Feline triaditis: cholangitis, pancreatitis and enteropathy
9-year-old domestic shorthair cat with chronic intermittent vomiting, anorexic and icteric over the last week.
| Parameter | Result | Reference |
|---|---|---|
| ALT | 310 U/L | 20–100 |
| Alkaline phosphatase (ALP) | 165 U/L | 10–80 |
| GGT | 14 U/L | 0–5 |
| Total bilirubin | 3.2 mg/dL | 0.0–0.4 |
| Spec fPL | 9.8 µg/L | ≤ 3.5 |
| Cobalamin | 190 ng/L | 290–1,500 |
Which explanation best fits this picture?
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A. Triaditis: concurrent inflammation of the biliary tract, pancreas and small intestine
Correct. In cats the main pancreatic duct and the common bile duct open together into the duodenum, and the duodenal bacterial load is higher than in dogs; both favour inflammation involving all three organs. The data support cholangitis (high GGT), pancreatitis and enteropathy (low cobalamin).
B. Primary hepatic lipidosis due to anorexia
In lipidosis ALP rises much more than GGT, which is usually normal. Here GGT is clearly raised and there were chronic signs beforehand, indicating underlying biliary disease (although secondary lipidosis may develop).
C. Hyperthyroidism with secondary liver involvement
Hyperthyroidism raises ALT and ALP, but does not cause jaundice or increases in GGT or fPLI, and it causes polyphagia, not anorexia.
D. Endogenous corticosteroid hepatopathy
Unlike dogs, cats have no corticosteroid-induced ALP isoenzyme and steroid hepatopathy is rare. It does not explain the jaundice, the fPLI or the low cobalamin.
lightbulb Key takeaway
In a cat with hepatobiliary, pancreatic or intestinal disease, look for involvement of the other two organs. Measure fPLI, cobalamin and folate, and consider bile cytology and culture if you suspect neutrophilic cholangitis.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.