Liver: cirrhosis in Cats (Felis) | Vetlexicon
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Liver: cirrhosis

ISSN 2398-2950


Introduction

  • Hepatic degeneration, necrosis, regeneration, fibrosis.
  • Cause: end-stage of chronic hepatic disease.
  • Signs: jaundice, anorexia, depression, weight loss, ascites, vomiting, diarrhea, neurological signs.
  • Diagnosis: histopathology, blood biochemistry, hepatic function tests.
  • Treatment: symptomatic management.
  • Prognosis: poor.

Presenting signs

  • Jaundice Jaundice .
  • Anorexia.
  • Depression.
  • Weight loss.
  • Ascites  Ascites 01: whole cat  Ascites 03: whole cat  Ascites 02: whole cat .
  • Vomiting.
  • Diarrhea.

Geographic incidence

  • Worldwide.

Cost considerations

  • Low to moderate 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

Pathophysiology

  • Loss of hepatic function   →  
    • Impaired fat digestion and metabolism and increased mobilization from peripheral stores   →   hyperlipidemia.
    • Impaired carbohydrate metabolism   →   hypoglycemia or hyperglycemia.
    • Impaired protein synthesis   →   catabolism of body protein   →   increased ammonia levels and cachexia.
    • Loss of detoxifying capacity and development of arteriovenous shunts   →   hepatic encephalopathy Hepatic encephalopathy.
    • Altered metabolism of hormones   →   disrupted circulating hormonal levels, eg insulin, glucagon, growth hormone, insulin-like growth factors, corticosteroids, catecholamines   →   polydipsia/polyuria (due to increased corticosteroids in liver failure), fluid retention.
    • Decreased synthesis of clotting proteins, along with vitamin K deficiency due to anorexia and fat maldigestion due to lack of bile acids   →   coagulation disorders.
  • Acute fulminating liver failure   →   release of tissue thromboplastins and other stimulators of coagulation   →   DIC.
  • Portal hypertension +/- concurrent hypoalbuminemia   →   ascites.
  • Jaundice   Jaundice  develops as result of failure of the hepatocytes to remove unconjugated bilirubin form circulation.
  • In the normal animal this unconjugated bilirubin is conjugated with glucoronic acid which is excreted in the bile.
  • Accumulation of bilirubin in the tissue results in yellow discoloration.

Timecourse

  • Weeks, months.

Diagnosis

Presenting problems

  • Ascites.
  • Jaundice.
  • Anorexia.
  • Weight loss.
  • Vomiting Vomiting.
  • Diarrhea.

Client history

  • Chronic liver disease.

Clinical signs

  • Icterus.
  • Ascites Ascites 01: whole cat  Ascites 03: whole cat  Ascites 02: whole cat .
  • Small liver on abdominal palpation.
  • Bleeding disorder.
  • Confusion, head pressing, seizures.
  • Poor body condition.

Diagnostic investigation

Biochemistry

Radiography

  • Survey films to demonstrate reduced size Liver: microhepatica - radiograph lateral  +/- ascites  Abdomen: ascites - radiograph lateral .

2-D Ultrasonography

  • To demonstrate size of liver Liver: normal - ultrasound , and often detects diffuse change in density.
  • May see changes in gall bladder/bile ducts +/- bile sludging.

Histopathology

  • Biopsy.
    Take 3 biopsies when using percutaneous method, as may miss lesions if only 1 biopsy obtained.

Confirmation of diagnosis

Discriminatory diagnostic features

  • Hepatic function tests.

Definitive diagnostic features

  • Hepatic biopsy.

Gross autopsy findings

  • Liver morphology similar for many etiologies, so examine all organ systems to help interpretation.
  • Liver morphology abnormal - smaller, firmer, often with nodules.
  • Microhepatica.

Histopathology findings

  • Parenchymal nodular regeneration, fibrosis and often, biliary proliferation seen - architecture distorted irreversibly.
  • Necrosis, regeneration and fibrosis.
  • May be monolobular or multilobular.
  • Trichrome staining better demonstrates fibrosis.

Differential diagnosis

  • Chronic hepatitis.
  • Chronic hepatopathies:
    • Hepatic neoplasia.
    • Vascular hepatopathy.
  • Idiopathic hepatic fibrosis.

Treatment

Standard treatment

Monitoring

  • Repeat hepatic function tests.

Subsequent management

Monitoring

  • History, clinical signs.

Prevention

Outcomes

Prognosis

  • Poor: changes progressive and irreversible.

Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • 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.