Anyone experienced w/ Cholangiohepatitis and non-anorexic fatty liver?

MissClouseau

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Happy weekend, everybody. I hope all is well.

If you saw my other thread (this), when I took Hima for her annual check-up last April her ALT came 800. 8 times higher than normal range. That month it went down to 500s after only a dewormer and adding a mild milk thistle-curcummin supplement. It's been going down since but it's still in 400s. Throughout the whole process she had no symptom other than tummy ache after meals or grooming herself, and excess saliva.

Ultrasound showed no tumor, no organ size change, nothing except for mild fat around the liver and inflammation on gallbladder-liver. She was diagnosed with Cholengiohepatitis and (mild) fatty liver. The reason is unknown but Hima was hospitalized the first days of 2019 after not eating for 3-4 days. Maybe it's a chronic inflammation from that time? Or maybe there is something about parasites or food sensitivity? Hima is not overweight, so it's not weight.

She was seen by two internist and her regular primary vet. But they actually confused me a lot because not only their machines measured Hima's enzymes differently but also even their prescription is different. One added only antibiotics for 10 days + Vet Expert Hepatiale Forte Advanced 30 tablets . The other says this is not enough, antibiotics should be used for 20 days, and ursodeoxycholic acid should be added too.

If you have experience with non-anorexic fatty liver, and cholangiohepatitis without anorexia/puking, etc, could you share your experience? What kind it was? Could you find the reason? How was it treated?
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FeebysOwner

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Hi. I was waiting to see if someone with 'real' knowledge/experience would respond, but since they haven't yet, I'll ask my very uninformed question. Did they talk about what form of Cholengiohepatitis Hima has? As I limitedly understand there can be two different types - but to distinguish between the two a liver biopsy might be required (done via needle aspiration, I believe).

The Supurrative type (not joking about that title btw) "is bacterial infection, probably initiating in a nearby area of a cat’s gut—the pancreas or small intestine, for example—and then traveling up the biliary tract. This tends to cause inflammation of neutrophilic cells, which the body recruits to fight bacteria.” This form of infection—referred to as suppurative (pus-forming)—tends to respond positively to antibiotic therapy..."

Non-Suppurative - "which is more common, is an immune-mediated phenomenon affecting cells called lymphocytes. These cases tend not to respond to antibiotics...treat this type...with immunosuppressive drugs, such as steroids..."

I know you do your homework, and do it well, so you may already be aware of the differences. The odd thing, as you have pointed out, is that both types tend to have similar symptoms that Hima does not have, if I have understood your posts correctly (loss of appetite, vomiting, fever, jaundice).

Not knowing your exact internet access to varying sites, I have attached two documents about these conditions just in case you haven't already seen them.
Cholangiohepatitis | Cornell University College of Veterinary Medicine
Cholangitis/Cholangiohepatitis Syndrome in Cats | VCA Animal Hospital (vcahospitals.com)

I am not helping with your questions, but was hoping there was additional information in these documents that go above and beyond what you already know.
 

fionasmom

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I absolutely do not know any more about this than what was already explained. It seems to me that the vets treating Hima feel that it must be the first kind of condition since they are using antibiotics. I would ask them if they agree on that or if it is a guess or the usual starting point. Since the ultrasound was clear, fortunately, the next step is the biopsy if you want to go in that direction.
 
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MissClouseau

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Did they talk about what form of Cholengiohepatitis Hima has? As I limitedly understand there can be two different types - but to distinguish between the two a liver biopsy might be required (done via needle aspiration, I believe
Thank you FeebysOwner FeebysOwner and fionasmom fionasmom . I believe they don’t know if it’s suppurative or non-suppurative. Neither the internist nor the primary vet seems concerned what type it is. In the veterinary book I have there are actually three types. Neutrophilic, Lymphocytic, and the third is “Chronic, Fluke associated.” Interesting thing is to treat the Fluke associated the book says Praziquantel is given. And Hima’s ALT began to go down after praziquantel dewormer back in April. Although we don’t know what it was like in, say March. Maybe in March her ALT was even higher but somehow started to go down so it didn’t start after the dewormer. :gaah:


The odd thing, as you have pointed out, is that both types tend to have similar symptoms that Hima does not have, if I have understood your posts correctly (loss of appetite, vomiting, fever, jaundice
The internist said Hima’s temporary tummy ache after meals and increased saliva are her symptoms and that there isn’t always necessarily more symptoms at early-mid stages of the condition.
🤷‍♀️ I’m very confused too!
 

FeebysOwner

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“Chronic, Fluke associated.” Interesting thing is to treat the Fluke associated the book says Praziquantel is given.
Is this what you meant by 'fluke'?
"Praziquantel is used to treat infections caused by schistosoma and/or liver flukes (worms), which enter the body through skin that has come into contact with contaminated water. Schistosoma worms are found in Africa, South America, Middle Eastern countries, the Caribbean, and parts of Asia."

It says the liver flukes live in or near the liver. I found this when searching the meds for humans. The article also talks about precautions in humans who are taking nutritional and/or herbal supplements, as well as certain meds.
Praziquantel: MedlinePlus Drug Information
So, are the vets, perhaps suggesting Hima has some sort of liver damage from flukes?
 
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MissClouseau

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Is this what you meant by 'fluke'?
"Praziquantel is used to treat infections caused by schistosoma and/or liver flukes (worms), which enter the body through skin that has come into contact with contaminated water. Schistosoma worms are found in Africa, South America, Middle Eastern countries, the Caribbean, and parts of Asia."

It says the liver flukes live in or near the liver. I found this when searching the meds for humans. The article also talks about precautions in humans who are taking nutritional and/or herbal supplements, as well as certain meds.
Praziquantel: MedlinePlus Drug Information
So, are the vets, perhaps suggesting Hima has some sort of liver damage from flukes?
Sorry for the late reply, I missed the notification.

The vets didn’t mention anything about liver flukes or another parasite. I specifically asked the internist if the problem could be about intestinal worms and she said no. I told her Hima hunts lizards and rarely rats despite never eating them, she didn’t make a comment there either. :ohwell:
 

FeebysOwner

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I specifically asked the internist if the problem could be about intestinal worms and she said no.
The thing is that liver flukes do not live in the intestine, they thrive in the liver or surrounding tissue. The parasitic meds referenced above can kill them, but I still believe from what I have read they can do damage to the liver, as well as 'mess' with bile production.

A bunch of articles that I found in case anything at all rings a bell with you, or gives you any other ideas on possible treatments that haven't been tried with Hima. I am only 'stuck' on this because of the use of the term you referenced - “Chronic, Fluke associated”.
Liver Fluke Infestation in Cats | PetMD
Cat Liver Fluke Treatment (vetinfo.com)
Liver Flukes in Outdoor Cats (acupetvetcare.com)
Liver Fluke Infestation in Cats - Symptoms, Causes, Diagnosis, Treatment, Recovery, Management, Cost (wagwalking.com)
 
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MissClouseau

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I don’t know where to write updates so I’ll just do here. I don’t think Hima is doing better after the antibiotics. She was on Synulox 9-18 October. She’s still playful, eats, even gets zoomies for a bit, but... Her short-term but frequent abdominal ache is the same. Excess saliva is the same. Since 28th September she puked a little amount of yellow bile at least 3 times that I saw and she’s not a puker. Two of them were minutes after a meal.

Her primary vet has prescribed something close to Denamarin, from another brand. It went well the first 3 days with pill pockets. Since, Hima completely rejects it. She won’t even eat Pill Pockets without a pill in it anymore. I tried coating it with greenies but nope. I’ll try different methods soon but for now I give her two different supplements that contain milk thistle. I don’t know what else to do.

The internist who saw her had told me ursodiol should be added to her prescription, primary vet said not necessary. I think I will just add it and not tell the primary vet.

I spent several thousands the past two weeks alone and I’m not even sure of Hima’s liver-gallbladder enzymes as the two clinics showed a very different picture. I try to not get overwhelmed but it’s getting difficult. Here’s to hoping I can post good updates next!
 

fionasmom

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I wish I had something definitive to say that would help, but I think you are really doing the best you can with the information that you have been given and I hope that you get some results.
 
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MissClouseau

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I wish I had something definitive to say that would help, but I think you are really doing the best you can with the information that you have been given and I hope that you get some results.
Thank you very much💜
 

FeebysOwner

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The internist who saw her had told me ursodiol should be added to her prescription, primary vet said not necessary. I think I will just add it and not tell the primary vet....I spent several thousands the past two weeks alone and I’m not even sure of Hima’s liver-gallbladder enzymes as the two clinics showed a very different picture.
Thanks for the update. Did you ask your vet why they disagree with the internist - just for clarification?

I take it the two different enzyme readings were one from your regular vet and the other from the internist? Did the internist review the readings from your vet? Might not hurt to check that out and see what they say. Were they by chance processed by different labs, and if so, were the ranges parallel between the two?

I suspect you've probably already checked all this out, but it never hurts for someone else to come along and ask, just in case you didn't. Everyone here should be a bit more 'objective' than you might be given it is your cat that you are worrying about. I know that has skewed my thought process a few times with Feeby!
 
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MissClouseau

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Did you ask your vet why they disagree with the internist - just for clarification?
Primary vet prescribed the Denamarin-like medicine above and thinks this takes care of Cholangiohepatitis. She said she would prescribe ursodiol if there was stones/bile sludging but there was neither at the ultrasound. Internist says ursodiol should be given on this case too
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I take it the two different enzyme readings were one from your regular vet and the other from the internist? Did the internist review the readings from your vet? Might not hurt to check that out and see what they say. Were they by chance processed by different labs, and if so, were the ranges parallel between the two?
They both believe the other is wrong! According to the primary vet’s in clinic machine Hima only has ALT high. Internist’s machine showed all liver enzymes high, even jaundice with 2,2 bilirubin. Primary vet says if Hima had 2,2 bilirubin her skin would be yellow. And it wasn’t. I brought that up to the internist too and she says the skin color doesn’t necessarily change until 4-6 bilirubin. I asked a third vet and he says bilirubin is probably not as high as 2,2 with her skin being pink, but he also doesn’t think out of all liver enzymes and gallbladder GGT, *only* ALT would be high with Cholengiohepatitis like the primary vet’s machine always showed. See my frustration?

I suspect you've probably already checked all this out, but it never hurts for someone else to come along and ask, just in case you didn't
I very much appreciate your support. I’m glad Hima has more than just me 💜
 
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FeebysOwner

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See my frustration?
:thud:No kidding!! Just to commiserate, I had 2 vets and one specialist that couldn't agree about Feeby either - although not as much mystery in her case as there is with yours. I guess that is when you have to go with your own gut and what makes the most sense to you. But, it is - to be sure - frustrating.
 
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MissClouseau

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:thud:No kidding!! Just to commiserate, I had 2 vets and one specialist that couldn't agree about Feeby either - although not as much mystery in her case as there is with yours. I guess that is when you have to go with your own gut and what makes the most sense to you. But, it is - to be sure - frustrating.
I know you had one vet getting retired in the middle of everything too ugh. Good luck to us both really.
 
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