (predominant villus flattening, fusion) have been determined, and after exclusion of lymphoma. Mild lymphocytic-plasmacytic enteritis (which does not cause significant structural changes) often responds to diet therapy (selection of a hypoallergenic or hydrolyzed diet). Patients who do not respond to dietary monotherapy and who have moderate to severe PPE usually respond to dietary and antibiotic therapy (tylosin), or dietary therapy, antibiotic therapy (tylosin) and immunosuppressive therapy (prednisolone).

Cats with moderate to severe PPE that do not respond to prednisone may have low-grade lymphoma more likely than IBD (use PCR and immunocytochemistry to make a diagnosis) and may respond to chlorambucil. In cats with neutrophilic and granulomatous infiltration, an infectious etiology of the disease (FIP, bacterial or fungal) should be excluded; empiric immunosuppression is not recommended until these factors have been excluded by careful reassessment of the patient, examination of faeces and additional biopsy of the mucosa and regional lymph nodes, for example: histochemical staining of tissues, culture, PCR (FIP), FISH study. In cats with chronic diseases intestines there is a deficiency of vitamin B 12, which is replenished parenteral administration cobalamin. Malabsorption of folate and vitamin K is less common and can be corrected by parenteral administration of cobalamin. Associated low-grade small cell T-cell intestinal lymphoma may respond well to therapy with chlorambucil, prednisolone, and vitamin supplements At 12 and folate.

conclusions

Signs of feline acute pancreatitis may indicate the presence of a wide range of pancreatic pathologies associated not only with a combination of inflammation in the liver and intestines, but also in the kidneys. While the place of pancreatitis in the pathogenesis of triaditis is unclear, preliminary data indicate the presence of a heterogeneous group of conditions with different involvement of the body in the immune response to intestinal bacteria. Comprehensive, prospective studies are required that simultaneously assess for the presence of standard clinical, clinicopathological, and histological abnormalities, combined with highly sensitive studies in the assessment of pancreobiliary morphology (eg, MRI), immunological profiling (eg, IgG4, autoantibodies), and screening for the presence of bacterial colonies , a large number of biopsies, post-mortem autopsies, to obtain a more complete picture of the diagnosis and treatment of this pathology.

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The original article is provided by the author - Dr. Kenneth Simpson (K. W. Simpson), the article is translated and published with his kind permission. Translation by Daria Zheltysheva.

SVM No. 1/2016

Sourced from www.icatcare.org

Liver- vital important organ located in the abdominal cavity directly behind the diaphragm. The liver performs many functions that are important for maintaining the normal state of the cat's body and ensuring the metabolic processes taking place in it:

• Digestive support (especially fats);
• Synthesis of proteins and hormones;
• Setting up energy and protein metabolism;
• Delay and withdrawal toxic substances and products;
• Support of immune system functions;

Since blood flows directly from the intestines to the liver, partly because of this, the liver is vulnerable to toxic and harmful substances, since everything that a cat eats quickly reaches the liver. The cat's liver has an increased sensitivity to poisoning, as it lacks some of the metabolic pathways to deal with certain toxins.

In addition, the cat's liver is prone to a number of diseases, including, for example, diabetes mellitus, hyperthyroidism, lymphoma, and others.

The cat's liver has a huge margin of safety, so liver failure rarely occurs in practice, since more than two-thirds of the entire liver must be seriously affected by the disease. The liver also has a good ability to regenerate, which makes it possible to hope for a cat's recovery even after severe liver diseases.

Symptoms of liver disease in cats.

Signs of liver dysfunction in cats are often very vague and vague. It can be:

• Loss of appetite;
• lethargy;
• Weight loss ;

Depending on the cause and degree of the disease, symptoms such as fever, increased thirst, and vomiting may occur. In some cases, liver disease can cause fluid to accumulate in the abdomen (ascites), and in more severe cases, jaundice (yellowing of the gums and skin) can occur.

Sometimes, with very serious illnesses liver or "shunt" formation (when blood from the intestine bypasses the liver due to the presence of an abnormal blood vessel - "shunt") toxins that are normally trapped by the liver can reach the brain. This can cause abnormal cat behavior, disorientation, increased salivation, and even seizures or blindness.

Diagnosis of liver diseases in cats.

Because Clinical signs Liver disease in cats is often vague and nonspecific, and blood and urine tests are usually required to make a diagnosis and identify the underlying cause. Indicators of blood and urine tests that allow us to talk about violations in the liver, include:

Elevated bilirubin in cat urine and blood.

The level of liver enzymes in the blood(such enzymes are produced by liver cells) with diseases (or, possibly, obstruction of the outflow of bile) may increase. These enzymes can be:

• Alanine aminotransferase (ALT, alanine aminotransferase);
• Alkaline phosphatase (ALP, alkaline phosphatase);
• Aspartame aminotransferase (AST, aspartame aminotransferase);
• Gamma-glutamyltransferase (GGT, gammaglutamyl transferase);

Bile acids. These acids, produced by the cat's liver, are very important for the digestion of fats in the intestines. With liver diseases and obstruction and impaired bile outflow, an increase in the concentration of bile acids in the blood of a cat is possible. While elevated enzyme levels may be a sign of liver disease, bile acid levels can provide information about liver function.

Hematology. Examination of red and white cells in the blood can give some indication of the potential presence of infection or inflammation in the liver.

Protein in the blood. Processing the results of blood tests can help identify liver diseases, although it is difficult to determine the severity and extent of the disease only from them. In addition, such tests do not allow to determine the cause of the disease. Some changes in a cat's blood can be caused by other diseases, such as diabetes or hyperthyroidism, so further research is needed to rule out other diseases.

Assessment of the liver (to determine its size) using x-ray and ultrasound(size and structure of the liver, possible violations bile flow) can also be very useful in helping to narrow down the possible causes of the disease.

Liver biopsy at the cat. Often, finding the cause of a cat's liver disease and choosing the most appropriate treatment involves taking a sample of liver tissue for biopsy (and possibly culture to rule out bacterial infections). Obtaining samples for a liver biopsy is usually straightforward, but it is important to first ensure that the cat is clotting normally; the liver produces the proteins (or clotting factors) necessary for this. Obtaining specimens for liver biopsy in cats is usually done under anesthesia and is done with a simple surgical procedure or with a biopsy needle.

Most common liver disease in cats.

Cats are prone to many liver diseases, which is why it is so important to determine the underlying cause of the disease and choose the most suitable treatment the biopsy is so important. Here are some of the diseases:

Neutrophilic cholangitis in cats.

This is a disease caused by a bacterial infection in the liver, leading to inflammation. It usually develops as a result of bacterial migration to the bile ducts and into the liver from the small intestine. The disease is sometimes observed simultaneously with pancreatic and intestinal diseases. Diagnosis requires a liver biopsy and cultures on the obtained samples (or on samples of bile from the gallbladder).

Treatment is with appropriate antibiotics. If treatment is started in a timely manner, the prognosis for recovery is usually favorable.

Lymphocytic cholangitis in cats.

Unlike the previous one, this liver disease is non-infectious in nature, although it also leads to inflammation. The exact cause is not known, but it is possible that the disease is associated with disorders in immune system cats (immune-mediated disease). Lymphocytic cholangitis often causes enlargement of the liver and may also cause fluid to accumulate in the abdomen. Diagnosis is made by examining liver biopsy specimens.

Treatment is with anti-inflammatory and immune-boosting drugs—usually corticosteroids. The prospects for recovery depend on the severity of the disease and, although good, in some cases long-term or even lifelong treatment is required, and relapses are possible.

Hepatic lipidosis in cats.

In this disease, a large amount of fat accumulates in the liver cells, which leads to the formation of significant edema and damage to the liver, which can cause severe liver dysfunction. Hepatic lipidosis usually occurs in cats abrupt rejection from food, especially if the cat was overweight before. The sudden change in metabolism in these cats is probably what causes fat accumulation. The diagnosis can be confirmed by a liver biopsy.

Treatment includes finding out the underlying cause of the disease or the circumstances that contributed to the development of hepatic lipidosis. The main way to treat the disease is to provide intensive nutritional support. The cat usually has to be hospitalized and fed on a special diet using a tube until she is able to eat on her own again. Although many cats eventually recover, the recovery process can take several months.

Toxic liver injury in cats.

Cats are very susceptible to liver disease, which is caused by exposure to a wide range of common medications or toxins that are not harmful to other animals. This is because the cat's metabolism lacks some of the processing abilities that other species have. This should be taken into account and when prescribing medication to a cat, be sure to consult a veterinarian.

Liver tumors in cats.

Many types of tumors can form in the liver of a cat. Some affect the liver itself (primary liver tumors), while others invade the liver from outside (secondary liver tumors). Unfortunately, many types of tumors are not treatable, although in the case of lymphoma, for example, chemotherapy can be effective. Tumors limited to one lobe of the liver are also amenable to surgical resection.

Amyloidosis and hepatic peliosis in cats.

Amyloidosis is a disease in which proteins of a certain type (amyloids) accumulate in the liver, causing liver dysfunction, and creating prerequisites for the occurrence of liver rupture and hemorrhage into the abdominal cavity. Some cats are genetically predisposed to this disease.

Hepatic peliosis- a rare disease in cats in which multiple cavities filled with blood develop in the liver. As with amyloidosis, the liver becomes very fragile, and spontaneous ruptures and bleeding into the abdomen are possible.

Other liver diseases in cats.

Other liver diseases are possible in cats, including portosystemic shunts, toxoplasmosis, feline infectious peritonitis, and many others.

Treatment of liver diseases in cats.

Treatment for a cat's liver mostly depends on the underlying cause of the disease, so additional tests, such as a biopsy, are usually required. Except special treatment, supportive care is usually given, often including intravenous fluids (to correct dehydration), nutritional support, and medications to help preserve liver function and blood clotting, such as:

• Vitamin K;
• Ursodeoxycholic acid (Ursodeoxycholic acid, UDCA);
• S-adenosylmethionine (s-adenosylmethionine, SAMe);
• Silybin/silymarin (Silybin/Silymarin);