10 Symptoms of Blocked Bile Duct in Cats

A blocked bile duct can make a cat very ill and result in big veterinary bills. But what exactly is a blocked bile duct and how can pet parents spot this condition? 

Read on to learn more about bile duct obstruction in cats, including signs to watch for and next steps to take.

What Is a Blocked Bile Duct?

Before we get into bile duct obstruction in cats, it is helpful to understand a bit about cat bile duct anatomy. One of the functions of the mammalian liver is to make bile, a yellow-green liquid that aids the intestines in digesting food. Small bile ducts collect bile from the lobes of the liver and transport bile via the common bile duct to the intestines where it is used to digest food. Extra bile is stored in the gallbladder, which is linked to the bile ducts inside the liver. Disease anywhere along the bile ducts or nearby organs can result in bile duct obstruction and the accompanying symptoms. 

Bile duct disease is also called cholestasis. Bile duct obstruction in cats often occurs when there is inflammation in the liver, gallbladder, or bile ducts. In those cases, the disease is called cholangitis or cholangiohepatitis. 

Because the bile ducts are sensitive to what is going on around them in the nearby organs, bile duct obstruction due to inflammation in the liver, gallbladder, pancreas, or small intestines is moderately common in cats. 

Bile duct obstruction can happen in any age cat, but is more common in middle aged cats. Cats with a history of liver inflammation, intestinal parasites, or cats who are predisposed to inflammation of the pancreas (pancreatitis), gallstones, or repeated bouts of small intestinal or stomach inflammation are at increased risk for bile duct obstruction. 

10 Symptoms of Blocked Bile Duct in Cats

Bile ducts are closely associated with the liver and gastrointestinal system, and the symptoms of a blocked bile duct reflect this relationship. Symptoms of blocked bile duct in cats are notoriously non-specific and can occur all of a sudden or wax and wane over a period of weeks or months. 

Symptoms of blocked bile duct in cats are vague, but include:

• Vomiting
• Diarrhea
• Increased hiding or lethargy, other behavioral changes
• Changes in appetite, either up or down
• Weight loss
• Abdominal pain
• Jaundice (yellowed skin, eyes, and gums due to a buildup of bile)
• Bleeding tendencies, increased bruising, bleeding gums
• Swollen abdomen
• Pale stools or orange urine

What Causes Bile Duct Obstruction in Cats?

There are a few reasons why bile ducts can become obstructed. The most common reason is inflammation in a neighboring organ, such as the liver, gallbladder, intestines, or pancreas, externally compresses the common bile duct, causing obstruction. Additional causes include:

• Gallstones
• Intestinal parasites
• Cancer
• Anatomical malformations (usually seen in young cats)
• Duct fibrosis and stricture secondary to trauma or peritonitis

Diagnosis

Because the symptoms of bile duct obstruction in cats are so vague, it can be tricky for a veterinarian to diagnose. A veterinarian will obtain a history by asking you questions and then conduct a physical examination. Based on the history and physical exam findings, a veterinarian will then recommend laboratory testing and imaging studies. These can include:

• Complete blood count (to check red blood cells and platelets, may see a low blood count)
• Serum chemistry (to check electrolytes and internal organ function, often see elevated liver enzymes, increased bilirubin, additional abnormalities include changes in glucose, albumin, cholesterol, and globulins)
• Urinalysis (often see bilirubin crystals)
• Serum bile acids (typically increased, indicates bile dysfunction)
• Coagulation tests (to determine the cause of bleeding)
• Fecal examination (to look for parasites)
• Abdominal radiographs (X-rays, may be able to see gallstones)
• Abdominal ultrasound (more sensitive test, may see distended bile ducts or gallbladder, pancreatitis, etc.)

Depending on what your veterinarian sees in the initial tests, they may recommend additional tests, such as a liver biopsy.

Treatment

Treatment for a blocked bile duct does vary depending on the underlying disease condition and how sick the cat is, but in general, bile duct obstruction requires hospitalization and inpatient care. These cats feel awful, are usually painful and nauseous, and early intervention is key to prevent secondary problems like hepatic lipidosis from occurring. 

Mainstays of treatment for most cats with bile duct obstruction include:

• Intravenous fluid therapy to rehydrate and balance electrolytes and vitamins (veterinarians often add water soluble vitamin B to IV fluids)
• Vitamin K
• Vitamin E (antioxidant)
• Antibiotics for bile duct infections and before surgery
• Appropriate nutrition (fat restricted)
• Ursodeoxycholic acid AFTER the bile duct has been decompressed (dissolves gallstones and thins out bile fluid)
• Gastro-protectant medications, such as antacids (famotidine), sucralfate, or omeprazole
• Pain medication as appropriate

In addition to these treatments, a cat with an obstructed bile duct needs the bile duct unobstructed. Treatment for this varies depending on what is causing the obstruction, but can range from surgical correction to hospitalization for pancreatitis. 

A cat with a blocked bile duct often will stop eating, which must be addressed if it happens. Ways to address inappetence in a sick cat include appetite stimulants or feeding a liquid diet through a stomach tube. 

Cost

Cost of treatment for bile duct obstruction is high, and includes initial testing, hospitalization, and surgery if required: 

• Initial testing costs can range from $300-$1,000
• Hospitalization can run several hundred dollars per day
• Surgery will cost $1,000-$3,000
• Take-home medications will likely cost $100 or more

After your cat has been discharged from the hospital, your veterinarian will want you to bring the cat back for recheck examinations and testing to make sure the condition has resolved. This includes checking the bile duct as well as checking coagulation and other laboratory tests. Your veterinarian may also want to ultrasound your cat’s belly again to ensure everything is healing. 

Recovery & Management

If the cat has an obstruction due to pancreatitis that is fully resolved, the prognosis is good. The prognosis for other cats with bile duct disease depends on several factors:

• The cause of obstruction and whether it can be resolved
• The health of the bile duct (secondary scarring and strictures make the prognosis worse)
• The overall health of the cat
• The motivation of the pet parents to care for the cat

If your cat has recovered from a bile duct obstruction, then it is possible for your cat to still live a long and happy life, however, there will be some things that your veterinarian will want you to do to ensure that the cat doesn’t relapse. These can include:

• Regular rechecks that may include laboratory tests or imaging studies
• Monitoring your cat for recurrent symptoms, letting your vet know immediately if they occur, and then following your vet’s recommendation
• Feeding your cat a low fat diet, which can be over the counter, therapeutic prescribed by your vet, or homemade with the guidance of a board certified veterinary nutritionist.