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Cholangiohepatitis

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Cholangiohepatitis

Cholangiohepatitis

Feline cholangiohepatitis is a term used to describe an inflammatory condition affecting the liver and biliary system of the cat. This is one of the most common causes of feline liver disease and can present multiple diagnostic and treatment challenges for veterinarians and cat owners.

Among the many vitally important roles performed by the feline liver is its contribution to the digestion of the food that a cat routinely consumes. This digestive process relies substantially on the liver’s manufacture and secretion of bile, a potent, greenish-brown fluid that travels from the liver via biliary ducts to the gall bladder. The bile is then stored in the gall bladder—a small balloon-like sac—until it is called upon to go to work in the intestinal tract. After eating, the gall bladder contracts and expels the bile through a tube (the common bile duct) into the small intestine, where it performs digestive processes such as the breaking down of dietary fats so that they can be absorbed into a cat’s body and the processing of harmful toxins so that they are unable to be absorbed. Inflammation and accompanying swelling within the liver and gall bladder interfere with the proper flow of bile, which results in its retention within the liver and biliary ducts. And because bile is a caustic digestive fluid, it can cause significant tissue damage when its normally fluent passage from the liver is impeded.

There are two main sources of this inflammation. The first is a bacterial infection which enters the gallbladder from the intestines via the common bile duct. The bacteria causes a type of white blood cell, called neutrophils, to invade the gall bladder and liver to help fight the infection. Neutrophilic cholangiohepatitis can occur in cats of any age, breed or sex, and more than 50% of cats diagnosed with this disease are found to have inflammation of the intestines and/or pancreas as well.

Lymphocytic cholangiohepatitis is another common form of this disease and tends to be more chronic and progressive than the neutrophilic form. This is an immune-mediated disease, causing an infiltration of a different type of white blood cells (lymphocytes) without an underlying infection in the liver or gall bladder.  Lymphocytic cholangiohepatitis can also occur in cats of any age, breed or sex, though Persian cats may have a genetic predisposition. Inflammatory bowel disease, or IBD, is a significant risk factor for the development of lymphocytic cholangiohepatitis in cats.

In tropical and sub-tropical areas, including Florida, Hawaii, Puerto Rico and Mexico, infestation of liver flukes can cause cholangiohepatitis. Free-roaming cats who ingest lizards, geckos and toads are most at risk for this parasitic infection, and many initially do not show clinical signs. Cats with this form of disease can often be diagnosed with a fecal exam and treated with anti-parasitic medication, though if extensive liver damage has already occurred by the time of diagnosis prognosis may be guarded.

Clinical signs

Cats with cholangiohepatitis often have vague and non-specific signs of illness at home. The most common reported symptoms include vomiting, weight loss, loss of appetite, jaundice/icterus (yellow tint to skin or gums), and fever. Cats with neutrophilic cholangiohepatitis tend to have more acute, severe clinical signs at home, while cats with lymphocytic cholangiohepatitis may initially show no clinical signs, or slow progression of weight loss, episodic vomiting, and listlessness. 

Cats with cholangiohepatitis often have concurrent inflammation in the pancreas (pancreatitis) and intestines (inflammatory bowel disease), a syndrome often called “triaditis”. Clinical signs of these diseases often overlap as they can all cause loss of appetite, vomiting, and weight loss, though diarrhea and abdominal pain are more common in cats with IBD and pancreatitis.

Diagnosis

Diagnosis of cholangiohepatitis will generally begin with bloodwork showing multiple elevated liver values indicative of damage to liver cells and elevated bilirubin indicating poor bile flow. In some cases of lymphocytic cholangiohepatitis, these changes on routine bloodwork may occur even before clinical signs are noted at home. The healthy liver is responsible for producing important coagulation factors which help with the formation of normal blood clots, and this process can be affected by inflammation and liver damage. In cats with suspected cholangiohepatitis, the coagulation status should be tested to prevent excessive bleeding.

Ultrasound examination of the liver and gallbladder can give important information about inflammation in those areas, though in some cases they may appear normal. Ultrasound of the abdomen will also evaluate for other issues, such as pancreatitis, intestinal inflammation, or stones in the gallbladder and obstruction of the bile ducts. During this procedure, a sample of bile can be collected, allowing for microscopic examination and culture for the presence of bacteria. This will be important in determining if antibiotics are needed, and which one is most appropriate.

Definitive diagnosis of cholangiohepatitis is made by examining a liver biopsy under a microscope. Biopsies are generally taken during a surgical procedure, though in some cases a minimally invasive laparoscopic procedure can be used to collect the samples. This procedure gives the veterinarian the most information regarding the diagnosis of cholangiohepatitis and differentiates between the neutrophilic and lymphocytic forms of the disease. However, in cases where a biopsy is not possible, either due to anesthetic concerns, financial constraints, or logistical difficulties, a presumptive diagnosis of cholangiohepatitis may be made based on clinical signs, bloodwork results, and ultrasound examination.

Cholangiohepatitis

Treatment

Treatment for cholangiohepatitis will depend on severity of the illness and the form of disease diagnosed. For cats with severe disease, especially those with neutrophilic cholangiohepatitis, hospitalization may be required for initial treatment. This will allow for the administration of fluids, antibiotics, and anti-nausea medications intravenously in sick cats who will not take medications at home. Nutritional support is also very important, as another form of liver disease known as hepatic lipidosis can occur if ill cats stop eating for more than a few days. Nutrition can be delivered via a feeding tube through the nose while cats are in the hospital, or through an esophageal feeding tube if continued feeding support is needed after the cat is discharged to go home. In rare cases involving blockage of the bile ducts, surgery may be needed to relieve the obstruction or remove the gallbladder. Once a cat is stable to go home, antibiotic therapy generally continues for 4 to 6 weeks.

Therapy for cats with lymphocytic cholangiohepatitis will include many of the treatments described above, though hospitalization may not be required in more chronic, mild cases. Because lymphocytic cholangiohepatitis is an immune-mediated disease, long-term treatment for this form of disease will involve immunosuppressive medications. The most common medication used is a high dose corticosteroid called prednisolone, though in some cases Ursodeoxycholic-acid or chlorambucil may be used as well. The dose of these medications will be gradually lowered over the course of 4 to 6 months, but some cats may need to stay on a low dose long term to prevent the recurrence of bloodwork abnormalities and clinical signs. Additional potential therapies include antioxidants and liver protective medications such as SAMe (S-adenosylmethionine), NAC (N-acetylcysteine), and B-complex vitamin supplementation, and some of these may be used long-term.

Prognosis

Neutrophilic and lymphocytic cholangiohepatitis both carry a variable prognosis. Cats with neutrophilic cholangiohepatitis can return to normal if treated aggressively and promptly, though data suggests that cats with concurrent diseases such as biliary duct obstruction tend to have a worse prognosis. Lymphocytic cholangiohepatitis can also go into long-term remission with medications, though some cats may need treatment and monitoring lifelong. Treatment for either disease is most successful when initiated at the early stages of disease, before significant liver damage or complications such as biliary cirrhosis develop.

Source: Cornell Feline Health Center

Dogs love liver – but how much liver is too much – can too much do harm?

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Dog

Dogs love liver – but how much liver is too much – can too much do harm?

Everyone who loves dogs knows that dogs love liver! Treats containing liver abound, recipes for liver “brownies” are perennial favourites (you can find one here on this blog, but there are countless versions) and simple baked treats are a mainstay as “bait” for show dogs and rewards for hard working canines in all kinds of sport and performance work. In home made recipes, some organ meat is always included, to boost nutrient levels, especially Vitamin A, and copper. But how much liver is enough, and is it possible to overdo it? Are all kinds – beef, lamb, chicken, pork – created equal? In this entry we’ll take a little closer look at liver; what it offers your dog, how to prepare it – and why you really can get too much of a good thing.

Let’s start with what’s good about liver, why it should be included in a canine diet, if it’s tolerated.

  1. Liver is nature’s most abundant source of Vitamin A, in the  most bioavailable form for carnivores. (This is why cod liver oil is so different from fish body oil, the vitamin content).
  2. Liver is an excellent source of protein, all the B vitamins, and iron.
  3. Liver is very high in copper, an important nutrient that can be low in home made diets.
  4. Liver contains Vitamin D which supports the immune system, muscles & bone growth
  5. Oh yes, and dogs love the stuff…can’t forget that one.

Look for a supplier that uses rural raised, clean air living, grass fed, hormone free Beef – always buy the best you can afford.

Now, what might some of the issues be?

  1. ​Liver is very high in copper (yes, this can be a problem if fed too much. We want to hit in around the  Recommended Allowance, not go, you know, 20 times above it. That carries its own problems)
  2. Liver is very high in phosphorus, which we like to watch especially with growth diets, seniors and very carefully with kidney disease.
  3. Liver is high in purines, a big no-no for dogs with uric acid stones(especially common in the Dalmatian, and serious stuff)
  4. Although we mention above that what is good is that liver contains Vit. A, we need to be aware that too much Vit. A can poison dogs, creating symptoms that in include tremors, convulsions and peeling skin. 
  5. There is always the risk of salmonella and campylobacter in raw organs which can be particularly harmful to young, old or unwell dogs. 
  6. When a dog has an allergic reaction, it is very often the protein that is the culprit. A good idea is to do an allergy test
  7. Always check with your vet before giving liver to your dog if your dog suffers from any disease. With some diseases, liver can do harm. 

This part can get technical, so bear with me.  I don’t, for the record, believe that every meal has to be “perfectly balanced” but I can easily demonstrate how not paying attention and relying on guesswork will create imbalances- which in turn, can have serious backlash over time. It’s good to know what is in our food – not just the toxins, which many are concerned about, but the nutrients! So to figure out how much liver to add, it’s smart to start off calculating your dog’s phosphorus and copper requirements. Then, calculate how much is in the diet. Often, there will be plenty of phosphorus but low copper.  Add just enough liver to bring the copper into the recommended range or a little higher. The exceptions to this of course, would be a cancer or renal diet where we need to restrict copper, or of course, any dog with urate stones. Just take a pass in those cases.

In a cooked diet, I generally need to add anywhere from 1 – 5 ounces per week, depending on the size of the dog. I did a St. Bernard diet yesterday and we’re using six ounces of liver; the dog’s recommended allowance is 35 mgs, and the recipe has 36. The dog’s allowance for phosphorus is 14,000 mgs; with the liver, we have 14,079.(this is beef liver I’m referring to here).

To calculate your dogs RA for phosphorus, follow the same basic procedure I’ve referred to in past entries; take the bodyweight in kilograms to the power of 0.75, then multiply by 100. That’s the DAILY recommended allowance. To find the copper recommendation, take the metabolic number as above, and multiply by 0.2, for the daily ideal level. Of course, you just X these levels by 7 to get the weekly amounts.

That’s the easy part. Figuring out what’s in the diet is harder. You can use a tool like nutrition data, or you can slog it out using the USDA database. In general, my feeling is one ounce a week for a small dog, 2 – 3 for a medium, 4-6 for large and giant breeds. This is not precision nutrition, but it gives an idea of how much we might use in a recipe. I often suggest to clients they reserve the liver I include in their dog’s recipe, and feed as treats. It doesn’t have to go into the batch, just into the dog. 

Dog

What about different types of liver?

I am often asked if they can be interchanged –  and I think, as treats they can ( given I am recommending not using liver in general all the time) but when we’re looking to meet a dietary requirement, different types of liver have different profiles.  Here’s a peek at four popular varieties:

Beef Liver
​82 grams, cooked weight (this will apply to all varieties)
Calories – 156
Phosphorus- 407 grams (this is substantial, when you consider an equivalent amount of lean muscle meat has about 168 mgs).
Copper– 11.7 mgs  (this too is a lot, consider my 72 kg St. Bernard needed only 5 mgs daily.)
Iron – 5.3 mgs
Zinc – 4.3 mgs

​Calf’s  Liver
​Calories – 155
Phosphorus – 377 mgs
Copper – 12.3 mgs
Iron – 4.19 mgs
Zinc – 9.2 mgs
Not much difference other than more zinc. These two are more or less interchangeable. But then there is…

Chicken Liver
Calories-136
Phosphorus – 332 mgs
Copper – 0.4 mgs
Iron – 9.5 mgs
Zinc – 3.26mgs
This is significant particularly if one is adding liver to amp up the copper. Note the higher iron, too; seems like a small difference, but small dogs can really be affected. Not interchangeable with calf’s of beef liver. And then we have…

Lamb Liver​
Calories– 180
Phosphorus– 344 mgs
Copper -5.8
Iron– 6.79 mgs
Zinc – 6.47 mgs

Other differences include Vitamin A, B12 and selenium. In dietary formulation we learn to pay attention to all of these levels, and aim for an optimal range. Very nutrient -dense foods like liver offer great benefits, but we need to use them properly. Liver is not to be fed as a main protein source, but a garnish, an addition, a booster of the nutrients we’ve highlighted here. Now, as TREATS, I feel you’re ok with a healthy dog, to mix liver types up and use judicious amounts. I like to emphasize heart, muscle meat and eggs, so as to minimize  the chance of driving some nutrient levels out of balance. But in a  recipe, where we are trying to reach specific levels, yes indeed, all liver is not created equal.

Source: Friends of the Dog

Vanquish the Hostile Takeover of Canine Halitosis

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Vanquish the Hostile Takeover of Canine Halitosis

Image: Pixabay

Getting up-close-and-personal is your furry friend’s way of showing their unconditional love and affection for you and the last thing you want is to shy away from them just because they have a disagreeable breath. You may think it insignificant, but halitosis could be the culprit for this unpleasant odour and should be investigated promptly.

Causes

Halitosis is the condition of accumulated odour-producing bacteria in the mouth which results in bad breath.

Periodontal disease (gum or dental disease) is most notably responsible for our canine companion’s bad breath and this occurs most frequently in smaller dogs who are particularly susceptible to plaque and tartar.

Breath that remains unrelentingly offensive could be an indication of something more serious than just a need for a professional dental clean. Halitosis can be a red flag for problems associated with severe medical issues in the mouth, liver, kidneys, respiratory system, inflammation of the throat, tonsillitis, gastrointestinal tract or even metabolic disorders such as diabetes mellitus. Cancer or foreign matter in the body can also play a role in producing bad breath as they result in disease.

Bacterial, fungal and viral infections within the body can be responsible for emitting foul odours, as can dietary-related problems. Consider that when your hungry hound eats foods that have naturally offensive odours, their breath will automatically smell bad. Some pooches display behaviour known as coprophagia, where they eat faeces and will, similarly, have the same foul-smelling breath thereof.

Trauma associated with an electric cord injury may also be a possible cause of halitosis.

Symptoms

  • If there is no indication of critical issues, the offensive smell may be the solitary symptom of halitosis.
  • If a disease in the mouth is the cause, the following symptoms could appear:
  • Pawing at the mouth
  • Severely reduced appetite
  • Losing teeth
  • Drooling excessively which could have traces of blood therein
  • A peculiar sweet and fruity-smelling breath, could be a potential warning for diabetes, especially if your pup is consuming water and urinating more than usual.
  • An ammonia-like or urine-smelling breath could be indicative of kidney disease.
  • Liver problems could be the trigger when the following symptoms are displayed:
    • Foul smelling breath
    • Vomiting
    • Severely reduced appetite
    • Yellow-shaded corneas or gums

Treatment

Treatment will vary according to what’s causing the halitosis. If halitosis is brought about by periodontal disease, a dental cleaning procedure is likely to be scheduled as your pup may lose some teeth if the procedure is delayed. A professional dental clean involves scaling your dog’s teeth to eliminate any plaque or tartar accumulation along with polishing those pearly whites. Teeth appearing to have above 50 percent chance of losing the supporting gum and bone may have to be extracted. Your furry pal will undergo general anaesthesia during the clean so ensure they fast the night before and chat to your vet about any concerns you may have with regards to having them endure anaesthesia. Your veterinarian may thereafter, prescribe medication that regulates the bacteria production in the mouth, enabling a reduction in the associated odour.

If your pooch’s halitosis is triggered by something other than periodontal disease, physical examinations will have to be conducted by your veterinarian to establish whether the root cause could be attributable to a condition such as diabetes, liver, digestive or kidney problems. The subsequent treatment plan will then depend on the identified cause thereof.

Don’t hesitate to visit your veterinarian as soon as you discover any suspicious symptoms relating to halitosis so to discount any chance of them developing into critical health issues down the line. 

Prevention

Why allow your furry pal to endure the unpleasantries or dangers of halitosis when you can take the initiative in preventing it in the first place?

  • Schedule regular veterinarian checkups to be made aware of or prevent any imminent medical issues that could be triggering halitosis.
  • Ensure that both you and your vet actively monitor the condition of your dog’s teeth and breath.
  • Ensure your pup is well nourished with a high-quality diet that is easily digestible.
  • Feed your pooch specially formulated treats that reduce bad breath and tartar.
  • Brush your fur ball’s pearly whites weekly, if not daily. Use a vet-recommended toothpaste especially formulated for dogs because cat or human toothpastes can cause upset stomachs in canines.
  • Allow your dog’s teeth to be cleaned naturally, by giving them safe and tough chew toys to gnaw on.
  • There is a plethora of oral products on the market so chat to your veterinarian about the most appropriate ones for your special canine companion.

Interesting Fact
Dog breeds with flat-faced, short-nosed characteristics, also known as brachycephalic breeds, such as Boston Terriers, Pugs, Pekingese, are more inclined to periodontal diseases and conditions associated with the mouth since their little teeth are set so closely together

Written for inFURmation
by Taliah Williamson

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Disclaimer: The information produced by Infurmation is provided for general and educational purposes only and does not constitute any legal, medical or other professional advice on any subject matter. These statements are not intended to diagnose, treat or cure any disease. Always seek the advice of your vet or other qualified health care provider prior to starting any new diet or treatment and with any questions you may have regarding a medical condition. If you suspect that your pet has a medical problem, promptly contact your health care provider.