🩺 Vet Guide to Cholangitis (Cholangiohepatitis) in Cats – 2025 🐱

Cholangitis, formerly referred to as cholangiohepatitis, is one of the more treatable liver conditions in cats—but it often hides a complex web of related illnesses. With links to inflammatory bowel disease (IBD) and pancreatitis, this condition may present as part of a broader syndrome known as triaditis. In this detailed 2025 guide, Dr. Duncan Houston BVSc walks you through cholangitis in all its forms, from acute infections to chronic immune-mediated liver damage. 🧬🐾

🔍 What Is Cholangitis?

The word “cholangitis” refers to inflammation of the bile ducts. Bile, produced by the liver, is stored in the gallbladder and travels via the common bile duct to the small intestine. In cats, inflammation often begins when intestinal bacteria travel up the bile duct and infect the liver—a system that is usually sterile. This causes liver dysfunction and potentially liver failure. 🧫

Cholangiohepatitis vs. Cholangitis:

• 🧪 Cholangiohepatitis = Inflammation of both liver and bile ducts (older term)
• 🧪 Cholangitis = Inflammation mainly confined to the bile duct system (preferred term in 2025)

🔄 Cholangitis, IBD, and Pancreatitis: Triaditis

In cats, the common bile duct and the pancreatic duct share the same exit into the intestine. This means that bacteria can easily spread from the intestines into both the liver and the pancreas, especially if the intestinal lining is inflamed from IBD. 🧬

• 🔁 Up to 80% of cats with cholangitis also have IBD
• 🔁 Around 50% also have pancreatitis

Together, this combination is called triaditis, and treatment success depends on managing all three conditions. 🔄

📊 Types of Cholangitis (WSAVA Classification)

1. 🧪 Neutrophilic Cholangitis – Often acute, bacterial origin
2. 🧫 Lymphocytic Cholangitis – Chronic, immune-mediated
3. 💔 Destructive Cholangitis – Severe chronic damage
4. 🐛 Chronic Cholangitis from Liver Flukes – Parasitic, common in tropical regions

🧪 Diagnosis

Diagnosis begins with history, clinical signs, bloodwork, and imaging. Common diagnostics include:

• 🧫 Blood tests – Liver enzymes, bilirubin, white blood cell count
• 🩻 Ultrasound – Evaluates bile ducts, liver texture, and gall bladder
• 🧬 Liver biopsy – Differentiates between forms of cholangitis

Clinical Signs:

• 🤢 Vomiting, diarrhea, poor appetite
• 🐌 Lethargy, fever, abdominal pain
• 🟡 Jaundice (yellow gums or eyes)

💊 Treatment Strategies

1. 🧪 Antibiotics (for Neutrophilic Cholangitis)

• 👨‍⚕️ Target intestinal or bile cultures when possible
• ⚠️ Broad-spectrum antibiotics if culture is not feasible

2. 💧 Hospitalization and Supportive Care

• 💉 IV fluids, anti-nausea meds, appetite stimulants
• 🍼 Assisted feeding as needed (tube or syringe feeding)

3. 🔄 Choleretics (Bile Flow Enhancers)

• 💊 Ursodiol – Improves bile flow and helps prevent bacterial reflux
• 🕰️ Often needed long-term or lifelong

4. 💊 Nutraceuticals for Liver Health

• 🌿 SAMe (S-adenosylmethionine) – Antioxidant and detox support
• 🌱 Silymarin (Milk Thistle extract) – Herbal liver support

5. 🔬 Immune Suppression (for Lymphocytic or Chronic Forms)

• 💊 Prednisolone or prednisone (first-line)
• 💉 Chlorambucil (chemotherapy) or cyclosporine for resistant cases

🐛 Liver Flukes and Cholangitis

Fluke infections, especially in tropical regions, can cause long-standing liver inflammation:

• 🦎 Infection pathway: snail → crustacean → lizard → cat
• 🍣 Raw fish can also transmit some species of liver flukes

✅ Treatment: Praziquantel

The same medication used for tapeworms, praziquantel, is highly effective against flukes. 💊

📆 Monitoring and Prognosis

With early intervention and full treatment, many cats improve within a week and can regain full health. However:

• ⚠️ Some cats require lifelong medication
• 🔁 Relapses or flare-ups can occur, especially with IBD
• 🧪 Regular rechecks, bloodwork, and ultrasound are often needed

Severe complications like pancreatitis or hepatic lipidosis can impact survival. Prognosis is better the earlier treatment begins. 🏥

📲 Ask A Vet for Ongoing Support

If your cat has been diagnosed with cholangitis, you may have questions about medications, diet, or what to expect long term. Connect with Dr. Duncan Houston or another licensed vet on the Ask A Vet app for expert, compassionate help. 🐾💬

Visit AskAVet.com for personalized liver support plans and disease management guidance. 📱

💬 Final Thoughts

Cholangitis in cats is treatable—and often curable—when diagnosed early and managed properly. Understanding triaditis, bacterial risks, and immune triggers is key to helping your cat recover. 🐱🧠

Trust Dr. Duncan Houston and Ask A Vet to guide you through every step of your cat’s liver health journey. 🧬🩺