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Liver: cholangiohepatitis
Introduction
- Infrequent sporadic cause of acute hepatic failure; chronic form also identified.
- Cause: disease leading to inflammation of the biliary tract and liver.
- Signs: mild, recurrent colic; inappetence, icterus, depression, hepatic encephalopathy, pyrexia. Weight loss and ventral edema in chronic form.
- Diagnosis: clinical pathology, hepatic ultrasonography, liver biopsy.
- Treatment: antimicrobial therapy, dietary change and fluid therapy.
- Prognosis: depends on biopsy findings; poor if hepatic encephalopathy present.
Presenting signs
- Recurrent colic Abdomen: pain – adult.
- Inappetence.
- Depression.
- Weight loss Weight loss: overview.
- Fever.
- Icterus Liver: icterus.
- Signs consistent with hepatic encephalopathy including altered mentation Liver: hepatic encephalopathy.
Geographic incidence
- Worldwide.
Cost considerations
- Cost of treatment.
Pathogenesis
Etiology
- Occurs secondary to biliary stasis.
- Suspected ascending bacterial infection from small intestine: enteric gram-negative rods usually implicated Liver: cholangiohepatitis – septic:
- Esherichia coli Escherichia coli.
- Salmonella spp Salmonella spp.
- Acinetobacter spp.
- Anaerobes.
- Usually associated with cholelithiasis.
- Also associated with large colon displacements and obstructive hepatic neoplasia in adult horses and duodenal ulceration in foals.
Predisposing factors
Specific
- Diseases associated with biliary stasis.
Pathophysiology
- Inflammation/infection of biliary tree (cholangitis) → fever.
- May extend to periportal region of liver (cholangiohepatitis Liver: cholangiohepatitis – septic).
- May result in formation of sludge within biliary tract and/or biliary calculi.
- Calculi are predominantly calcium bilirubinate and calcium phosphate.
- Biliary obstruction/hepatic enlargement → colic.
- Biliary obstruction → jaundice and photosensitivity.
- With chronic disease, significant periportal and bridging fibrosis occurs.
- See Liver disease: overview.
Diagnosis
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Treatment
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Peek S F (2004) Cholangiohepatitis in the mature horse. Equine Vet Educ 16 (2), 72-75 VetMedResource.
- Peek S F & Divers T J (2000) Medical treatment of cholangiohepatitis and cholelithiasis in mature horses – 9 cases (1991-1998). Equine Vet J 32 (4), 301-306 PubMed.
- Reef V B, Johnston J K, Divers T J et al (1990) Ultrasonographic findings in horses with cholelithiasis: eight cases (1985-1987). JAVMA 196 (11), 1836-1840 PubMed.
Other sources of information
- Mair T S & Divers T J (2017) Diseases of the Liver and Liver Failure. In: The equine acute abdomen. 3rd edn. Eds: Blikslager A T, White N A, Moore J N & Mair T S. John Wiley & Sons Inc. ISBN 9781119063216.
- Barton M H (2004) Disorders of the Liver. In: Equine Internal Medicine. 2nd edn. Eds: Reed S M, Bayly W M & Sellon D C. W B Saunders, USA. ISBN: 0721697771.
- Rose R J & Hodgson D R (1999) Manual of Equine Practice. 2nd edn. W B Saunders, USA. ISBN: 0721686656.
- Divers T J (1997) Hepatic Disorders. In: Current Therapy in Equine Medicine. 4th edn. Ed: Robinson N E. W B Saunders, USA. ISBN: 0721626335.