Feline biliary tree and gallbladder disease: Aetiology, diagnosis and treatment

Abstract

Practical relevance Diseases of the biliary tree and gallbladder are more common in cats than diseases of the liver parenchyma. The parenchyma is usually affected secondarily to systemic illnesses, while the biliary system is the prime target for infectious agents (eg, bacteria and flukes) and non-infectious conditions (eg, neoplasia and cysts). Clinical approaches Cats with biliary disease are evaluated because of common feline clinical signs such as anorexia, nausea, vomiting and lethargy. Icterus may or may not be obvious. Biopsies for histological evaluation, and bile aspirates for culture and cytological evaluation are helpful diagnostically. Antibiotics and immunosuppressive drugs have been used successfully. Hepatosupportive drugs may help in liquefying thick bile and protecting hepatic tissue from damage. Ultrasound is a noninvasive diagnostic tool that may help in identifying dilated bile ducts, liver cysts and choleliths. It is also used to guide percutaneous bile aspiration. Audience This review, written for all veterinarians who treat cats, describes the various conditions that can affect the feline biliary tree and gallbladder. Treatment options are discussed, and brief summaries provided of surgical techniques and diagnostic approaches. Evidence base The veterinary literature pertaining to feline biliary disease is comprehensively reviewed. When appropriate, data on dogs and humans has been included to provide background information. Based on the available literature, more research into feline biliary diseases is needed.

Hepatorenal Syndrome in Dogs with Experimental Extrahepatic Cholestasis

“…These results are similar to those obtained by Wang and Wei-Feng [27]. Abdominal pain, excessive emaciation and reduced appetite recorded in this study could be attributed to impaired bile flow in the extrahepatic biliary tree and the retention of bile salts in the liver with severe damage of hepatocytes and hepatic dysfunction occurred, these findings agreed with other studies [28][29][30].…”

The cytologic features of biliary diseases: A retrospective study

“…In congenital cystic diseases, the lack of biliary cells in cytologic samples is most likely caused by large cystic structures that comprise the primary lesion and are filled with secretory material and debris, surrounded by a single layer of cells that do not exfoliate. The presence of variable amounts of proteinaceous debris in the background, with small numbers of erythrocytes and rare, normal‐appearing hepatocytes, together with ultrasonographic findings, as previously suggested, 17 are useful in the diagnosis of suspected primary biliary disease. Nevertheless, a histologic examination is necessary for diagnosis 18 mostly to differentiate biliary disease from a cholangioma 19 …”

Feline abdominal ultrasonography: what’s normal? what’s abnormal? The liver

“…The main disadvantage of FNA is the small sample size obtained and the limited diagnostic utility of the technique with regards to inflammatory liver disease, such that it is not considered appropriate for diagnosing lymphocytic cholangitis. 49,51,52 In a report on the accuracy of FNA of the liver in 41 cats, there was agreement between the histopathological results and cytological diagnosis in only 21 (51.2%) cats. 51 A different study highlighted the issue of misleading results from FNA of the liver in four cats; 53 cytology of FNA samples was indicative of hepatic lipidosis in each case whereas histology of tissue samples obtained by Tru-cut or wedge biopsy was consistent with inflammatory or neoplastic disease.…”