Cholangiohepatitis, Chronic, and Biliary Fibrosis

Cholangiohepatitis, Chronic, and Biliary Fibrosis



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Definition


Cholangiohepatitis is an inflammatory process of the walls of the bile ducts and the adjacent liver parenchyma. A bacterial infection (primary or secondary) is a common component of cholangiohepatitis, which frequently presents with biliary stasis and sometimes cholelithiasis. With chronicity, ongoing inflammation triggers the onset and progression of liver fibrosis.



Epidemiology



Risk Factors




• Gastroduodenal ulcers and duodenal strictures in foals.


• Anterior enteritis in adult horses.


• Enterocolitis.


• Cholelithiasis.


• In a case series of cholangiohepatitis in horses, broodmares were overrepresented, but the low number of subjects in the study did not allow making an association. In human medicine, pregnancy (and particularly the cholestatic effect of estrogens) is suspected to predispose to biliary tract diseases.


• Sepsis in neonatal foals.



Associated Conditions and Disorders




• The form of chronic active hepatitis characterized by neutrophilic infiltration, cholangitis, and cholestasis is consistent with chronic cholangiohepatitis.


• Cholelithiasis, defined by the presence of calculi within the biliary ducts, is commonly accompanied by cholangiohepatitis and biliary fibrosis.


• Bacterial hepatitis.



Clinical Presentation



Disease Forms/Subtypes




• Most commonly subtle and gradual in onset


• Manifestation of clinical signs can be acute



History, Chief Complaint


Depressed mentation, inappetence, weight loss, signs of abdominal discomfort, loose stools



Physical Exam Findings




• Fever.


• Icterus.


• Dehydration.


• Colic or diarrhea may be directly related to cholangiohepatitis or may be secondary to an underlying gastrointestinal disease.


• Signs of hepatic failure (photosensitization, mucosal petechiation, hepatic encephalopathy) are less commonly present.



Etiology and Pathophysiology




• The most common isolates are enteric bacteria:


• Gram negative: Salmonella spp., Escherichia coli, Enterobacter spp., Citrobacter spp., Actinobacillus spp.

• Anaerobes: Bacteroides spp.

• Hypotheses of pathogenesis:


• Bacterial infection ascends the bile ducts from the lumen of the small intestine and is secondary to any condition that is associated with cholestasis (eg, right dorsal colon displacement, anterior enteritis, enterocolitis, duodenal stricture in foals).

• Bacterial translocation of intestinal microorganisms into the blood stream drained by the portal vein with secondary bacterial infection of the portal triad and cholangitis.

• Cholelithiasis: Bilirubin precipitates with calcium, forming calcium bilirubinate, with secondary bile stasis, cholangitis, and bacterial infection. However, it is more likely that choleliths may be a consequence, rather than a cause, of chronic cholangiohepatitis.

• Hematogenous spread secondary to septicemia in neonatal foals.
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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Cholangiohepatitis, Chronic, and Biliary Fibrosis

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