Triaditis

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Triaditis refers to an inflammatory process that involves the;

  1. liver - cholangiohepatitis
  2. pancreas - pancreatitis
  3. small intestine - irritable bowel disease (IBD)

Triaditis is a syndrome unique to cats, and does not appear to occur in dogs and other species.

Unlike the dog, the pancreatic duct in cats enters the common bile duct before it opens into the duodenum. When there is disease (e.g., inflammation, infection, neoplasia, stasis) in the small bowel, it may ascend into the common bile duct and, from there, affect the pancreas, resulting in pancreatitis. The rest of the biliary tree may also be affected[1].

Rare cases of congenital bile duct atresia have also been reported, which can present as triaditis[2].

There appears to be no breed, age or sex predilection for this disease, however pancreatitis and IBD are common in middle-aged to older cats.

Clinical signs are generally vague and non-specific, including anorexia, vomiting, diarrhoea, lethargy and dehydration.

Diagnosis is based on ultrasonographic findings of pancreatitis, cholangiohepatitis and inflammation of duodenum. Blood tests may reveal neutrophilia or chronic non-regenerative anaemia[3].

Treatment is usually supportive, including fluid therapy, H2 blockers (e.g. famotidine 5 mg orally) to control vomiting, cisapride (5 mg orally every 8 hours) as a promotility drug. Antimicrobial therapy (usually based on culture and sensitivity) should continue for 6 - 8 weeks, or longer.

S-adenosyl-L-methionine (90 mg orally every 12 hours) may be beneficial as a glutathione donor that enhances cellular metabolism[4].

References

  1. Scherk, M (2003) Triad disease (Triaditis). In: Norsworthy, GD et al (Eds), The feline patient: Essentials of diagnosis and treatment. 2nd edition, pp:485-489
  2. Veterinary Pathology Forum
  3. Akol, KG et al (1993) Pancreatitis in cats with hepatic lipidosis. J Vet Intern Med 7:205-209
  4. Baez, JL et al (1999) Radiographic, ultrasonographic and endoscopic findings in cats with inflammatory bowel disease of the stomach and small intestine: 33 cases (1990-1997). J Am Vet Med Assoc 215:349-354
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