Canine Cholangiohepatitis

Cholangiohepatitis in dogs is rare and usually associated with suppurative inflammation and ascending biliary tree infection with a wide variety of bacterial organisms (both gram-negative and gram-positive enteric bacteria, Salmonella, Campylobacter jejuni, coccidiosis). Canine cholangiohepatitis is most commonly associated with disorders causing stasis of bile flow, biliary mucocele formation, cholelithiasis, and surgical manipulations of the biliary tree. Clinical signs include anorexia, vomiting, diarrhea, lethargy, PU/PD, fever, and abdominal pain.

Laboratory abnormalities are consistent with hepatic cholestasis and include hyperbilirubinemia and increased activities of ALP, GGT, and transaminases. Ultrasonography may or may not reveal abnormalities involving the biliary tree or gallbladder. In some cases, a coarse hepatic echogenicity is identified, reflecting portal tract inflammatory infiltrates and connective tissue. In some cases, ultrasonographic findings may indicate need for emergency surgical intervention (eg, mature gallbladder mucocele, cholelithiasis associated with EHBDO). Aspirates or impression smears of liver or bile may reveal suppurative septic inflammation. Samples collected from liver, bile, and sections of the biliary tree should be submitted for aerobic and anaerobic culture and sensitivity. Antibiotic treatment should be based on cultured organisms, and other treatments should target underlying disease processes. Initial treatment with combination of ticarcillin, metronidazole, and enrofloxicin is commonly used before culture and biopsy results are available. For best outcome in animals undergoing surgery, antimicrobials should be started before the surgical procedure.