Feline cholangitis is inflammation of the bile ducts inside the liver. It is the second most common liver disease in cats after hepatic lipidosis. About 40 to 50 percent of feline liver biopsies in chronic cases show cholangitis (Boland & Beatty, 2017, JFMS). Yellow gums, decreased appetite, vomiting, and weight loss in a middle-aged or senior cat warrant a same-week vet visit.
Last reviewed: May 2026
What Cholangitis Means in a Cat
Cholangitis refers to inflammation of the small bile ducts that drain bile from the liver into the gallbladder and then into the small intestine. In cats, the disease is divided into three main forms: neutrophilic cholangitis (often bacterial, ascending from the gut), lymphocytic cholangitis (chronic, immune-mediated), and chronic cholangitis associated with liver flukes (regional, rare in most of North America). Because the feline pancreatic duct shares a common opening with the bile duct, cholangitis frequently co-exists with pancreatitis and inflammatory bowel disease — the so-called "triaditis" — in about 50 to 80 percent of biopsied cats.
Signs Owners Notice
The most common signs are decreased appetite (often the earliest sign), unexplained weight loss over weeks to months, intermittent vomiting, and lethargy. Yellowing of the gums, sclera, or skin (jaundice) is the most specific sign and occurs in 30 to 60 percent of affected cats. Cats with the acute neutrophilic form may also have fever, while the chronic lymphocytic form tends toward gradual decline. Diarrhea is common when concurrent inflammatory bowel disease is present.
Why Anorexia Is a Bigger Emergency Than It Seems
Any cat off food for more than 2 to 3 days is at risk of developing hepatic lipidosis — a separate, dangerous liver disease in which fat floods the liver of an anorexic cat (Valtolina & Favier, 2017, JFMS). Cats with cholangitis who stop eating can develop lipidosis on top of cholangitis within days, dramatically worsening prognosis. This is why the threshold for seeing a vet is much lower in cats than in dogs — even 48 hours of poor appetite warrants a call. The Chan, 2009, JFMS review on nutritional management emphasizes feeding tubes early in any anorexic cat to prevent this complication.
How Vets Diagnose Cholangitis
Workup typically begins with bloodwork — affected cats often show elevated liver enzymes (ALT, ALP, GGT), elevated bilirubin, and sometimes a low albumin or elevated globulins. Bile acids may be elevated. Abdominal ultrasound is the most useful imaging — it can show thickened bile ducts, gallbladder sludge, and concurrent pancreatic or intestinal changes. Definitive diagnosis requires liver biopsy with bile aspirate and culture, usually obtained surgically or laparoscopically. Many cats are treated empirically based on history, bloodwork, and ultrasound when biopsy is declined.
Treatment
For neutrophilic (likely bacterial) cholangitis: antibiotics chosen ideally by culture (commonly amoxicillin-clavulanate or enrofloxacin), 4 to 8 weeks, plus ursodiol to improve bile flow, S-adenosylmethionine for liver support, and supportive care. For lymphocytic (immune-mediated): immunosuppression with prednisolone, often combined with ursodiol and S-adenosylmethionine. Concurrent pancreatitis is treated with anti-nausea drugs, pain control, and feeding tube support. Most cats need a feeding tube for 2 to 6 weeks early in treatment to prevent hepatic lipidosis and ensure caloric intake.
When to See a Vet
Call your vet today if:
- Decreased appetite lasting more than 48 hours
- Yellowing of the gums, eye whites, or ear skin
- Unexplained weight loss in a middle-aged or senior cat
- Repeated vomiting over more than 24 hours
- A cat with known IBD or pancreatitis who develops new lethargy or jaundice
Go to the ER immediately if:
- Bright yellow jaundice plus weakness or collapse
- Vomiting blood or producing dark tarry stool
- Severe abdominal pain (hunched posture, hiding, hissing on touch)
- Anorexia for more than 3 days plus rapid breathing
- Sudden disorientation or seizures (possible hepatic encephalopathy)
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Frequently Asked Questions
How much does cholangitis workup and treatment cost?
Bloodwork plus abdominal ultrasound runs $400 to $800. Liver biopsy with bile culture, done surgically or laparoscopically, is $1,500 to $3,500. Hospitalization for an actively ill cat — IV fluids, anti-nausea drugs, feeding tube placement — typically costs $1,500 to $4,000 for a 3- to 5-day stay. Long-term oral medication and rechecks add $50 to $150 per month for 6 to 12 months. Insurance bought before diagnosis usually covers most.
Will my cat fully recover from cholangitis?
Neutrophilic cholangitis carries a fair to good prognosis if treated promptly — many cats recover fully on antibiotics within 6 to 12 weeks. Lymphocytic (chronic) cholangitis is managed long-term with immunosuppression and supportive care, similar to IBD; many cats live 1 to 3 years or longer with good quality of life. Cats with triaditis or hepatic lipidosis on top of cholangitis have a more guarded prognosis.
What is feline triaditis?
Triaditis is the simultaneous inflammation of the liver (cholangitis), pancreas (pancreatitis), and small intestine (IBD). Roughly 50 to 80 percent of cats with chronic cholangitis on biopsy also have evidence of pancreatitis and IBD because the three organs share anatomic and immune connections in cats. Treatment usually targets all three simultaneously.
Is my cat's diet causing this?
Diet does not cause cholangitis directly, but obesity, rapid weight loss, and feeding only dry food can worsen liver disease in cats. Cats with cholangitis often do well on a moderate-protein, easily digestible diet, ideally wet food. Sudden diet changes should be avoided. Your vet may recommend a specific therapeutic diet during recovery.
Can a feeding tube be removed once my cat eats again?
Yes. Feeding tubes (esophageal or gastric) are routine, well-tolerated, and removed in a 5-minute office visit once the cat is reliably eating on their own — typically 2 to 6 weeks. Many owners are surprised at how comfortable cats are with feeding tubes. The tube is the single biggest predictor of survival in cats with serious liver disease.
Still Not Sure if Your Cat Needs a Vet?
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