Cholangitis-Cholangiohepatitis Complex

The cholangitis-cholangiohepatitis complex (CCH complex) is an inflammatory disease of the biliary tract in cats. The cause of the disease is unclear. The disease manifests itself in unspecific clinical manifestations and is characterized by the migration of white blood cells into the walls of the bile ducts. In the later stages, changes in the actual liver cells and cirrhosis of the bile ducts also occur. It corresponds most closely to biliary cirrhosis in humans .

Cause and development of the disease

The cause of the cholangitis-cholangiohepatitis complex has not yet been explained. An immunopathological origin is assumed by autoantibodies . Triggers for this could be biliary disorders , infections of the biliary tract or chemical changes in the composition of the bile .

In the disease, white blood cells migrate into the epithelium of the bile ducts, in the early stages mainly lymphocytes , in the late stages also neutrophils and eosinophils . This leads to gradual tissue destruction with cirrhosis of the bile ducts and, in the later stages, also to the destruction of the liver cells.

Clinical manifestations

The cholangitis-cholangiohepatitis complex is unspecific. There is weight loss, unwillingness to eat, fever, jaundice and often ascites . Acute phases with signs of systemic illness such as fatigue, anorexia, vomiting (always) and / or diarrhea alternate with clinically inapparent phases in which the animals show a good appetite and general well-being. Hepatomegaly is usually palpable. Hypoglycaemia can occur as cirrhosis progresses.

Investigation methods

The blood count shows a slight, non-regenerative anemia and leukocytosis with a shift to the left . The activities of the liver enzymes ALT , GLDH , γ-GT as well as the content of bilirubin and the total protein in the blood are mostly increased. In symptom-free phases, the liver enzymes are often not changed at all, which makes diagnosis difficult. There is often a hypoalbuminemia .

When sonography numerous hyperechoic areas show up in the liver, if appropriate, an accumulation of bile or gallstones .

An exact diagnosis can only be made by fine needle aspiration followed by a histopathological examination.

treatment

Since infectious causes are also suspected and there is occasionally an inflammation of the small intestine, antibiotics are used , preferably based on an antibiogram on bile samples. Ampicillin , amoxicillin and cefalexin are mostly effective . In the case of pronounced lymphocytic infiltrates, the anti-inflammatory prednisolone is used. If gallstones are present, surgical removal may be indicated. Ursodeoxycholic acid is also beneficial. The use of metronidazole , which also has immunomodulating properties, is also propagated.

A sufficiently long treatment is important: After the acute clinical symptoms have subsided over 3 to 6 months.

literature

• Ingo Nolte and Andrea Meyer-Lindenberg: Liver diseases in cats . In: Small Animal Practice . tape 40 , 1995, pp. 131-142 .

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