Feline Triaditis

By Rebecca Kimsey

What is Feline Triaditis?
Triaditis is a broad term used to indicate that a cat has three specific and concurrent conditions: Inflammatory Bowel Disease (IBD), chronic pancreatitis, and chronic cholangitis, i.e. inflammation of the liver. It is not in and of itself a disease. There are relatively few studies about triaditis in felines, although the human condition is more extensively studied, but is different in nature from that of cats. “’Triaditis’ is the term coined many years ago in a lecture by David Twedt in the USA to denote concurrent chronic cholangitis, chronic pancreatitis and inflammatory bowel disease in cats. The term as used for cats, has gained widespread acceptance as a short-hand way of reminding us that these three conditions can occur together in cats.”

There’s some disagreement in vet circles as to what initially causes any of these diseases, and which is the main culprit. In some literature, it’s felt that liver inflammation leads to the others, while others claim that IBD is the primary cause. But my kitty Boston developed acute pancreatitis first, followed by IBD, and within several months’ time, cholangitis. An argument is made that a cat’s anatomy, the close alignment or joining of ducts from the liver and pancreas into the small intestine can permit inflammation to travel from any of the three organs to the other two.

“Triaditis refers to a syndrome of concurrent inflammatory diseases of the liver, pancreas, and small intestines in cats. Veterinarians believe that the initial symptoms of Triaditis are due to liver disease (cholangitis), with pancreatitis (inflammation of the pancreas) and inflammatory bowel disease (IBD) being secondary. However, some cats may first develop IBD, then pancreatitis and cholangitis. Feline anatomy is the likely reason these 3 inflammatory diseases occur simultaneously. In cats, the liver’s main bile duct and the pancreatic bile duct share a single opening into the small intestine (duodenum). Additionally, the feline duodenum is believed to have 100 times more bacteria than the canine duodenum. Therefore, a cat’s vomiting may cause bacteria-laden intestinal fluid to move into the pancreas and the liver through this common opening, which can cause inflammation and bacterial infection in the liver and pancreas.” http://www.drsfostersmith.com/pic/article.cfm?articleid=3040

All three diseases that comprise triaditis have very similar symptoms, which is one reason why it can be difficult to diagnose what’s going on. Vomiting, lethargy, inappetence (anorexia) and/or weight loss are the most common symptoms for all three diseases. Diarrhea is more common to IBD, while severe pain is most common in pancreatitis. Of course, just to confuse us: some kitties have very few of these symptoms.

Beyond physical symptoms, blood serum tests are used to varying degrees in diagnosing the individual diseases, along with imaging technologies. X-rays are of limited use, particularly in viewing the pancreas, so ultrasound is a primary tool. Biopsies may be recommended, but should be carefully discussed as to the benefits vs drawbacks.

General treatment
Since triaditis is simply a term to describe these three conditions, there is not a treatment specifically for it. But since IBD, pancreatitis and cholangitis share many similar symptoms, treatments for the individual diseases also share many similarities. Steroids and/or antibiotics can be prescribed to address inflammation, and are most commonly used in IBD, and to a much lesser degree in pancreatitis. Anti-emetics and anti-nausea medicines are given for vomiting and nausea and ensuing inappetence, while appetite stimulants can be used to get a kitty to eat again. Fluids are used to address any dehydration issues. Pain medications are much more frequently needed for pancreatitis, which is often very painful.

Diet is of course an important part of treatment: specifically, to make sure a cat eats enough calories to stave off hepatic lipidosis (fatty liver disease). Anyone with a ‘finicky’ sick cat knows how tricky this can be. Most veterinarians have been trained to use ‘prescription’ cat foods, and will recommend them most of the time. While some kitties will do fine on them, many will do better on grain-free wet food: good quality commercial canned foods, home-cooked or raw. Both of the latter must be supplemented to be balanced. One concern often raised about the diet for a pancreatic cat is the fat content. But unlike humans and dogs with pancreatitis, fat has not been found to be a primary culprit in feline pancreatitis.

For more specific information about each of the triad diseases, refer to these IBDKitties articles
Inflammatory Bowel Disease

Liver Disease
There are quite a few terms used for the various types of liver disease in cats: cholangitis, cholangeohepatitis, triaditis, triad disease, cholangitis-cholangeohepatitis disease (CCHS), hepatic lipidosis (aka Fatty Liver disease). In medical terminology in ‘itis’ indicates inflammation. Each of the named diseases ending in ‘itis’ refers to specific issues and/or areas of the liver that are affected by some type of inflammation. While triaditis or Triad Disease is referring to inflammation in the triad region of the liver, it is also used to describe cats with three gastric organs with inflammatory diseases: pancreatitis, Inflammatory Bowel Disease (IBD) and liver disease.

An overlying concern with inflammatory gastro-intestinal disease is the condition called hepatic lipidosis or Fatty Liver disease. Hepatic lipidosis is not an inflammation per se, but rather a reaction to problems created by inflammation in the organ, which can cause or contribute to a cat suddenly exhibiting inappetence, nausea or vomiting. Without prompt intervention (within a day or two at most) in ensuring sufficient calories are consumed and digested, the build-up of fat in the liver can ultimately prove fatal.

There are several other conditions that affect the pancreas: EPI, Diabetes, SIBO.

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