Biliary Cirrhosis in Small Animals

Biliary cirrhosis refers to periportal bridging fibrosis associated with marked hepatic architectural remodeling and biliary hyperplasia subsequent to chronic (months) of EHBDO or years of nonsuppurative cholangiohepatitis. However, it is uncommon in cats with cholangitis/cholangiohepatitis, because these animals usually succumb before biliary cirrhosis develops. Biliary cirrhosis is misidentified in cats with ductal plate malformations (a form of polycystic liver disease). Clinical features of biliary cirrhosis include variable inappetence, cachexia, jaundice, variable liver size, and ascites. Liver enzymes may be normal. Hypoalbuminemia, hyperglobulinemia, hyperbilirubinemia, and coagulopathies are common. The liver may be considered large on abdominal radiographs and appears nodular on ultrasonographic evaluation. Biopsies are needed for definitive diagnosis. Coagulation deficits complicate tissue sampling and necessitate vitamin K₁ supplementation and fresh frozen plasma transfusions before procedures. Treatment is symptomatic, requiring management of HE, hypoalbuminemia, EHBDO, and ascites. Prognosis is generally poor. Biliary cirrhosis is most commonly seen in animals with chronic EHBDO caused by obstructive neoplasia. Although cholecystoenterostomy or choledochoenterostomy can avert progression of EHBDO to biliary cirrhosis, it introduces recurrent retrograde infection through biliary structures causing chronic or recurrent septic cholangitis.