felis - Articles
Liver: chronic disease
Introduction
- Cause: malformation, toxicity, neoplasia, endocrinopathy, metabolic (lipidosis), auto-immune (lymphocytic cholangitis), infection.
- Signs: non-specific - lethargy, anorexia, vomiting. Signs of hepatic encephalopathy.
- Diagnosis: biochemistry, hepatic function tests, ultrasonography, hepatic biopsy.
- Treatment: elimination of cause, supportive.
- Prognosis: depends on severity and treatment of inciting factor.
- See also Liver: acute disease Liver: acute disease.
Print off the owner factsheet Liver problems in your cat Liver problems in your cat to give to your client.
Presenting signs
- Insidious onset when reserve functional capacity is lost (>60%).
- Anorexia Anorexia, depression.
- Vomiting, diarrhea.
- Abdominal distension (ascites).
Acute presentation
- End-stage liver failure.
Age predisposition
- <5 yrs - lymphocytic cholangitis and feline infectious peritonitis.
- >6 yrs - hyperthyroidism.
- >10 yrs - neoplasia.
- Middle aged - hepatic lipidosis.
Cost considerations
- Long-term therapy can be expensive.
- Expenses incurred in establishing a diagnosis.
Special risks
- Anesthesia - as many commonly used drugs are metabolized in liver.
Warn owner of increased risk of anesthesia.
Pathogenesis
Etiology
- Idiopathic chronic hepatitis.
- Drugs - cats have a relative sensitivity to many drugs due to low levels of glucuronyl transferase delaying metabolism, eg acetaminophen, griseofulvin, megestrol acetate, ketoconazole.
- Infectious, eg FeLV Feline leukemia virus, FIP Feline sarcoma virus; bacterial, fungal and parasitic.
- Portosystemic shunt (congenital) Congenital portosystemic shunt (CPSS).
- Neoplasia, lymphoma Lymphoma or metastatic.
- Endocrinopathies.
Pathophysiology
- Cumulative hepatic insult → functional reserve capacity exceeded → failure to perform diverse metabolic functions → clinical signs.
- Hepatic functional reserve large → 75% damage before exhausted → periacinar zonal necrosis, infiltration of inflammatory cells due to toxins, living agents and metabolic disease will cause massive damage.
- Decreased production of clotting factors → bleeding tendency.
- Hepatic cellular damage → cellular release of bilirubin → icterus.
- Inflammation of biliary system → partial obstruction to biliary flow → icterus.
- Inadequate bile delivery to intestine → impairment of fat digestion → diarrhea.
- Failure to maintain euglycemia → hypoglycemia Hypoglycemia.
- Decreased production of albumin → hypoalbuminemia.
- Failure to detoxify ammonia and other mercaptans from intestine → hepatic encephalopathy Hepatic encephalopathy.
Diagnosis
Subscribe To View
This article is available to subscribers.
Try a free trial today or contact us for more information.
Treatment
Subscribe To View
This article is available to subscribers.
Try a free trial today or contact us for more information.
Prevention
Subscribe To View
This article is available to subscribers.
Try a free trial today or contact us for more information.
Outcomes
Subscribe To View
This article is available to subscribers.
Try a free trial today or contact us for more information.
Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Godfrey D R & Rest J R (2000) Suspected necrolytic migratory erythema associated with chronic hepatopathy in a cat. JSAP 41 (7), 324-328 PubMed.
- Center S A (1999) Chronic liver disease - current concepts of disease mechanisms. JSAP 40 (3), 106-114 PubMed.
Other sources of information
- Johnson S E (2000) Chronic hepatic disorders. In:Textbook of Veterinary Internal Medicine.5th edn. Ettinger S J & Feldman E C (eds). W B Saunders, Philadelphia. pp 1298-1325.
- Laflamme D P (2000) Nutritional management of liver disease. In:Kirk's Current Veterinary therapy XIII.Bonagura J D (ed). W B Saunders, Philadelphia. pp 693-697.
- Center S A (1996) Feline hepatic disease - Current therapeutic concepts. Proceedings of BSAVA Waltham Symposium on liver disease. pp 56-63.
- Watson T (1996) Nutritional management of canine liver disease. Proceedings of BSAVA Waltham Symposium on liver disease.pp 42-46.
- Michel R (1995) Nutritional management of liver disease. Vet Clin North Am Small Anim Pract 25, 485.