What is biliary in cats?
The biliary system in cats refers to the gallbladder and bile ducts that store, transport, and release bile. Bile is a digestive fluid produced by the liver that helps break down fats in the small intestine. The main components of the feline biliary system include:
Gallbladder – a small pear-shaped organ that stores and concentrates bile after it leaves the liver. It is located under the right lobe of the liver. When food containing fats enters the small intestine, the gallbladder contracts and releases bile through the bile ducts.1
Bile ducts – thin tubes that carry bile from the liver and gallbladder to the small intestine. The main ducts are the hepatic ducts, cystic duct, and common bile duct.
The main functions of the feline biliary system are to 2:
- Store and concentrate bile produced by the liver
- Release bile into the small intestine to emulsify fats and aid digestion
- Remove waste products from the liver and bloodstream
Diseases of the biliary tract can disrupt these functions and cause serious health issues in cats.
What causes biliary disease?
There are a few main causes of biliary disease in cats:
Gallstones – Gallstones form when bile components precipitate and form crystals that aggregate into stones. Gallstones are more common in cats than dogs. Risk factors include obesity and high-fat diets.1
Inflammation – Inflammation of the biliary system, known as cholangitis or cholangiohepatitis, can obstruct bile flow. It may be caused by bacterial infections ascending from the intestines, pancreatitis, or liver disease.2
Cancer – Cancer of the bile ducts or liver can cause biliary obstruction. These cancers are more common in older cats.3
Symptoms of biliary disease
Biliary disease often causes noticeable symptoms in cats. Some of the most common signs of biliary disease include:
Jaundice
One of the hallmark symptoms of biliary disease is jaundice, which is yellowing of the skin, gums, and whites of the eyes. This occurs when bilirubin, a pigment in bile, builds up in the bloodstream. Jaundice is caused by obstruction of bile flow or liver disease [1].
Vomiting
Vomiting is another common sign of biliary disease in cats. Obstruction of the bile ducts or gallbladder often leads to nausea and vomiting. The vomit may be yellow or green tinged with bile [2].
Loss of appetite
Cats with biliary disease frequently experience a decreased appetite or complete loss of appetite (anorexia). Gallbladder inflammation, liver disease, and obstruction of bile flow can all suppress appetite.
Abdominal pain
Biliary disorders often cause pain or tenderness in the upper right abdomen where the gallbladder is located. Cats may exhibit signs like vocalizing or growling when the belly is touched.
Diagnosing biliary disease
There are several tests vets use to diagnose biliary disease in cats:
Blood tests
Vets will run blood tests to check for elevated liver enzymes and bilirubin levels, which can indicate liver or gallbladder problems. Some specific blood tests include:1
- Serum bile acids test
- Alanine aminotransferase (ALT)
- Alkaline phosphatase (ALP)
- Gamma-glutamyl transferase (GGT)
- Total bilirubin
Ultrasound
An abdominal ultrasound allows the vet to visualize the liver, gallbladder, and bile ducts. It can detect gallstones, thickening of the gallbladder wall, tumors, and other abnormalities.2
Biopsy
A liver biopsy may be recommended to determine the cause of liver disease. The vet takes a small sample of liver tissue and examines it under a microscope.3
Treatment Options
There are several treatment options for biliary disease in cats, including:
Surgery
Surgery may be necessary to remove gallstones or damaged tissue depending on the severity of the disease. Common procedures include cholecystectomy to remove the gallbladder and choledochotomy to remove stones from the bile ducts [1].
Medication
Medications can help manage symptoms and dissolve gallstones. Antibiotics, ursodeoxycholic acid, corticosteroids, and pain medications may be prescribed [2].
Diet Changes
Switching to a low-fat, high-protein diet can help reduce inflammation and ease symptoms. Your vet may recommend prescription gastrointestinal food [3].
Surgical Procedures
The main surgical procedures for treating biliary disease in cats are cholecystectomy (gallbladder removal) and bile duct repair.
Cholecystectomy involves the complete removal of the gallbladder. This is the most common and effective treatment for gallbladder disorders like gallstones, gallbladder inflammation, cysts, and obstructions that fail to respond to medical management [1]. Surgery typically lasts 1-2 hours. The cat is placed under general anesthesia, and the gallbladder is removed either via open surgery or laparoscopically with small incisions. After surgery, most cats recover fully within 2 weeks.
Bile duct repair is necessary when there is an obstruction or leakage in the common bile duct. This may involve techniques like choledochal stenting, choledochoenterostomy, or cholecystojejunostomy [2]. These procedures aim to bypass bile duct blockages and restore normal bile flow from the liver into the small intestine. Recovery time is around 2-4 weeks. Complications like infection and leakage are possible but infrequent with experienced surgeons.
The prognosis for cats after biliary tract surgery is generally good, with 80-90% returning to normal quality of life. However, surgery is still considered high-risk, and potential complications include bleeding, infection, and liver dysfunction. Close monitoring and care is required during recovery.
Recovery and healing
Recovery time after cholecystectomy (gallbladder removal) surgery in cats can vary depending on the invasiveness of the procedure, but typically takes around 2 weeks. Most cats will be hospitalized for 2-3 days after surgery for close monitoring and IV medications before being discharged home.
Once home, your cat will likely need to be confined and prevented from jumping or running for approximately 2 weeks to allow the abdominal incision to fully heal. Your vet will prescribe pain medication, such as buprenorphine, to manage discomfort during this time. Additionally, your cat may be sent home with antibiotics and could have an Elizabethan collar to prevent licking or biting at the stitches.
Follow-up vet exams are crucial during the recovery period to check the incision site, remove skin sutures or staples around 10-14 days post-op, ensure adequate pain control, and monitor for potential complications. Your vet will advise when your cat can return to normal activity levels and diet.
While most cats recover well from cholecystectomy surgery, possible complications can include infection, slow wound healing, recurrence of gallbladder sludge or stones, leakage from the bile ducts, and persistent vomiting or nausea. Contact your vet promptly if you notice any concerning symptoms that could indicate an issue with your cat’s recovery.
Caring for your cat post-surgery
After biliary surgery, proper care of your cat during recovery is essential for healing. Here are some tips for caring for your cat after surgery:
Incision site care
Check your cat’s incision site daily for signs of infection like redness, swelling, discharge, or oozing. Keep the area clean by gently wiping around it with a damp cloth and pat dry. Avoid letting your cat lick or scratch at the incision. An Elizabethan collar may be necessary. Monitor for suture reactions and contact your vet if any issues arise (VCA Animal Hospitals).
Diet and eating
Feed soft, bland foods for a few days after surgery to prevent nausea and vomiting. Avoid fatty foods. Stick to the diet recommended by your vet. Make sure your cat stays hydrated by providing fresh water daily. Loss of appetite is common initially but should improve within 24-48 hours. Contact your vet if vomiting, diarrhea, or lack of appetite persists (Wagwalking).
Activity restrictions
Restrict activity for at least 1 week after surgery to allow proper healing. Confine your cat to a small room or cage when unattended. Limit jumping, running, and rough play. Avoid stairs if possible. Restrict licking and scratching at the incision site with an e-collar. Follow all activity instructions from your vet to ensure proper recovery (VCA Animal Hospitals).
Long-term prognosis
The long-term prognosis for cats with biliary disease depends on the underlying cause and how early treatment is initiated. In many cases, with prompt treatment, cats can make a full recovery. However, if the disease is advanced or complications like liver damage or infection have occurred, the prognosis declines.
According to a study published in the Journal of Feline Medicine and Surgery, cats treated surgically for extrahepatic biliary obstruction had an overall survival rate of 70% at 3 years post-surgery. However, cats with concurrent pancreatitis had reduced survival rates.
For cats treated medically for less severe biliary disease like cholelithiasis, prognosis is generally good with appropriate antimicrobial treatment. A study in the Journal of Veterinary Internal Medicine found 94% of cats with cholelithiasis survived to discharge when treated with antibiotics and ursodeoxycholic acid.
Even after successful treatment, long-term monitoring is recommended. Periodic bloodwork and abdominal ultrasounds can check for recurrence of clinical signs or complications. Any decrease in appetite, lethargy, vomiting, or jaundice warrants immediate veterinary attention to prevent relapse.
With diligent at-home care and follow-up veterinary visits, many cats with biliary disease can live normal lifespans. However, recurrence is possible, especially if the underlying cause like pancreatitis or inflammation is not fully resolved.
Preventing biliary disease
There are some steps cat owners can take to help prevent biliary disease in their feline companions:
Diet – Feeding your cat a high-quality diet that is low in fat and calories can help prevent obesity, which is a risk factor for biliary disease. Avoiding table scraps and unhealthy treats is also recommended. Your vet can provide feeding guidelines based on your cat’s age, activity level, and health status.
Exercise – Ensuring your cat gets adequate physical activity through playtime and exercise can help them maintain a healthy weight and prevent obesity. Interactive toys and daily play sessions are great ways to keep your cat active and engaged.
Annual vet exams – Bringing your cat in for annual wellness exams allows your vet to monitor your cat’s health, recommend preventive care, and catch any potential issues early on. Bloodwork and other screening tests may help diagnose conditions like liver or gallbladder disease before they become advanced.
