Liver Disease in Cats

There are two types of liver disease that are common to cats. One is "Cholangitis" (cholangiohepatitis), and the other is "Fatty Liver Disease" (hepatic lipidosis).

CHOLANGITIS

This type of liver disease can be characterized by sporadic illness that comes and goes, and is generally considered to be less serious than "Fatty Liver Disease". However, left untreated, Cholangitis can result in liver failure. Cholangitis, which is an inflammatory process involving the biliary ducts, can also be associated with both FeLV (feline leukemia) and FIP (feline infectious peritonitis).

Treatment of Cholangitis usually involves antibiotics and supportive therapy such as "dehydrocholic acid" (Decholin Rx) if bilirubin levels are high. Often, appetite stimulants are given ("Valium" is the one most often used in cats), and many vets also recommend administration of corticosteroids or other immunosuppressive medications. It is important to try to determine the cause of the Cholangitis, if possible, as changes in the cat's diet may be helpful, depending upon the exact cause of the liver problems.

Since corticosteroids can be very dangerous for cats with hepatic lipidosis, it is very important before starting treatment, to have a liver biopsy performed. If your vet does not perform this procedure, ask him or her to refer you to a feline internal medicine specialist. It is always a good idea to take blood work and also to perform X-rays prior to doing a liver biopsy to be sure there aren't any other contributing factors to your kitty's condition. Most vets want to try to identify the cause of the liver enzyme increases if possible.

Cats with Cholangitis usually do better on a diet that has very good quality protein in limited amounts. Your vet can assist you in providing the proper nutritional therapy for your cat with Cholangitis. All cats with liver disease seem to do much better with small meals given on a very frequent basis.

FATTY LIVER DISEASE

Hepatic lipidosis is the accumulation of fat within the liver, and it may be secondary to some other condition or illness in the animal, or it can just occur on its own. Most cats that develop this disease are somewhat obese at the onset of the disease, and have often led a very pampered life. It is thought (although not known for sure) that STRESS (usually major changes in the home environment of the cat such as moving, adding a new kitten/cat/dog, and for some sensitive kitties, when YOU are under stress because they feel it too) is the main catalyst to bring on this condition, which begins by the cat stopping eating, even for just a day or two. This is the presentation of the cornerstone of Fatty Liver Disease, which is ANOREXIA. The fat, or lipid cells, in the cat then are mobilized in the liver, which is unable to utilize them. The mechanism for the inability of the liver to break down the fat cells is not fully understood, but it may be caused by a deficiency in certain proteins.

There has been some research into the possibility that a deficiency in Arginine , one of the amino acids, may play a role in the development of Fatty Liver Disease. Cats cannot synthesize arginine, and during fasting (anorexia), some cats may be able to obtain some arginine from the break down of muscle protein; however, supplies may be limited. Arginine is necessary for proper function of the urea cycle in converting ammonia to urea; therefore, a deficiency in arginine may cause hyper-ammonemia.

Another possible cause of Fatty Liver Disease may be damage to mitochondria in the liver, due to toxic substances, drugs such as tetracycline, or even severe obesity leading to a high degree of fat accumulation.

Fatty Liver Disease is the most commonly reported liver problem in cats, and the average age for this disease to occur is 8 years, although instances have been reported in cats from ages 1 year old to 16 years old. The signs of Fatty Liver Disease are: anorexia; weight loss; vomiting; loss of muscle (especially in the hind legs and hips); and depression. As the disease progresses, stupor and coma may follow, or the cat may have seizures and excessive salivation with head-pressing. Cats at high risk for contracting Fatty Liver Disease are those cats who are overweight, who experience anorexia from any cause including stress from changes in their environment, and those cats who have any illness resulting in chronic anorexia.

Some of the signs of Fatty Liver Disease can also occur in cats with Cholangitis, FIP, Pancreatitis, and Hepatic neoplasia. All the above conditions can be ruled out by having a liver biopsy performed. Since cats with advanced hepatic lipidosis are often anesthetic risks, most veterinarians prefer to perform a percutaneous or laparoscopic needle biopsy using a Vim Tru-cut needle. A fine needle aspiration with a 22-gauge, 1 in. needle may also provide an adequate specimen for impression smear cytology and presumptive diagnosis.

Cats that are severely ill with Fatty Liver Disease will need to be hospitalized as critical care patients. Outpatient care is definitely preferable with this disease, but requires a great deal of commitment and work on the part of the owners of the cat. Outpatient care involves minimizing stress (which promotes anorexia), and continuous feeding and fluid therapy. The diet therapy is the main focus in the treatment of this disease, and is targeted at reversing the anorexia, and ultimately, reversing the liver disease. A high protein, high calorie diet should be fed in amounts designed to meet the cat's energy needs. Your vet will help you determine what and how much to feed your cat. For most cats with Fatty Liver Disease, vomiting is such a large problem that a stomach tube needs to be surgically inserted in to the cat to enable home care and feeding. There are three types of stomach tubes that can be put in to assist your cat; all go through the esophagus, and one runs through the nose, one comes out the neck, and the third comes out through the abdomen.

Valium is also used as an appetite stimulant for cats with Fatty Liver Disease, and another medication is often used to help with nausea. Anti-nausea medications such as Reglan Rx, Propulsid Rx, or Tagamet Rx can be given orally 15 minutes prior to force feeding, to help keep vomiting to a minimum. There are many different anti-nausea medications your vet can prescribe for your cat, so if the one you start with isn't working, ask your vet to recommend and prescribe another. You may have to try a few until you find the one that works best for your cat.

Cats with Cholangitis and Fatty Liver Disease need to be monitored by you and your vet for weight gain or loss, and for hydration status. There may need to be adjustments to the dietary and fluid therapies as the disease remits. Blood work should be done every 1-2 weeks, or as your vet feels is warranted, to know the status of the disease. Your vet will depend greatly upon you and your intuitive feelings as well as your own observations to do much of this care and monitoring, because keeping stress (such as trips to the vet, etc.) to a minimum is very important for the recovery of your cat. You should also keep your cat in an environment where s/he feels safe and secure, and is not competing with any other cats or animals. Improvement in cats with liver disease should be observed within 2 to 3 weeks after initiation of treatment. For cats that have had stomach tubes put in, the tubes can be removed from 5 to 7 days after the cat is eating normally.

Some things to keep in mind to help prevent liver disease in cats are to try to prevent obesity in your cat. Also, any weight reduction plan in an obese cat should be undertaken VERY slowly and carefully. Cats switched to special weight reduction diets should be carefully monitored to be sure they are taking in an adequate amount of food. All cat owners should watch their cats very carefully, especially during periods of family stress such as moving or the addition of a new member to the family, to be sure that each cat is continuing to eat well and adequately. When you know that your cat is in a period of stress (such as during a move, or when there is an addition or loss to the family, etc.), it is perhaps a wise idea to go ahead and force-feed your kitty several times a day during the period of crisis; therefore, not allowing the anorexia any opportunity to take hold again.

With aggressive tube feeding and/or diet therapy and fluid therapy, 60% of cats with primary Fatty Liver Disease survive and return to normal, while without this long-term commitment and follow-through on the part of the owners, only 10% will recover.

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