Portal triad disease, or “triaditis,” is a serious but treatable condition occurring primarily in cats. The illness can be complex and difficult to understand, as it involves not one system of the body, but three simultaneously.
What is triaditis?
Triaditis is not a singular illness, but a combination of three separate illnesses that frequently occur together. The three conditions are:
- Pancreatitis – inflammation of the pancreas. The pancreas produces enzymes vital for digestion. This condition can be serious if not treated promptly. Pancreatitis can be caused by injuries or trauma to the abdomen, bacterial infection, high-carbohydrate diets, ingestion of cooked fats, and diabetes. Often the cause is unknown.
- Cholangiohepatitis/Cholangitis – Cholangiohepatitis is inflammation of the liver, gallbladder, and bile ducts. Cholangitis is inflammation of the bile duct. It is largely believed that triaditis in cats commonly starts with this condition.
- Inflammatory Bowel Disease (IBD) – occurs when intestines are chronically inflamed and irritated. Inflammatory cells move into the walls of the GI tract, causing them to thicken. As a result, the digestive tract is unable to absorb and digest the food consumed.
Since these organs are interconnected, inflammation that begins in one system or organ can spread to the other two systems as well. Triaditis presents itself as “acute” or “chronic” and each type can have distinct symptoms that may require different treatment approaches. If not treated, this condition can lead to rupture of the gallbladder and bile peritonitis (inflammation of the abdominal wall).
What causes triaditis?
There are several different scenarios in which triaditis may occur. Bacterial infection is a common cause. Bacteria naturally living in the gut can cause serious problems if they travel to other parts of the body, such as the pancreas or gallbladder. Food intolerances or allergies are another common cause. An allergic reaction to ingredients in pet food can lead to inflammation in the intestines, which again, can spread to the pancreas or bile ducts. Autoimmune disease can mistakenly attack healthy organs and contribute to triaditis.
What are the symptoms of triaditis?
Triaditis in cats can have different symptoms and treatment approaches whether the case is acute or chronic. The symptoms of acute triaditis can be quite severe and occur suddenly. Chronic triaditis comes on slowly, and the symptoms can come and go over time. Chronic triaditis can have acute episodes, and acute triaditis can progress to a chronic diagnosis. The symptoms are much like all cases of liver disease.
The symptoms of acute triaditis include:
- Poor appetite, eating less
- Vomiting and/or diarrhea
- Increased thirst and urination
- Abdominal discomfort, swelling, pain. Cats may appear to be “hunched over”
- Abdominal swelling
- Lethargy, lack of energy
- Jaundice and yellowing of the eyes
The symptoms of chronic triaditis include:
- Poor appetite, eating less
- Weight loss
- Vomiting
- Diarrhea
- Abdominal swelling
How is triaditis diagnosed?
Your veterinarian may need to run several of the following tests to arrive at a triaditis diagnosis.
- A physical exam will show signs of jaundice, and palpation of the liver will uncover abnormal size or abdominal discomfort. Your veterinarian can also check for fever, and weakness during the exam.
- Blood testing including a CBC (complete blood count) and chemistry panel provides insights into the liver’s function. These tests help identify signs of infection or inflammation in the liver, gallbladder or pancreas.
- Urine and fecal testing are performed to rule out other potential causes of the symptoms.
- X-rays (radiographs) are taken to check for gallstones and other potential causes of the symptoms.
- Ultrasound is used to examine the liver, pancreas, and intestines.
- In some cases, endoscopy or surgery may be necessary to directly examine the gut and obtain biopsies.
- CT scan may be used as an alternative imaging method to examine the liver, pancreas, and intestines.
How is triaditis treated?
Depending on the severity of the illness, acute triaditis may require hospitalization. Your veterinarian may administer IV fluids to keep your pet hydrated. A feeding tube may also be indicated if the pet has not eaten in several days. Whether your pet is being treated in the hospital or at home, treatment may include:
- Anti-nausea medication to relieve the vomiting
- Appetite stimulants to encourage them to eat
- Steroids to reduce inflammation
- Medication for pain relief
- Antibiotics if an infection is present
There are a variety of supplements that support liver, pancreas, and intestinal function during treatment. They are especially important if medications such as steroids and antibiotics are needed in acute triaditis cases.
- Antioxidants such as glutathione, SAMe, dandelion root, vitamin E, milk thistle, and artichoke leaf extract help to detoxify the liver, pancreas and intestines, and prevent or slow cell damage caused by inflammation or infection.
- N-acetyl-cysteine (NAC) helps boost glutathione production in the body and remove toxins from the liver.
- Cannabidiol (CBD oil) is anti-inflammatory and protects the liver.
- Turmeric is anti-inflammatory and improves digestion. It is the key ingredient in Golden Paste.
- Probiotics help restore beneficial gut bacteria and stimulate the immune system to decrease inflammation.
- Taurine is recommended for anorexic cats; it should be given until they are eating normally again.
- Vitamin B12 is used by every cell in the body; it supports liver function, amino acid metabolism, and intestinal cell function.
Your veterinarian may recommend a special diet to reduce inflammation in the intestines. Considering the amount of toxins potentially present as well as the lack of real nutrition in dry kibble diets, a species-appropriate gently cooked diet is recommended. Be sure to include dark leafy greens and sprouts to support the liver.
TCVM Treatment of Triaditis
While it may be necessary to use conventional veterinary protocols to stabilize a patient with acute triaditis, Traditional Chinese Veterinary Medicine goes a long way to support a pet through treatment. TCVM can also be used in chronic cases of triaditis.
In TCVM each of the three conditions making up triaditis are closely related. Each involves the accumulation of Damp and Heat in the digestive system. The symptoms of triaditis point to Liver Qi stagnation, and possible Spleen Qi deficiency. This can occur when house pets receive too little exercise and outside exposure. Poor diet also contributes to these factors.
With stagnation of Liver Qi, bile flow will be obstructed, and it will overflow under the skin leading to jaundice. Foods to resolve Liver Qi stagnation include barley, turnip, mushroom, chicken, celery, and dark leafy greens. Avoid fatty foods, mutton, venison, dairy products, and ultra-processed foods (kibble). It is also recommended to feed smaller meals while under treatment.
The Chinese herb Long Dan Xie Gan Tang has long been used to clear Damp-Heat from the liver. The herbal formula Yin Chen Zhu Fu treats cholecystitis, cholangiohepatitis, and cholangitis. It works to warm and tonify the Spleen, eliminates Damp, and reduces jaundice. Yin Chen Hao works to clear Damp-Heat in the liver and resolve jaundice.
Your pet’s constitution can also guide the type of treatment. For example, it is essential that pets with a Wood constitution get regular exercise. It is always a good idea to play regularly with your cat – give them a focus and a game! Try to avoid prolonged exposure to stressful environments as well as damp/hot environments. Therapies such as acupuncture and Tui-na can help alleviate pain, stop vomiting, help move Liver Qi, and eliminate stagnation in the liver and gallbladder.
The life expectancy of a cat with triaditis depends on the severity of the disease. Cats with mild clinical signs can have a very good prognosis with no long-term effects. Cats with severe disease have a poorer prognosis with the potential for lifelong issues. Some of the causes of triaditis can be prevented, but not all. You can minimize the risk of your cat developing triaditis by feeding a high-quality, species appropriate diet. If you choose to change your kitty’s diet, do so slowly. Get regular check-ups and keep good hygiene practices (regularly clean litter boxes and beds). Avoid using toxic substances in your home, and reduce stress by providing a stress-free environment filled with exercise, and fun play.
