Clinical features, concurrent disorders, and survival time in cats with suppurative cholangitis-cholangiohepatitis syndrome

Abstract OBJECTIVE To characterize clinical features, comorbidities, frequency of bacterial isolation, and survival time in cats with suppurative cholangitis-cholangiohepatitis syndrome (S-CCHS). ANIMALS 168 client-owned cats with S-CCHS. PROCEDURES Data were prospectively (1980 to 2019) collected regarding clinical features, comorbidities, bacterial infection, illness duration, and treatments. Variables were evaluated for associations with survival time. RESULTS Median age of cats was 10.0 years, with no breed or sex predilection observed. Common clinical features included hyporexia (82%), hyperbilirubinemia (80%), lethargy (80%), vomiting (80%), jaundice (67%), weight loss (54%), and hypoalbuminemia (50%). Comorbidities included extrahepatic bile duct obstruction (53%), cholelithiasis (42%), cholecystitis (40%), and ductal plate malformation (44%) as well as biopsy-confirmed inflammatory bowel disease (60/68 [88%]) and pancreatitis (41/44 [93%]). Bacterial cultures were commonly positive (69%) despite prebiopsy antimicrobial administration in most cats. Of surgically confirmed choleliths, diagnostic imaging identified only 58%. Among 55 cats with “idiopathic pancreatitis,” 28 (51%) were documented to have transiting choleliths, and 20 had pancreatic biopsies confirming pancreatitis. Cholelithiasis (with or without bile duct obstruction) and cholecystectomy were associated with survival advantages. Survival disadvantages were found for leukocytosis, ≥ 2-fold increased alkaline phosphatase, and hyperbilirubinemia. Cholecystoenterostomy had no survival impact. Cats with ductal plate malformations were significantly younger at diagnosis and death than other cats. Chronic treatments with antimicrobials, S-adenosylmethionine, and ursodeoxycholic acid were common postbiopsy. CLINICAL RELEVANCE S-CCHS in cats was associated with bacterial infection and various comorbidities and may be confused with pancreatitis. Surgically correctable morbidities (ie, cholecystitis, cholecystocholelithiasis) and cholecystectomy provided a significant survival advantage.

Download Full-text

Clinical and Prognostic Findings in Dogs with Suspected Extrahepatic Biliary Obstruction and Pancreatitis

Journal of the American Animal Hospital Association ◽

10.5326/jaaha-ms-6985 ◽

2020 ◽

Vol 56 (5) ◽

pp. 270-279

Author(s):

Shannon Marie Palermo ◽

Dorothy C. Brown ◽

Stephen J. Mehler ◽

Mark P. Rondeau

Keyword(s):

Bile Duct ◽

Body Temperature ◽

Survival Time ◽

Extrahepatic Bile Duct ◽

Clinical Findings ◽

Bile Duct Obstruction ◽

Survival Times ◽

Duct Obstruction ◽

Factors Associated ◽

Extrahepatic Bile Duct Obstruction

ABSTRACT Pancreatitis in dogs may lead to extrahepatic bile duct obstruction as a result of local inflammation. Medical records of 45 client-owned dogs with clinical suspicion of extrahepatic bile duct obstruction secondary to pancreatitis were reviewed to determine clinical findings, outcome, and factors associated with survival. Survival times were determined using the Kaplan-Meier product limit method. Cox multivariable survival methods were employed to determine factors associated with survival time following diagnosis. The median survival time was 241 days (95% confidence interval [CI] 25–631), with 34 of 45 dogs (76%) surviving to discharge. Dogs 9 yr of age or older with azotemia at presentation had a 9.9 greater hazard for death (95% CI 2.5–38.1; P = .001) compared with dogs younger than 9 yr old without azotemia at presentation. Dogs without subjective ultrasonographic gallbladder distension had a 4.4 greater hazard for death (95% CI 1.3–15.4; P = .018) compared with dogs with subjective gallbladder distension. Dogs with a body temperature ≥102.5°F at admission had a 3.1 greater hazard for death (95% CI 1.3–7.7; P = .013) than dogs with a body temperature <102.5°F at admission. This information may help clinicians discuss prognosis with owners of affected dogs.

Download Full-text