Cholangitis — inflammation of the bile ducts and surrounding liver — is the most common inflammatory liver disease in cats. The neutrophilic form usually responds to antibiotics and supportive care, while the lymphocytic form needs long-term immune suppression. Cats often have concurrent inflammatory bowel disease and pancreatitis, the so-called triaditis pattern (Valtolina & Favier, 2017, JFMS).
Last reviewed: June 2026
Two Main Forms
Neutrophilic cholangitis is driven by bacteria ascending from the intestine into the bile ducts. Cats are usually sick over days to weeks with vomiting, jaundice, fever, and a tender belly. Lymphocytic cholangitis is a chronic immune-mediated form that produces months of weight loss, intermittent appetite, and a fat belly from ascites. The two forms look similar on bloodwork — high liver values, sometimes jaundice — but the treatment is opposite, which is why biopsy matters.
Common Signs
Reduced appetite is the most consistent sign. Vomiting, weight loss, and jaundice (yellow gums, ear margins, or the whites of the eyes) appear in many cats. Lymphocytic cases may not look acutely sick — they are 'losing weight even though they eat' — but neutrophilic cases often have fever and abdominal pain on exam. Triaditis cats may also have soft stool from concurrent inflammatory bowel disease and lethargy from pancreatitis.
Diagnosis
Bloodwork shows elevated ALT, ALP, GGT, and total bilirubin in most affected cats. Abdominal ultrasound looks for thickened bile ducts, gallbladder sludge, biliary obstruction, and pancreatic changes. The gold standard for distinguishing the two forms is liver biopsy, ideally with a bile sample for culture. Fine-needle aspirates are sometimes diagnostic for lymphocytic cholangitis but miss many cases. Cobalamin (B12) and folate are checked because both are commonly low in triaditis cats, as described in Ettinger's Textbook of Veterinary Internal Medicine.
Antibiotics for Neutrophilic Disease
Neutrophilic cholangitis is treated empirically while waiting for culture results. Amoxicillin-clavulanate or a fluoroquinolone is common, sometimes with metronidazole added for anaerobic coverage. Duration is 6 to 8 weeks. Most cats respond within days. Cholecystocentesis or surgical drainage is sometimes needed for biliary obstruction or mucocele.
Immune Suppression for Lymphocytic Disease
Lymphocytic cholangitis usually needs prednisolone, often for life, at a tapered dose. Chlorambucil is added in refractory cases. Concurrent treatment of inflammatory bowel disease with a hydrolyzed or novel-protein diet is helpful. Ursodiol is added to improve bile flow, and SAMe or silybin is often used for hepatoprotection. Cats with concurrent triaditis typically improve when all three components are addressed at once.
Why Cats Cannot Skip Meals
Any cat that has not eaten for more than 2 to 3 days is at risk of hepatic lipidosis, a separate and rapidly progressive fatty liver disease that can kill a cholangitis cat who stops eating (Valtolina & Favier, 2017, JFMS). Appetite stimulants (mirtazapine), syringe feeding, and feeding tubes are used aggressively. The 2022 AAHA Pain Management Guidelines, 2022 recommend analgesia for any sick cat with abdominal disease to support recovery.
When to See a Vet
Call your vet today if:
- Yellow gums, ear margins, or whites of the eyes
- Reduced appetite for more than 24 to 48 hours
- Vomiting more than 2 to 3 times in a day, especially with hiding
- Weight loss over weeks despite eating
- Confirmed cholangitis cat who suddenly stops eating
Go to the ER immediately if:
- Jaundice plus vomiting, weakness, or refusal to eat or drink
- Severe lethargy or unresponsiveness
- Distended abdomen with reduced appetite (possible bile peritonitis)
- Bloody vomit or black tarry stool
- Collapse, pale gums, or labored breathing
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Frequently Asked Questions
What is the difference between neutrophilic and lymphocytic cholangitis?
Neutrophilic is bacterial and acute — sick for days, fever, tender belly, jaundice. Treatment is antibiotics. Lymphocytic is chronic and immune-mediated — months of weight loss and intermittent appetite. Treatment is prednisolone and other immune suppression. Biopsy distinguishes them and is strongly recommended before committing to long-term steroids.
How much does cholangitis workup and treatment cost?
Initial exam typically runs $50 to $150, bloodwork and bile acids add $200 to $400, and abdominal ultrasound is $300 to $600. Liver biopsy under anesthesia at a referral center is $1,500 to $3,500. Hospitalization for severe cases ranges $1,500 to $4,500. Long-term medication and rechecks add $40 to $120 per month. Catching cholangitis early is far cheaper than treating an obstructed cat.
Can my cat recover fully from cholangitis?
Many neutrophilic cats recover fully with a single 6 to 8 week antibiotic course. Lymphocytic cats are managed lifelong but usually do well on stable immune suppression. Cats with biliary obstruction or advanced cirrhosis carry a guarded prognosis.
Is cholangitis the same as feline triaditis?
Triaditis is the combination of cholangitis, inflammatory bowel disease, and pancreatitis, which often coexist in cats because the bile and pancreatic ducts meet at a common opening in the duodenum. A cat with cholangitis has triaditis in roughly 50 to 80 percent of cases. Workup of one should always look for the other two.
Should my cat be on a special diet?
Yes. A highly digestible, moderate-protein, hydrolyzed or novel-protein diet helps cats with concurrent inflammatory bowel disease. Cobalamin (B12) supplementation is needed in many cats. Severe protein restriction is avoided unless hepatic encephalopathy develops.
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