Cholangio Hepatitis | Sphynxlair

Cholangio Hepatitis

Discussion in 'Sphynx Cat Questions?' started by EdieSample, Dec 31, 2009.

  1. EdieSample

    EdieSampleLairian

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    Took my cat to the vet today because he was vommiting and not eating on Wednesday.. As soon as I got him into the lighted vet room I noticed immediately that he was jaundice, I told the tech and they started to run blood work. He has been at the vet for about 4 hours now.. They did blood work and an x-ray on him. They said his liver from the x-ray did not look bad but that he had Cholangio Hepatitis, we are still waiting on other blood work. They are currently holding him at the office, he is on IV fluids and is being force fed. The office he is currently at is not 24 hours and they are closed tomorrow so I'm transfering him to a 24 hour emergency clinic in a little while.

    I was just wondering if anyone else had gone though something like this before with their Sphynx, or if they could share their experience or some links to this problem with the Sphynx.

    My cat is 8 months old, just noticed the jaundice today
     

  2. susi794

    susi794Moderator Staff Member

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    Oh dear God--another thing to be terrified of! My prayers are with you. I can't offer anything more than that, as I have never heard of that kind of hepatitis. Hope your baby gets well soon!
     
  3. ilovemysphynx

    ilovemysphynxAdministrator Staff Member

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    So sorry to hear this:ThumbsDown: Sounds like he is in good hands and going to A 24hr vet.
    It sounds good because his liver looks goon in the x-ray, I would think that if they find nothing they will do A liver function test, (they do them on people so I would think they can on A cat). We will cross our fingers and paws that your baby will be ok. Be sure to keep us updated.
     
  4. Mews2much

    Mews2muchV.I.P Lairian V.I.P Lairian

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    Prayers for him to be ok.
    My sisters Bengal was only 8 months whn she lost him to a liver shunt.
    Can you please have the vet check him for that.
    I do not now much about the problem your cat has.
     
  5. admin

    adminAdministrator Staff Member

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    Well I don't know much about this subject and I am sorry to hear about your baby, but I did find this bit of information about the disease:

    [​IMG]


    When the cat’s liver fails there are four conditions that we look to as the most common causes:

    Hepatic Lipidosis (fatty liver)

    Lymphoma (a type of cancer)

    Feline Infectious Peritonitis

    Cholangiohepatitis

    The most common of the above are Hepatic lipidosis, which occurs when a cat, particularly an overweight one, goes for a long period without eating. (Clearly, any condition that causes a cat to lose his appetite could cause hepatic lipidosis as a serious complication.) The next most common cause of feline liver failure is “cholangiohepatitis,” which amounts to a bacterial infection and prognosis is generally fair. The other two common causes carry a much poorer outlook so obviously it is important to distinguish them and this can only be done with some sort of tissue sampling of the liver, ideally a biopsy.

    We will assume that you have already had this procedure done, that you already know your cat has cholangiohepatitis, and that you are looking for more information.

    What is “cholangiohepatitis?”

    The word cholangiohepatitis breaks down into “chol” (bile), “angio” (vessel), hepat (liver) and “it is”(inflammation). Putting this all together means inflammation of the liver and bile ducts.

    You have probably heard of bile ducts but may not really be sure what bile is all about. Bile is a greenish material the liver makes, transports to the gall bladder via small bile ducts. The gall bladder is a small greenish sac about the size of a superball where bile is stored. When the appropriate hormonal signals are present, the gall bladder contracts and squirts bile into the small intestine via one very large duct called the “common bile duct.”

    Bile has several functions. It emulsifies the fat in our diets so that we can absorb it into our bodies. It also serves as a medium to dump toxins that the liver has removed from our bodies and processed so they cannot be reabsorbed.

    This is a fine system but problems can occur when the bacteria that live in the small intestine venture up the bile duct and invade the liver, which is normally sterile (free of bacteria). Inflammation results and the liver can fail.



    What is the connection with Inflammatory Bowel Disease and Pancreatitis?

    In one study, 80% of cats with cholangiohepatitis also had Inflammatory Bowel Disease and 50% also had Pancreatitis. Feline anatomy is a little different from that in other species. In the cat, the pancreatic duct, which delivers digestive enzymes to the intestine, opens into the same “pore” as the common bile duct. Both ducts share a “doorway” to the intestine. This means that if bacteria invade the doorway, both the liver and pancreas are at risk for infection.

    Inflammatory Bowel Disease involves infiltration of the intestinal lining with cells of inflammation. Absorption of nutrients becomes altered which in turn alters the populations of bacterial living in the intestine. An overgrowth of bacteria can occur or more aggressive species of bacteria can take over the area. It is easy to see how the bile duct can become invaded.

    Treatment

    The cat in liver failure will require hospitalization, fluid therapy, and some kind of nutritional support (force-feeding, syringe feeding of a liquid diet or whatever is necessary) regardless of the cause of the liver disease.

    Antibiotics

    Antibiotics are helpful in any liver failure case as they help reduce the intestinal bacterial populations (any noxious substances they produce are normally detoxified by the healthy liver but a sick liver will not be so efficient). Antibiotics also clear the liver of invading bacteria, which is what cholangiohepatitis is all about. Expect the cat to require 3-6 months of antibiotics after recovery.

    Choleretics

    A choleretic is a medication that makes bile more liquid so that it can flow smoothly without sludging. Flow of bile in the proper direction helps remove not only the toxins the liver is trying to remove in bile but also helps prevent bacteria from “swimming upstream” towards the liver tissue. The chief choleretic prescribed for animals is Ursodiol. A cat may well be on this medication for life after an episode of cholangiohepatitis.

    SAMe

    This nutritional medicine has gained tremendous popularity in therapy for all liver diseases and should probably not be left out here. SAMe stands for S-adenosylmethionine. It has several desirable functions but mostly it is an antioxidant, protecting the sick liver cells from the toxins they have absorbed and normally would be excreting in bile.

    Silymarin

    This is the active ingredient in the herbal medication commonly known as “milk thistle.” It has been shown to be protective to the liver in Amanita mushroom poisoning and many have extrapolated that it should be protective to the liver in other toxic scenarios. It be prescribed for cats with cholangiohepatitis.

    Immune Suppression

    This may seen intuitively inappropriate for a condition that involves a bacterial infection, but some patients simply cannot get better until their immune system is suppressed. Why is this? For many cats, the problem started with Inflammatory Bowel Disease: infiltration of the intestinal lining with inflammatory cells. Immune suppression is the cornerstone of therapy for this condition. Once the immune reaction is suppressed, the lining of the GI tract regains normal thickness and function, the bacterial bloom subsides, the invasion of the liver and pancreas ceases. In some cases, immune suppression is simply needed to relieve the inflammation inherent to cholangiohepatitis. Typical medications include prednisone (or prednisolone depending on how severe the liver failure is). More aggressively, chlorambucil, a chemotherapy drug, is used.

    Overall, cholangiohepatitis is one of the more treatable liver conditions of the cat. This does not mean that every cat will recover; some cats are quite advanced by the time they are first seen by the veterinarian. Pancreatitis can represent a lethal complication, depending on severity. The cat that survives the acute episode can expect long term medication administration and the possibility of relapse or flare-up. The owner should become familiar with Inflammatory Bowel Disease and Pancreatitis as well.
     
  6. Maggies mommy

    Maggies mommyV.I.P Lairian V.I.P Lairian

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    O no my fingers r crossed that he will be ok & make a speedy recovery
     
  7. EdieSample

    EdieSampleLairian

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    Thank you for the responses. I just got back from the emergency vet. I spent as much as my baby cost me in vet bills today, and it will probably be much more expensive when we find what the problem is.

    After leaving the first vet I thought it was just the hepatitis problem - but at the E vet she was only telling me about fatal conditions, not even listing anything that could be treated. She said lymphoma, or FIP. I read up on the FIP and my cat isn't showing any of the neurological signs of FIP, and you can't even get a clear diagnosis of that until the cat has already passed. I am trying to not be too concerned about cancer since he is so young, but I know it can happen. His lymph nodes are swollen.

    The bloodwork from the lab should be to the E vet sometime today/tonight, I just hope that it comes back as something treatable, I just don't have a very good outlook on things now.

    They did force feed Ziggy 6ccs of food which he has kept down for a couple of hours now, and he has been on IVs since probably 10am. The E vet is putting him on antibiotics and anti-nausea medication along with the IV fluids.

    I really have no idea what is going on now, the waiting is terrifying
     
  8. admin

    adminAdministrator Staff Member

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    I really feel for you Edie, every one here on Sphynxlair has their fingers crossed for Ziggy! We truly hope he pulls out ok!!!!! just pray and keep him in your thoughts!!!:ThumbsUp:
     
  9. Mews2much

    Mews2muchV.I.P Lairian V.I.P Lairian

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    FIP was mentioned with TY also.
    It was a liver shunt though.
    Have them check for that.
     
  10. gizmo6370

    gizmo6370Banned

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    I hope that the vet can help your baby....keep my fingers crossed that he soon will be doing better.....
     
  11. PitRottMommy

    PitRottMommyBanned

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    That's actually not true. FIP doesn't have to show any signs at ALL to cause internal problems. In fact, that's usually where the problems start. And there's two different forms, neither of which act the same. And running a corona PCR may not diagnose FIP but it can RULE IT OUT. When trying to test for FIP, all the PCR test can tell you is IF the cat has been exposed. For diagnosis, it's really not all that helpful. However, if the PCR test comes back negative, FIP has been ruled out because FIP is caused by a corona virus. You can use it diagnostically, but it may not work one way where it does the other.

    I think this bears asking, have you contacted your breeder? This age of cat is very young for cancer (lymph node swelling can be anything from stress to infection or, of course, cancer). At this age, lymphoma should be at the very bottom of the list of rule outs. FIP would top my list. And I'd certainly want to be in contact with my breeder about something of this magnitude being diagnosed in such a young cat.

    Another question, when did he start feeling unwell? You said Wednesday, but you didn't say "yesterday". Was it yesterday or was it a week ago that he started feeling ill? Hepatic lipidosis can set in within 48 hours of a cat not eating a normal meal. This is precisely why your vet is now force feeding your companion, so the liver doesn't become any worse in condition than it already is.

    If this turns out to be something other than FIP (or even early-age cancer), I urge you to discuss using SAM-e and milk thistle with your vet. A baby this young already in liver compromise, sadly, doesn't leave a long-life prognosis ahead of him, and even shorter of time if his liver isn't functioning with some regularity pretty quickly. Many pets add months to years of life to their life expectancy with these medications.

    Keep us posted!
     
  12. susi794

    susi794Moderator Staff Member

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    Am praying for you both.
     
  13. lemmysmommy

    lemmysmommySenior Lairian Senior Lairian

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    Sending prayers to you and Ziggy. I hope that you find out the real problem fast and that is treatable. I know how it feels when your cat is sick. The waiting can sometimes be the hardest part. Keep us updated.
     
  14. EdieSample

    EdieSampleLairian

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    I think this bears asking, have you contacted your breeder? I have contacted my breeder, I e-mailed her immediately after getting home from the e-vet, she is a very unreliable person I have come to find and I do not expect to be hearing back from her at all, or at least for about 2-3 weeks since that seems to be how long it takes for her to get around to responding to me. I asked if she has dealt with this in the past or if any of her other cats have had an issue that would help me and my vets understand what is going on.

    Another question, when did he start feeling unwell? He was only vomiting Wednesday, but he was a little lethargic two days prior to the vomiting but still eating for me. I work for an equine vet and her husband does small animal, they were out of town so I figured since he did not have a temp and he was still eating for me that I could wait until they got back in town for him to be seen. On Wednesday he was vomiting, but not vomiting food, only what looked like water and a really mucusy bubbly vomit. I called the vet that day and had the appointment set for first thing Thursday morning, which just happened to be the first day my vet was back in town. I did talk to a vet on the phone that evening and she did say that it sounded like something that could wait until the morning since it just started that day and I wasn't getting a high temperature on him at home. The morning I went to the vet is when I noticed the jaundice and informed the tech that was examining him, I did not notice the jaundice prior to Thursday morning.



    There is good news though - I got a call at 7am from the e-vet and they said he was ready to go home. He had eaten twice on his own for them and as soon as I got him home he ate for me, used the bathroom, drank water, played with one of my other cats for a min. then went to his favorite blanket to lay down. He is acting like himself now, but is still jaundiced. The vet said it will take time for that to clear. He is going to our regular vet again tomorrow now that he is stable so we can figure out what exactly caused him to be sick. It really wasn't noticeable that anything was wrong until Wednesday when he was vomiting and Thursday morning at the vet after the jaundice had set in. My vet said that it was a good sign that he made a turn around like that so quickly, but since we still do not know what caused it yet I'm not going to get my hopes up. He is staying in my bedroom now by himself (away from the other cats at least), he has his own litter box so I can know when and how many times he is using the bathroom and I'm keeping an eye on how much he is eating and drinking. He is on clavamox right now.

    I will post more on his condition as I find things out, right now we are thinking it is digestion related but I haven't had a real chance to talk things though with the vet because yesterday was so hectic and unexpected.
     
  15. EdieSample

    EdieSampleLairian

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    Bad news again.. Ziggy went for his re-check this morning and I knew as soon as I woke up he would be back in the emergency vet. I just dropped $3,000 on him for him to stay at the e-vet until Tuesday. The internist will be back in town Monday and they will be doing an ultrasound on his internal organs and hopefully since this is an internal problem that vet can give me a better idea of what the problem is.

    Ziggy did have a fecal done 2 months ago, there were fat droplets in the sample I brought in and the vet said he wasn't digesting fat properly.. we put him on a sensitive stomach formula and his stools appeared to be getting much much better but they still were not looking completely normal compared to my other cats. I brought this up with the vet today since I know digestive issues can sometime lead to the problems he is having so they are looking into that as well.

    I had $4,000 in savings and that is gone now, my mom is going to help me with the bill we will end up with after the internist sees Ziggy and I'm getting a second job to help build up more money in case he is going to have to undergo more treatments or tests. I'm doing everything I can for him, I'm not sparing any expenses, I haven't turned down anything the vets have offered and I am close with my boss (equine vet) who is married to my cats regular vet so we have been keeping in contact though texts and phone conversations and they are keeping on top of things as well since he is seeing about 5 vets at this time. I don't know what else I could possibly do for him, he is in the hands of the emergency vets and techs now and I just hope he feels better once he gets back on the IVs and then we can find out what is causing these problems. The IVs helped him greatly yesterday, he was acting 100% like him self again so I just want him to be comfortable until we know what is wrong with him.

    Thanks for the kind words everyone
     
  16. susi794

    susi794Moderator Staff Member

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    OMG--that baby is very lucky to belong to you. God bless you for all you're doing for Ziggy. I will remember you both in my prayers and hope they can find out what's wrong and help him. I feel so terribly sorry about what you're going through. Good luck and please keep us posted.
     
  17. PitRottMommy

    PitRottMommyBanned

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    EdieSample,
    I'm sorry to hear about Ziggy. I read your initial response of him being ready to go home and nearly came out of my chair. Then you mentioned that he was ill again and back in the hospital, which is precisely what I was going to include in my response. I'm so sorry he's not doing well. As you're likely going to hear over the next few days, he truly needs to be in the hospital on fluids for the time being. The fluid itself is going to help flush the yellow buildup in his system that's making him yellow, bilirubin.
    It sounds like Ziggy truly had about 3 days worth of not feeling himself. This, itself, could have led to the hepatic lipidosis state. In addition, he was already predisposed for this because his liver isn't processing fats normally. For him, 24 hours of not eating could very well have sent him into liver compromise (or even liver failure).
    Emergency care is awesome, IMO and IME. It's much more specialized and prepared for big problems like those involving the liver. I pray that a specialist (or a veterinarian with a particular affinity for these type of cases) sees Ziggy and gets him quickly on the road to recovery. Many people spare expenses with their pets, I personally do not and I commend you highly for meeting this adversity forefront and getting a second job to care for your little man. This is precisely the route I wish 100% of owners would take. I hope that your efforts are paid back ten-fold.
     
  18. EdieSample

    EdieSampleLairian

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    PitRottMommy..

    Thank you. I too knew the risks of having him home so soon, I was nervous about it but they did not want to keep him there and he went in to my normal vet first thing the next morning where they immediately sent me back to the e-vet. He was at home with me yesterday from 9am-10am the next day.. He was acting 100% his normal self from 9am-4am then I noticed he was starting to become more lethargic again (I slept only for one hour last night and he slept right next to me). I'm glad they have decided to keep him for a longer time, which is what I thought they were going to do the first time. We just got back from the e-vet, I visited him tonight.. he is still very lethargic but he is on fluids constantly and they are microwaving rice bags and water bottles to keep the heat in his kennel up so he isn't expending more calories trying to stay warm. He crawled into my sweater and fell asleep on me for 15 mins. there, I wish I could have stayed there all night with him. I am going to call the vet tonight at 1am.. they are offering food every 4 hours and if he hasn't eaten then he should be force fed at midnight so I am going to call at 1 to see if he ate on his own or if he was force-fed, and if either happened I want to know if he has kept it down. They did say he vomited once earlier today and they put him back on the anti-nausea medication which helped him eat last time he was at the vet.

    The digestive issues he had are a huge concern for me since that is the only other problem he has ever had and he never fully cleared it, I brought this up with the vet today and I will continue to bring it up with each new vet we see, especially the internist. I will be visiting him two times tomorrow as well to keep an eye on what they are doing and how he is progressing. I will post more as I see what happens.
     
  19. susi794

    susi794Moderator Staff Member

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    Here! here! Well said, PitRittMommy!
     
  20. Mews2much

    Mews2muchV.I.P Lairian V.I.P Lairian

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    I sure hope he feels better soon and they can figure outwhat the problem is.
     
  21. ilovemysphynx

    ilovemysphynxAdministrator Staff Member

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    What A roller coaster ride. Things like this stink but I also think they are given to the people that can handle them and it sounds like you are doing a great job. Wishing the best for your baby!
     
  22. PitRottMommy

    PitRottMommyBanned

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    Edie,
    Without having a full run of diagnostics and a full history (better obtained in person), I won't be able to help heavily with food recommendation. I can tell you that rabbit (raw rabbit is my favorite) is very low in fat. Your vet probably prefers Hill's, but start doing research now. Meeting with a specialist will probably be your best effort. I'm praying for your little man :)
     
  23. EdieSample

    EdieSampleLairian

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    Just got back from the vet.. They couldn't find anything on the ultrasound but he has improved greatly by being on the anti-nausea, and IV fluids and IV antibiotics (His lymph nodes have gone down in size on antibiotics so they are ruling out lymphoma). I am bringing him home tomorrow and keeping in on Clavamox, and we are going to put him on milk thistle and sam-e and the a/d prescription diet. I know what to look for when he gets home as far as him becoming sick again is concerned. We are hoping this was all just an diet issue since he was FIV/FeLV/FIP neg and now lymphoma isn't an issue.

    I should know more tomorrow when we talk to the doctor again, I just want to make sure I'm prepared for everything when he gets home. They can't think of anything else to do with him as far as testing is concerned so a diet change is the next step for him. He was great today when I visited him, had a full belly of food and wanted to play the whole time. I hope it keeps going up from here.
     
  24. Brooke

    BrookeBanned

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    Fingers crossed!
     
  25. gizmo6370

    gizmo6370Banned

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    Here also fingers crossed :ThumbsUp: