Triaditis in Cats
Written by Small Door's medical experts
Triaditis is a condition in cats involving three different organs. The term is used when a combination of three diseases occur together: pancreatitis, inflammatory bowel disease, and cholangiohepatitis. Medical management and recovery involve addressing all three diseases. Cats may have a good prognosis when the condition is less severe and properly diagnosed and treated.
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Triaditis translates into “inflammation in three specific organs.” When your cat has triaditis, their liver, small intestine, and pancreas are affected at the same time. It’s a complex condition with inflammatory, immune, and infectious factors.
Inflammatory bowel disease is inflammation of the intestines.
Pancreatitis is inflammation of the pancreas.
Cholangiohepatitis is inflammation or infection of the liver, bile duct, or gallbladder.
As the Journal of Small Animal Practice states, 50% to 56% of cats diagnosed with pancreatitis and 32% to 50% of cats diagnosed with cholangitis/inflammatory liver disease have triaditis.
Why are cats susceptible to feline triaditis?
Scientists are not entirely sure why cats are susceptible to triaditis, but suspect it is due to the physical location of the pancreas, small intestine, and liver. The bile duct and pancreatic duct both connect into a single opening, which flows into the duodenum, the first section of the small intestine. Due to the proximity of all three organs and a high number of natural bacteria found within a cat’s duodenum, it becomes easy for bacteria to transfer from the intestine to the pancreas or liver, especially when your cat vomits. This may lead to inflammation of the affected organs.
Signs and symptoms can vary, and the condition can range from mild to more severe. If your cat is showing any of the following symptoms, consult your veterinarian immediately:
Vomiting
Diarrhea
Fever
Abdominal pain
Decreased appetite
Jaundice (yellowing of the eyes, gums, and skin)
Abdominal swelling
Weight loss
Increased thirst
Increased urination
Since triaditis involves three different diseases, there are many potential underlying causes of triaditis. Some of the more common causes of each disease can include one or a combination of the following:
Pancreatitis: Exposure to toxins, bacterial infections, physical trauma, viruses, an active feline distemper infection, parasitic infection, certain medications, certain foods
Cholangiohepatitis: Hepatic lipidosis (fatty liver), viruses, exposure to toxins, bile tract or gallbladder infection, mucus accumulations, portosystemic shunt, diabetes, hyperthyroidism
Inflammatory bowel disease: Idiopathic inflammation (inflammation of unknown origin), food allergies, intestinal parasites, vitamin deficiencies, bacterial infections, exposure to toxins, autoimmune disorders
How your veterinarian will diagnose triaditis may depend on your cat’s symptoms and how sick they are. Your veterinarian may recommend performing one or more of the following tests:
Complete blood count (CBC): A CBC will measure your cat’s red and white blood cells and platelets (anemia can be a symptom secondary to liver disease).
Blood chemistry test: A blood chemistry test will check the function of your cat’s organs. Your veterinarian will specifically be looking for abnormalities within your cat’s liver enzymes such as alanine aminotransferase (ALT) and alkaline phosphatase (ALP), as well as other enzymes that can also indicate a liver issue, such as albumin, bilirubin, blood urea nitrogen (BUN), creatinine, glucose, and cholesterol.
Coagulation profile: Prothrombin time (PT) and activated partial thromboplastin time (APTT) will show your cat’s ability to form blood clots and detect bleeding risk.
Urinalysis: A urinalysis will check your cat’s urine for protein, blood, infection, crystals, and pH levels.
Fecal analysis: A fecal analysis can be helpful to rule out any intestinal parasite infections, as well as check for bacterial infections that can cause gastrointestinal issues.
Spec-fPL: The Spec-fPL test is a blood test that specifically identifies pancreatic enzyme elevations that are not commonly picked up on a routine chemistry panel.
Cobalamin: Cobalamin testing checks your cat’s vitamin B12 levels, as these can be lower than normal in cats with intestinal bowel disease.
Trypsin-like immunoreactivity (TLI): TLI testing will evaluate thefunction of your cat’s digestive pancreatic enzymes.
Radiographs: Abdominal radiographs may be taken to view your cat’s liver and surrounding organs. Radiographs can help your veterinarian determine whether the border of the liver appears irregular, if it is enlarged, or if there are any masses present.
Ultrasonography: An abdominal ultrasound can be used to view the intestines, pancreas, liver, and biliary system. Ultrasonography offers a different perspective from X-rays and allows your veterinarian to obtain more information. Some things an ultrasound can show include:
How thick and large an organ is
An accumulation of mucus (also known as a mucocele) within the liver or gallbladder
Enlarged lymph nodes
An accumulation of free fluid (effusion) in the abdomen
Problems with the veins and arteries attached to the liver
Computed tomography: A computed tomography (CT) scan can be a useful tool in identifying mass lesions or abnormalities of the veins and arteries attached to the liver.
Biopsy: A biopsy is when a small collection of tissue and cells are obtained from an organ (such as the intestines or liver), which are then studied under a microscope, also known as a histopathology. A biopsy can help your veterinarian to identify the presence of any cellular abnormalities and diseases, such as a bacterial infection or cancer. The biopsy itself can be performed through different methods, including:
Wedge biopsy: Performed under anesthesia, a small wedge is taken from the organ during either an abdominal exploratory or laparoscopic surgery.
Ultrasound-guided needle biopsy: Performed with or without sedation/anesthesia, your veterinarian will use an ultrasound probe to locate the organ and then aspirate (take) a small portion of cells using a syringe and needle. This method does not involve any surgical incisions.
For triaditis in cats to be successfully treated, you and your veterinarian will discuss a plan to treat all three diseases. Treatment of each disease can overlap or vary depending on the underlying cause or severity of symptoms. Common treatments of each disease include:
Inflammatory bowel disease: Antibiotics, anti-diarrheal medication, anti-nausea medications, corticosteroids, fluid therapies, vitamin supplementation, immunosuppressants
Pancreatitis: Pain medication, anti-nausea medications, fluid therapy
Cholangiohepatitis: Liver and gallbladder protectants (such as ursodiol or Denamarin), antibiotics, anti-nausea medications, pain medications, fluid therapy
Sometimes complications can occur, such as bleeding problems, gallstones, or deficiencies. Your veterinarian will help you monitor your cat for any complications and recommend treatment. You and your veterinarian will also need to closely monitor your cat’s food intake. In cats that have a severely decreased appetite, hospitalization may be required, as anorexia in cats can quickly develop into a life-threatening illness affecting the liver, called hepatic lipidosis. In order to prevent this from occurring, your veterinarian may administer an appetite stimulant or supply nutritional support through either a nasogastric or esophagostomy tube.
Is there a cure for feline triaditis?
Cats can recover from less severe triaditis if they receive the necessary medical treatment, but some symptoms may linger. Inflammatory bowel disease is usually a chronic disease, but it can be medically managed. Whether or not pancreatitis and cholangiohepatitis can be cured depends on the underlying cause and severity of disease.
Is triaditis in cats contagious for humans or other pets?
Some of the underlying causes that can lead to cholangiohepatitis or pancreatitis can be contagious to other cats or humans. The viral infections calicivirus (which can lead to liver disease) and distemper (which can cause pancreatitis) are contagious to other cats. However, most cats are vaccinated against these viruses as part of their distemper combination vaccine (FVRCP).
One of the underlying causes of cholangiohepatitis, toxoplasmosis (a parasitic infection), is transmissible to humans (also known as zoonotic).
What is the cost of treating feline triaditis?
The cost of treating feline triaditis can vary depending on the severity of symptoms and what treatment is needed. It may cost several hundred dollars for the initial basic examination, bloodwork and medications to upward of thousands of dollars more if further testing and supportive care is needed.
Recovery and management of triaditis can depend on the severity of each of the three diseases involved. Inflammatory bowel disease is a chronic condition, whereas pancreatitis and cholangiohepatitis can either be acute (short-term) or chronic (long-term).
Feline triaditis life expectancy
The life expectancy of cats with triaditis depends on the severity of disease. Cats with more severe disease and complications have a poorer prognosis. However, for some cats with milder disease, overall prognosis is usually good if diagnosed early and your cat receives all the necessary treatment and therapeutic support. Partnering with your veterinarian to manage aspects of this complex condition will help your cat to live comfortably and happily.
Often, triaditis is not preventable. However, there are preventive measures that can help remove or lower the risk of outside factors that can contribute to the development of triaditis. These preventive measures include keeping your cat away from toxic substances (such as certain flowers, plants, and human medications). Ask your veterinarian what possible plants, foods, or objects may be within your home that could potentially harm your cat. Additionally, following your veterinarian’s recommendations for annual preventive wellness lab work or medication-monitoring lab work can also help prevent liver disease in your cat.
Is there a vaccine for feline triaditis?
Vaccines can minimize the severity of symptoms of certain viruses, as well as their potential of developing into triaditis should your cat contract a vaccinable disease. Two viruses that vaccines can protect your cat from are calicivirus (a virus that can lead to liver disease), and feline distemper (which can cause pancreatitis), and both are components of your cat’s distemper (FVRCP) vaccine.
While triaditis is a complex disease, if all three diseases are properly diagnosed and treated, your cat can live comfortably and have symptom relief. If you notice any symptoms of inflammatory bowel disease, pancreatitis, or cholangiohepatitis, consult your veterinarian right away. You can help prevent triaditis in your cat by avoiding toxic substances and preventing severe infections through vaccines and wellness check-ups.
