Cholangitis and Cholangiohepatitis in Dogs: A Descriptive Study of 54 Cases Based on Histopathologic Diagnosis (2004-2014)

Abstract

Background: Cholangitis in dogs appears to be more common than previously thought, but understanding of the disease remains incomplete.

Objective: To describe a population of dogs with cholangitis or cholangiohepatitis.

Animals: Fifty-four client-owned dogs with cholangitis or cholangiohepatitis.

Methods: Medical records of dogs with cholangitis or cholangiohepatitis confirmed by histopathology between January 2004 and December 2014 were identified using a computer-based search and retrospectively reviewed.

Results: Clinical signs included vomiting (72.2%), lethargy (70.4%), and inappetence (64.8%). Most dogs (49/50) had increased liver enzyme activities, hyperbilirubinemia (32/50), and hypercholesterolemia (24/43). Ultrasonographic abnormalities of the hepatobiliary system were seen in 84% of cases. On histopathology, 53 of 54 affected dogs had neutrophilic cholangitis (NC) or cholangiohepatitis, whereas 1 dog had lymphocytic cholangitis. Most cases (42/54) were chronic. Evidence of concurrent biliary disease (46.2%) and biliary tract obstruction (42.6%) was common. Seventeen of 36 biliary and 11 of 25 liver cultures were positive for bacterial growth; Escherichia coli and Enterococcus spp. were most common. Median patient survival was 671 days (95% confidence interval [CI]: 114-1,426). On Cox regression, dogs that did not have a cholecystectomy performed had a 2.1 greater hazard for death (P = 0.037; 95% CI: 1.0-4.3) compared to cholecystectomized dogs. Dogs >13 years old had a 5.0 greater hazard for death (P = 0.001; 95% CI: 1.9-13.2) compared to younger dogs.

Conclusions and clinical significance: Chronic NC or cholangiohepatitis was most common. Cholecystitis and biliary tract obstruction often occurred in conjunction with cholangitis. Cholecystectomized dogs had decreased risk of death; thus, cholecystectomy may improve patient outcome.

Keywords: Biopsy; Culture; Gallbladder; Liver.

Figure 1

Liver Histopathology—Cholangiohepatitis. Severe neutrophilic cholangiohepatitis with inflammation extending from the portal region beyond the limiting plate into the periportal parenchyma. Hematoxylin and eosin (H&E) stain.

Figure 2

Liver Histopathology—Chronic Cholangitis. Severe chronic neutrophilic cholangitis. Hematoxylin and eosin (H&E) stain.

Figure 3

Liver Histopathology—Severe Fibrosis. Moderate chronic neutrophilic cholangitis with severe fibrosis. Masson's trichome stain.

Figure 4

Liver Histopathology—Severe Neutrophilic Cholangitis. Severe neutrophilic cholangitis and focal cholangiohepatitis with moderate fibrosis. Note the periductal concentric fibrosis indicative of obstructive biliary disease. Masson's trichrome stain.

Figure 5

Kaplan–Meier Survival estimate for Dogs with Cholangitis. The median survival time was 671 for the 54 dogs included in the study. Each hash mark along the survival curve represents the last point at which a dog that was lost to follow‐up was known to be alive (ie, censored).

Figure 6

Survival Curves Base on Cox Proportional Hazards Regression. Dog age and surgical treatment with cholecystectomy were significantly associated with survival. Dogs <13 years old and dogs that had a cholecystectomy had improved survival compared to dogs that were older or did not have surgical removal of the gallbladder.