Paragraphs taken from my recent geriatric textbook (Geriatrics & Gerontology of the Dogs and Cats ,
Second Edition. WB Saunders Co., Philadelphia, 2004): "On ultrasonography, severe ascending cholangitis associated with thickening
of the extrahepatic biliary system and inflammation within the lumen of the intrahepatic bile ducts may be observed. Ultrasonography
also may show coexisting extrahepatic bile duct obstruction (enlarged gall bladder, distended and tortuous common bile duct,
and obvious intrahepatic bile ducts), cholecystitis (thickened, laminar appearance to gall bladder wall, adjacent fluid accumulation),
and pancreatitis (prominent, easily visualized enlarged pancreas with adjacent hyperechoic fat).
Cytologic evaluation of liver aspirates or imprints may reveal suppurative inflammation.
"Cats with extrahepatic bile duct obstruction should have their biliary occlusion decompressed, if possible. If biliary tract
decompression cannot be accomplished, the biliary pathway may be rerouted by a cholecystoenterostomy. Biliary diversion is
a vital early therapeutic intervention in the prevention or control of sepsis in obstructive suppurative cholangitis."
This cat would benefit most from having biliary tract decompression done by exploratory laparotomy. Otherwise, medical management
for biliary tract disease can include the following:
- Fluid therapy according to the cat's needs;
- Prednisone (2-4 mg/kg PO SID or divided BID with titration to the lowest effective dose during the next several months) -
an important part of the general treatment plan;
- Metronidazole (5.0-7.5 mg/kg PO BID) or daily enrofloxacin;
- Vitamin E at oral dose of 200 IU per day or daily Denosyl SD4;
- 1 mg injectable vitamin ±2 every 2-4 weeks;
- Diet that the cat will eat well.