NAVLE® Question of the day

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April 3, 2024

NAVLE

A five-year-old female spayed domestic short-haired cat is presented with chronic vomiting, anorexia, and weight loss.

Physical examination reveals icterus, dehydration, and fever. Abdominal palpation identifies thickened small intestinal loops, and serum biochemistry shows increased bilirubin and liver enzymes.

The cat is diagnosed with extrahepatic biliary obstruction with accompanying cholangitis and inflammatory bowel disease.

Which one of the following normal anatomic features may predispose cats to this triad of diseases?

A - Enlarged duodenal papilla in comparison to other species

B - Common opening of the pancreatic and common bile ducts into duodenum

C - Narrowing of the duodenum distal to the entry of the common bile and pancreatic ducts

D - Decreased proportion of alpha-smooth muscle actin in muscle fibers of the wall of the gall bladder in cats

E - Decreased diameter and increased branching of the hepatic ducts in comparison to other species

Sorry. You chose "A - Enlarged duodenal papilla in comparison to other species" but the correct answer is "B - Common opening of the pancreatic and common bile ducts into duodenum"

In cats, there is a common opening of the pancreatic and common bile ducts into the duodenum.

It is thought that this may predispose them to ascending cholangitis and pancreatitis after vomiting associated with inflammatory bowel disease, resulting in extrahepatic biliary obstruction.

Other possible etiologies of EHBO include neoplasia, biliary stricture, duodenal obstruction, diaphragmatic hernia, and parasitic infection.

In all cases, there is a lack of bile entry into the intestinal tract, leading to decreased absorption of fat and fat soluble vitamins such as vitamin K, potentially resulting in coagulopathies.

Except in transient cases that are related to acute pancreatitis, need surgical intervention to relieve the obstruction as well as appropriate supportive care, antimicrobial treatment, and vitamin K administration.

Click here to see a good summary of extrahepatic biliary obstruction with images, courtesy of the American College of Veterinary Surgeons (ACVS).