Cholangiohepatitis -elevated Liver Enzymes - Help???

[Bentley1960]

I have been going back and forth to the vet since august and Winston, my 11 year old bi-color ragdoll, has had a liver biospy (needle aspiration) and was diagnosed with cholangiohepatitis, but we've been treating him since september with antiobiotics and the liver enzymes continued to rise and then his bilirubin got high and he was jaundiced, had to be hospitalized for 3 days, back on antiobotics and Denamarin (his liver enzymes came down, but not as much as vet hoped; his bilrubin and other enzymes came down, but then after Christmas started to rise again and my Vet said at that time she didn't know what to do as he was acting normally, eating, playing etc. So I took him to specialist and the physical exam showed he had loss of lean body mass and the spleen felt enlarged so they did another ultrasound, fine needle aspirates of both the liver and spleen, x-rays, blood panel etc. and nothing jumped out at them. They suggested possibly a liver biopsy that would be surgical but I've put him through so much and the cost is somewhat prohibitive....I've aready spent more than $3,700 to date and I asked if there was another alternative for fear that opening him up would be invasive and may not provide us with any more information. Specialist was very understanding and said we could try medical management so Winston take 1 1/2 pill of amoxicillian in morning and at night, 1 zeniquin in the morning along with his denamarin. At night I also give him urdosial (another liver supplement) and 200 mgs of vitamin E. He was doing okay, but now he doesn't want to eat as much and he hides when I need go give him his pills, which I am used to - but he seems worse with the medications rather than better? I will call my specialist but was wondering if anyone out there has had issues with antibiotics causing them not to want to eat? Love love my little guy and do not want him to be in any distress. Any thoughts on this would be helpful or perhaps if anyone has been through this type of situation. Would love to hear from you all!

 

[furmonster mom]

I can only relate my own experience with managing my angel-kitty Pippen's liver disease for most of his life.

Quick background:
When Pippen was 4 years old, he suffered from a double bacterial infection in his liver, which caused scarring. Not only was there a bacterial infection, but his bile was running in reverse, backing into the liver and continuing with damage.
We managed his condition for 10 years.

• First, we fought the infections with antibiotics. This was rough, because one of those bacteria was resistant and it took several rounds of various antibiotics to combat it.
• Second, we treated the bile issue with Ursodiol, which, as you mentioned is also a support for the liver.
  
• Third, we supported the liver with Milk Thistle (silymarin) and S-Adenosyl (sam-e). When Pippen didn't respond as well as we would have liked, I consulted my vet, and I gave him a higher dose than the veterinary prescription. I basically found the cleanest (no additives) supplements I could find, and gave him 1/8 of a human dose.
  
• Lastly, after doing a LOT of research, we switched to a raw food diet.

I'm not gonna kid you, here. The age of your cat is a factor. Pippen was very young and otherwise healthy when we started this lifetime regimen. Eventually, Pippen's liver couldn't keep up anymore, it was in a state of constant re-growth, and it literally got too big. Still, I'm grateful to have had him in our lives for those 10 extra years.

 

[Furballsmom]

I'm glad you're here. My Big Guy had elevated liver numbers as well. Admittedly nowhere near the urgency, but still, in my opinion part of the idea is to try and make it so the liver doesn't have to work as hard. The vets were no help on either point as to what caused it or how to address it ...so, here's what I did. I got rid of nearly all the food (wet and dry) that has menadione in it. I added store bought raw to his diet, I started him on Milk Thistle (as furmonster mom mentioned clean supplements), I got a water filter for my kitchen faucet. I tried goat milk but he said no go. If I were you I'd listen to my instincts and be really alert to the no-eating. Are you to the point you need to try tuna juice and such not as additives to entice your boy to eat? In any case, I'm not sure if or how any of my actions/reactions help. I seem to recall threads here mentioning medications apparently causing appetite issues. Poor Winston, poor you - our thoughts are with you!!

 

[Bentley1960]

I can only relate my own experience with managing my angel-kitty Pippen's liver disease for most of his life.

Quick background:
When Pippen was 4 years old, he suffered from a double bacterial infection in his liver, which caused scarring. Not only was there a bacterial infection, but his bile was running in reverse, backing into the liver and continuing with damage.
We managed his condition for 10 years.

• First, we fought the infections with antibiotics. This was rough, because one of those bacteria was resistant and it took several rounds of various antibiotics to combat it.
• Second, we treated the bile issue with Ursodiol, which, as you mentioned is also a support for the liver.
  
• Third, we supported the liver with Milk Thistle (silymarin) and S-Adenosyl (sam-e). When Pippen didn't respond as well as we would have liked, I consulted my vet, and I gave him a higher dose than the veterinary prescription. I basically found the cleanest (no additives) supplements I could find, and gave him 1/8 of a human dose.
  
• Lastly, after doing a LOT of research, we switched to a raw food diet.

I'm not gonna kid you, here. The age of your cat is a factor. Pippen was very young and otherwise healthy when we started this lifetime regimen. Eventually, Pippen's liver couldn't keep up anymore, it was in a state of constant re-growth, and it literally got too big. Still, I'm grateful to have had him in our lives for those 10 extra years.

I have been going back and forth to the vet since august and Winston, my 11 year old bi-color ragdoll, has had a liver biospy (needle aspiration) and was diagnosed with cholangiohepatitis, but we've been treating him since september with antiobiotics and the liver enzymes continued to rise and then his bilirubin got high and he was jaundiced, had to be hospitalized for 3 days, back on antiobotics and Denamarin (his liver enzymes came down, but not as much as vet hoped; his bilrubin and other enzymes came down, but then after Christmas started to rise again and my Vet said at that time she didn't know what to do as he was acting normally, eating, playing etc. So I took him to specialist and the physical exam showed he had loss of lean body mass and the spleen felt enlarged so they did another ultrasound, fine needle aspirates of both the liver and spleen, x-rays, blood panel etc. and nothing jumped out at them. They suggested possibly a liver biopsy that would be surgical but I've put him through so much and the cost is somewhat prohibitive....I've aready spent more than $3,700 to date and I asked if there was another alternative for fear that opening him up would be invasive and may not provide us with any more information. Specialist was very understanding and said we could try medical management so Winston take 1 1/2 pill of amoxicillian in morning and at night, 1 zeniquin in the morning along with his denamarin. At night I also give him urdosial (another liver supplement) and 200 mgs of vitamin E. He was doing okay, but now he doesn't want to eat as much and he hides when I need go give him his pills, which I am used to - but he seems worse with the medications rather than better? I will call my specialist but was wondering if anyone out there has had issues with antibiotics causing them not to want to eat? Love love my little guy and do not want him to be in any distress. Any thoughts on this would be helpful or perhaps if anyone has been through this type of situation. Would love to hear from you all!

 

[Bentley1960]

Thanks everyone for your responses with regards to my "Winston". He is doing okay - still taking his meds and he goes back to the Specialist Vet on February 6th. I don't want to make any rash decisions until I take him back again on the 6th. It is funny because last night was a really good one....he was a little trooper with his meds (no throw up in 2 days) and he played more last night. His ears now have some brownish stuff in them, but I don't believe it is ear mites (he doesn't seem at all bothered by it) - called my regular vet and they said get ear cleaner from Pet store and wipe them out and if it continues we can schedule an appointment. This seems to be a day by day situation for me and my boy. I apologize I did not get back to all of you sooner.....hugs to all!

 

[walterandjuniper]

I just found this thread because I'm basically going through the same thing with my 10 year old walter! It's been going on since last July. He started being very picky about eating and was diagnosed with pancreatitis (at the same time his diabetes returned- which had been in remission for 4/5 years). We treated that supportively and things did not get better. Then he underwent dental surgery (thinking bad teeth could be causing the bad appetite). Then, all his liver values began to climb and he turned yellow. We tried a round of a antibiotics (clavamox) which made him nauseas all the time, so he was also on appetite stimulants & anti nausea. The antibiotics didn't work, so we had an ultrasound done. They suspected blocked bile ducts and started Ursodiol and denamarin. He was very good about eating the pills for a while and then absolutely refused to eat one more pill, so we stopped the denamarin. After the recheck, his numbers jumped up even higher, and also his lymphocytes were up. So then we did a second ultrasound & aspirates. There was no evidence of cancer or bacteria. Then we tried 2 weeks of a steroid, and just this weekend, the bilirubin had gone down but all the other liver values had gone up... again! We've spent over $6,000 and still don't have a good solution. I'm at my wits end. The vet cut the steroid dose in half as a last ditch effort. She said if this doesn't work, she would want to try exploratory surgery, to perhaps flush out his bile ducts. We really don't want to go down that road, but I also don't want to give up on him. Meanwhile, he's eating/playing and seems quite happy (& yellow). I don't have much advice to contribute, other than to say- this is tough! It's up and down every. single. day. Somedays he acts perfectly normal & somedays are tough. Good luck to you and please let me know if you find the magic cure!

 

[abyeb]

Have you seen this article yet? Elevated Liver Enzymes In Cats - Should You Be Worried?

This gives a lot of helpful info.

 

[Bentley1960]

I just found this thread because I'm basically going through the same thing with my 10 year old walter! It's been going on since last July. He started being very picky about eating and was diagnosed with pancreatitis (at the same time his diabetes returned- which had been in remission for 4/5 years). We treated that supportively and things did not get better. Then he underwent dental surgery (thinking bad teeth could be causing the bad appetite). Then, all his liver values began to climb and he turned yellow. We tried a round of a antibiotics (clavamox) which made him nauseas all the time, so he was also on appetite stimulants & anti nausea. The antibiotics didn't work, so we had an ultrasound done. They suspected blocked bile ducts and started Ursodiol and denamarin. He was very good about eating the pills for a while and then absolutely refused to eat one more pill, so we stopped the denamarin. After the recheck, his numbers jumped up even higher, and also his lymphocytes were up. So then we did a second ultrasound & aspirates. There was no evidence of cancer or bacteria. Then we tried 2 weeks of a steroid, and just this weekend, the bilirubin had gone down but all the other liver values had gone up... again! We've spent over $6,000 and still don't have a good solution. I'm at my wits end. The vet cut the steroid dose in half as a last ditch effort. She said if this doesn't work, she would want to try exploratory surgery, to perhaps flush out his bile ducts. We really don't want to go down that road, but I also don't want to give up on him. Meanwhile, he's eating/playing and seems quite happy (& yellow). I don't have much advice to contribute, other than to say- this is tough! It's up and down every. single. day. Somedays he acts perfectly normal & somedays are tough. Good luck to you and please let me know if you find the magic cure!

 

[Bentley1960]

Oh my gosh you, too, have been thru the ringer. Winston is actually doing okay on the meds, which is ursodial, and amoxicilan, and Demavarin (liver supplement) and Vitamin E. Winston goes to the Specialist Vet next Tuesday, Feb 6th so it will be interesting to see his levels, etc. He has been eating, playing, etc. He doesn't like his meds; however, he has been a lil trooper with them. I, too, have spent thousands of dollars with no real clue yet what is the underlying cause (they feel it more than just cholangical hepatitis); I do NOT want to have a liver biopsy whereby he goes into surgery (Cost is $3,000) - and we've already done two liver biopsies via needle aspiration. I am fearful that if we open him up it could exacerbate the situation and interestingly enough I spoke to one of the ladies that works at the Specialist Vet office and she, too, has a cat that is 14 years of age (a little older than my 11 year old) that has been diagnosed with cholangical hepatits and her cat is VERY resistant to taking meds and she is losing her relationship with her cat so she has decided to take her off the meds and allow her to be happy! She realizes this might shorten her life, but quality of life is more important. I will let you know how we make out on Tuesday and I agree this is so difficult! Glad you are keeping your chin up. I believe you said your cat IS yellow? I know when Winston got jaundiced is when we had to hospitalize him and give sub Q fluids under the skin for two weeks. If I find the magic bullet I will share it with you! All the Best...............

 

[Bentley1960]

Oh my gosh you, too, have been thru the ringer. Winston is actually doing okay on the meds, which is ursodial, and amoxicilan, and Demavarin (liver supplement) and Vitamin E. Winston goes to the Specialist Vet next Tuesday, Feb 6th so it will be interesting to see his levels, etc. He has been eating, playing, etc. He doesn't like his meds; however, he has been a lil trooper with them. I, too, have spent thousands of dollars with no real clue yet what is the underlying cause (they feel it more than just cholangical hepatitis); I do NOT want to have a liver biopsy whereby he goes into surgery (Cost is $3,000) - and we've already done two liver biopsies via needle aspiration. I am fearful that if we open him up it could exacerbate the situation and interestingly enough I spoke to one of the ladies that works at the Specialist Vet office and she, too, has a cat that is 14 years of age (a little older than my 11 year old) that has been diagnosed with cholangical hepatits and her cat is VERY resistant to taking meds and she is losing her relationship with her cat so she has decided to take her off the meds and allow her to be happy! She realizes this might shorten her life, but quality of life is more important. I will let you know how we make out on Tuesday and I agree this is so difficult! Glad you are keeping your chin up. I believe you said your cat IS yellow? I know when Winston got jaundiced is when we had to hospitalize him and give sub Q fluids under the skin for two weeks. If I find the magic bullet I will share it with you! All the Best...............

I just found this thread because I'm basically going through the same thing with my 10 year old walter! It's been going on since last July. He started being very picky about eating and was diagnosed with pancreatitis (at the same time his diabetes returned- which had been in remission for 4/5 years). We treated that supportively and things did not get better. Then he underwent dental surgery (thinking bad teeth could be causing the bad appetite). Then, all his liver values began to climb and he turned yellow. We tried a round of a antibiotics (clavamox) which made him nauseas all the time, so he was also on appetite stimulants & anti nausea. The antibiotics didn't work, so we had an ultrasound done. They suspected blocked bile ducts and started Ursodiol and denamarin. He was very good about eating the pills for a while and then absolutely refused to eat one more pill, so we stopped the denamarin. After the recheck, his numbers jumped up even higher, and also his lymphocytes were up. So then we did a second ultrasound & aspirates. There was no evidence of cancer or bacteria. Then we tried 2 weeks of a steroid, and just this weekend, the bilirubin had gone down but all the other liver values had gone up... again! We've spent over $6,000 and still don't have a good solution. I'm at my wits end. The vet cut the steroid dose in half as a last ditch effort. She said if this doesn't work, she would want to try exploratory surgery, to perhaps flush out his bile ducts. We really don't want to go down that road, but I also don't want to give up on him. Meanwhile, he's eating/playing and seems quite happy (& yellow). I don't have much advice to contribute, other than to say- this is tough! It's up and down every. single. day. Somedays he acts perfectly normal & somedays are tough. Good luck to you and please let me know if you find the magic cure!

How is Walter doing? Just wanted to give you an update on my Winston. After meeting with Specialist Vet and keeping him on antibiotics for 3 weeks, along with the ursodial, vitamin E, and Denamarin the Doctor did not see his AlT or ALP #'s change that much...His bilirbun was down slightly and thinks the ursodial helped with that; we took Winston off antibiotics and I've decided to move forward with the guided ultrasound with scope along with a liver biopsy (where tissue will be extracted). My Doctor thinks if we do both of these procedures we should get a diagnosis (he currently suspects either gut disease and/or small cell lymphoma; both which could be treated and managed with oral meds). I won't kid you the cost for doing both is $2,500 (cut me a bit of a deal since I am doing both at once) and I've already put out $3,800 to date. But we could opt NOT to do that and put him on steroids, but if he doesn't improve on steroids then to backtrack and do a liver biopsy would be difficult since steroids would skew his blood and chem values and we would have to take him off that for a while before we could proceed. I was under the impression that Winton would be opened up for the liver biopsy; but alas it is done via scope down thru his mouth and is not that invasive; certainly no cutting! So after many questions to the Doctor I have decided to move forward with the procedures. He goes in on Feb 19th, 2018 and I am praying for a diagnosis that can be managed so that he will be around for more years! I pray that your baby is doing well? Let me know!!!

 

[di and bob]

My thoughts and prayers are with you both, it's so hard to see your little one like this......

 

[Bentley1960]

My thoughts and prayers are with you both, it's so hard to see your little one like this......

Aww thanks so much!

 

[walterandjuniper]

I hope you finally get some answers, and that it's completely treatable! All fingers crossed for good news for you & winston! We haven't gone down the road to the liver biopsy... yet... but it lingers in the near distance. We also didn't have much luck with the antibiotics. We tried 2 weeks and in our case, they made everything much, much worse. Walter is doing... okay. After 2 weeks on the steroid all his liver values skyrocketed (except the bilirubin, which finally started to come down...a little). So the vet cut his dose in half and we rechecked and everything has come down quite a bit. Don't get me wrong, everything is still way, way higher than it should be, but they've come down, so I'm excited about that! Just yesterday we decreased his steroids again and will recheck his liver values in 10 days. His lymphocytes have also returned to normal, and all other blood work looks good. He's also looking less yellow these days and his diabetes is pretty much under control. So... we're still just waiting & rechecking. If the steroids don't significantly improve things, we will need to go the exploratory surgery route. And we're sort of tapping out on what we can continue to spend, so that's a bit stressful. This month marks month #7! Happy to hear your update and sending positive vibes your way! I think having an answer is always so preferable to the guessing & worrying game!

 

[Bentley1960]

I hope you finally get some answers, and that it's completely treatable! All fingers crossed for good news for you & winston! We haven't gone down the road to the liver biopsy... yet... but it lingers in the near distance. We also didn't have much luck with the antibiotics. We tried 2 weeks and in our case, they made everything much, much worse. Walter is doing... okay. After 2 weeks on the steroid all his liver values skyrocketed (except the bilirubin, which finally started to come down...a little). So the vet cut his dose in half and we rechecked and everything has come down quite a bit. Don't get me wrong, everything is still way, way higher than it should be, but they've come down, so I'm excited about that! Just yesterday we decreased his steroids again and will recheck his liver values in 10 days. His lymphocytes have also returned to normal, and all other blood work looks good. He's also looking less yellow these days and his diabetes is pretty much under control. So... we're still just waiting & rechecking. If the steroids don't significantly improve things, we will need to go the exploratory surgery route. And we're sort of tapping out on what we can continue to spend, so that's a bit stressful. This month marks month #7! Happy to hear your update and sending positive vibes your way! I think having an answer is always so preferable to the guessing & worrying game!

Oh my gosh this is so true Walter's MOMMY! Thank you so much for your kind words and I am happy that Walter seems to be doing better. I am praying (as is everyone I know lol that knows me) for good news or at least manageable news. I realize that something is definitely going on with my lil guy and I do want to get to the bottom of it. I'm told there is a 90% chance we should get a diagnosis, but if they are still puzzled then we would get him on broadbased steroid to address whatever issue is out there. I will keep you all in my prayers and I will have to find a pic that I can upload as he is a cutie pie!

 

[Bentley1960]

Update on Winston: He had

I hope you finally get some answers, and that it's completely treatable! All fingers crossed for good news for you & winston! We haven't gone down the road to the liver biopsy... yet... but it lingers in the near distance. We also didn't have much luck with the antibiotics. We tried 2 weeks and in our case, they made everything much, much worse. Walter is doing... okay. After 2 weeks on the steroid all his liver values skyrocketed (except the bilirubin, which finally started to come down...a little). So the vet cut his dose in half and we rechecked and everything has come down quite a bit. Don't get me wrong, everything is still way, way higher than it should be, but they've come down, so I'm excited about that! Just yesterday we decreased his steroids again and will recheck his liver values in 10 days. His lymphocytes have also returned to normal, and all other blood work looks good. He's also looking less yellow these days and his diabetes is pretty much under control. So... we're still just waiting & rechecking. If the steroids don't significantly improve things, we will need to go the exploratory surgery route. And we're sort of tapping out on what we can continue to spend, so that's a bit stressful. This month marks month #7! Happy to hear your update and sending positive vibes your way! I think having an answer is always so preferable to the guessing & worrying game!

 

[Bentley1960]

Update on Winston: He had his biospy and endoscopic guided ultra sound on Monday. They found some stomach ulcers as well and are biopsying those as well. We will have results in 5-7 days. I will keep you posted. This is updated picture of my lil guy this morning!

 

[Bentley1960]

Update on Winston - Mucosal biopsies revealed severe gastric and small intestinal lymphoplasmacytic inflammatory bowel disease IBD with some intestinal areas that were concrerning for transformation to lymphomo. An ultrasound guided liver biopsy revealed severe lymphoplasmcytic cholangiohepatits. Additional test, immunohistochemistry of the liver and small intestine did NOT reveal evidence of lymphoma. Therapy has started with prednisolone on March 16th and he has gained weight (finally) as a result of that; however, his liver enzymes have gone up to over 700 so the decision was made to start him on Chlorambucil (chemo drug) to see if that will bring his levels down. He will be starting that drug tomorrow 4-18-18 and will be back to internist in 2 weeks for review. The internist DID say that we may have to do steroid and this new companion drug since he has a really severe case. I am just happy that it is not cancer (at least at this point). He has been very lethargic and not quite as social, but I am hoping that will change with introduction of additional medication. If ANYONE out there has dealt with this...please please please let m know your experience. Thanks so much and I'm sorry it has taken so long to post this.

 

[Furballsmom]

Winston, sweetheart!! Oh my goodness!!

I am just happy that it is not cancer

Oh me too!
I'm hoping that someone with experience will come on to talk with you....

 

[Furballsmom]

I came across this, I'm not sure if it will be of any help for you. Also, @mrsgreenjeens is the OP's situation something you're familiar with? or would you know of someone who is?
Acute Liver Failure in Cats - Symptoms, Causes, Diagnosis, Treatment, Recovery, Management, Cost