Cholangitis-Cholangiohepatitis Syndrome in Dogs
Liver inflammation in dogs can be a minor condition with minor symptoms or a major issue with dire consequences. Basically two forms exist.
Cholangitis is basically an inflammation of the bile ducts as well as the intrahepatic ducts that carry the bile out of the liver to the gallbladder. The bile is then stored there until the dog eats. After the do has had its meal the bile is used to aid digestion in the small intestine of the animal. The main purpose of the bile is to breakdown the fatty substances in the food which will then be used as the energy that is needed by the body to function for the day.
If you hear your vet say the word cholangiohepatitis he or she is describing a condition in which both the liver and the bile ducts are inflamed. Put together these two words describe a condition known as cholangitis-cholangiohepatitis syndrome or CCHS. This syndrome is a condition which affects cats more often than dogs as it is relatively rare in dogs.
Types and Symptoms
CCHS can often be found in conjunction with other diseases and conditions such as inflammation or clogging of the liver ducts which run outside of the liver (also known as EHBDO), inflammation of the pancreas, inflammatory bowel disease (IBD), long-term inflammation of the kidney tissue, or fatty liver disease. Symptoms of CCHS may occur very suddenly, they may be intermittent, or they may be long-term and slow to develop. Basically there are three types of cholangitis-cholangiohepatitis syndrome that are recognized. These are suppurative which includes a discharge fluid within the biliary canal and usually has a very sudden onset and a good outcome with proper treatment; The nonsuppurative form of CCHS which is a reoccurring type and tends to have a poor prognosis; and the lymphocytic/lymphoplasmacytic form. The latter form of CCHS is the type where lymphocytes and plasma cells invade and surround the liver's portal triad or portal vein and has a very poor outcome due to its very long-lasting and chronic nature which gives it the tendency to progress to cirrhosis of the liver. The symptoms of the suppurative form of CCHS include the following:
- Yellow skin and yellow whites of the eyes
- Swollen painful abdomen which is due to fluid crossing over into the abdomen (ascites)
For the nonsuppurative form of CCHS the following symptoms may be present: Enlarged liver (hepatomegaly)
- A lack of appetite (anorexia)
- Lack of energy
Causes of CCHS
The suppurative form of CCHS has two possible causes which can be a direct result of several types of infections or pre-existing or earlier medical conditions:
- The animal has had EHBDO (extra-hepatic bile duct obstruction)
- The animal has had a recent gall bladder blockage
The nonsuppurative form of CCHS may be caused by the following conditions. These, however, may not be directly causal, but concurrent with the disease.
- Inflammation of the pancreas
- Inflammatory Bowel Disease (IBD)
- Inflammation of the gallbladder
- A long-term swelling of the kidney tissue
Diagnosis of CCHS
In order for your veterinarian to properly diagnose this disease your pet will need a complete and thorough physical examination. He or she will also take into account the background history of the animal's health, the onset of the current symptoms, and any possible incidents of illness which may have led to this condition. Some of the factors which will place a dog at risk of acquiring CCHS are inflammatory bowel disease, pancreatitis, or an obstruction of the bile ducts which lie outside of the liver.
The vet will also do a chemical blood profile along with a complete blood count and urinalysis of the animal. This will help the veterinarian to rule out other conditions such as anemia, high liver enzymes, bilirubinuria (bilirubin in the urine), and lymphocytosis. A possible outcome at this point is the possibility of the animal being diagnosed with cancer if the condition is causing swelling of the gallbladder and/or liver. At this point it may also be discovered that the bile is sludged which may be the cause of the blocked bile ducts.
If swelling of the pancreas is suspected the veterinarian will order a TLI blood test to test for the trypsin-like immunoreactivity pancreatic digestive enzyme, a sign of pancreatic sufficiency. Also, the animal's B12 vitamin level will be tested as low values are a sign of problems with absorption in the small intestine of the animal as well as pancreatic problems.
The thyroid gland will probably be tested as well to rule out any possibility of thyroid tumors and cancer.
The veterinarian may also do a chest X-ray, abdominal X-ray and an abdominal ultrasound as a check for cancer and to visualize the liver, pancreas and kidneys for other abnormalities.
If a closer visual exam is required the veterinarian may do a laparotomy. This procedure requires that the animal be sedated because the vet will pass a small tube with a camera into the animal through a small incision. This tube also has forceps at the end for the veterinarian to take biopsy tissue samples. With this tool the veterinarian will inspect the walls and ducts of the liver and pancreas and take samples to be sent off for biopsy examination at a laboratory. He may also take samples of abdominal fluids as well as other cell samples during this procedure.
Treatment of CCHS
To treat the suppurative form of CCHS the veterinarian will prescribe antibiotics.
Treatment of the nonsuppurative form of CCHS is a little more involved. For this type the veterinarian will prescribe immune-modulating drugs and antibiotics. If the animal has lymphoma (cancer of the lymphocyte white blood cells) the veterinarian will probably suggest that the animal undergo chemotherapy.
Antioxidants are often also prescribed with the other drugs to help protect the liver and vitamin B and E supplements are highly recommended as well.
If it is discovered during the examination of the animal that there is also a problem with the blood clotting properly you may have to also give the animal vitamin K to aid in the clotting process.
In rare circumstances the animal may need surgery if the obstruction is bad enough to prevent the bile from flowing normally. Most cases, however, only need that the animal be treated as an outpatient.
Sometimes the animal may become dehydrated and develop a problem with malnutrition. If this happens the animal will need to be placed on a feeding tube and intravenous line until it is stabilized.
The whole timeframe for treatment is about three to four months with regular visits to the veterinarian every two weeks so that the liver enzymes can be checked. The animal will also have to undergo repeated bile culture tests and probably other biopsy and other fluid tests during the treatment period.
This disease has a tendency to return a few times. If it does do not hesitate to take the animal back to the veterinarian immediately so that the vet can get a jump on the disease. It is also very highly recommended that the animal have regular veterinary visits every three or four months to keep an eye on the condition after treatment.
If the animal has the nonsuppurative form of CCHS it will definitely need a lifelong immunomodulatory, hepatoprotective, and antioxidant therapy.
While the animal is recovering from this condition it is necessary to restrict the dog's activity. The animal will also need an easily digestible food that is high in protein. The animal's diet may also need a variety of water-soluble vitamins as a preventive measure against the reoccurrence of this condition.
For animals that suffer from either inflammatory bowel disease or swelling of the pancreas a more specialized diet will be required.