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Liver: lipidosis
Introduction
- Accumulation of fat in >50% of hepatocytes.
- Cause: idiopathic, secondary to systemic illness.
- Signs: anorexia, jaundice, vomiting, diarrhea, constipation, weight loss.
- Diagnosis: liver biopsy including fine needle aspiration (FNA).
- Prognosis: fair-good, reversible if underlying disease controlled.
Presenting signs
- Due to hepatic dysfunction +/- underlying disease.
- Jaundice
. - Gastrointestinal signs:
- Most commonly anorexia and vomiting.
- Less often diarrhea or constipation.
- Hepatic encephalopathy Hepatic encephalopathy - depression, ptyalism, weakness.
- Period of anorexia 2-7 days +.
- Often obese cats but can be seen in thin patients.
- May be associated with many diseases including acute pancreatitis Pancreatitis, inflammatory bowel disease Inflammatory bowel disease: overview, cholangitis Liver: cholangitis, hyperthyroidism Hyperthyroidism and diabetes mellitus Diabetes mellitus.
Geographic incidence
- Common in USA.
- Increasingly recognized in UK.
Age predisposition
- Can develop in cats of any age but most commonly middle-aged (median age 7 years).
Cost considerations
- Diagnostic tests to confirm hepatic lipidosis (biochemistry, hematology, imaging and tissue sampling of the liver).
- Evaluation for underlying cause.
- Supportive treatment including placement of enteral feeding tubes, fluid therapy and medications.
Pathogenesis
Etiology
- Idiopathic - between 1-50% of reported cases.
- 50-98% of cases reported secondary to systemic disease, eg neoplasia, diabetes mellitus Diabetes mellitus, hyperthyroidism Hyperthyroidism, hyperadrenocorticism Hyperadrenocorticism.
- Syndrome characterized by hepatocellular lipid accumulation, intrahepatic cholestasis and abnormal hepatic function.
- Pathophysiology incompletely understood and is likely due to multiple mechanisms including:
- Chronic overnutrition and excess caloric intake leading to increased hepatic triglyceride content.
- Increased mobilization of fat from peripheral stores Hyperlipidemia overwhelms hepatic fat utilization and/or mobilization capacity.
- Increased hormone sensitive lipase activity (via increased levels of noradrenaline, adrenaline, cortisol, growth hormone, glucagon and thyroxine) promotes lipolysis.
- Decreased rate of fatty acid oxidation.
- Increased hepatic fat synthesis.
- Decreased mobilization of fat from liver as lipoproteins.
- Relative carnitine deficiency - carnitine is required for fatty acid transport into and out of hepatocytes.
- Resistance to insulin activity (hence reduced lipoprotein lipase activity, which cause lipid uptake and reduced inhibition of hormone sensitive lipase).
- Protein-calorie malnutrition.
- Nutrient deficiencies (taurine, arginine, methionine, cysteine, vitamin K1 and B-vitamins).
Predisposing factors
General
- Obesity Obesity.
- Anorexia.
- Caused by illness, change in diet, environmental factors and stress (eg boarding cattery stay, introduction of new cats to household).
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Armstrong P J, Blanchard G (2009) Hepatic lipidosis in cats. Vet Clin North Am Sm Anim 39 (3), 599-616 PubMed.
- Centre S A (2005) Feline hepatic lipidosis. Vet Clin North Am Sm Anim 35 (1), 225-269 PubMed.
- Chastain C B, Panciera D, Waters C (2000) Metabolic and hormonal alterations in cats with hepatic lipidosis. Sm Anim Clin Endocrinol Sept-Dec 10 (3), 10.
- Griffin B (2000) Feline hepatic lipidosis: pathophysiology, clinical signs and diagnosis. Compend Contin Educ Pract Vet 22 (9), 847-858 VetMedResource.
- Griffin B (2000) Feline hepatic lipidosis: treatment recommendations. Compend Contin Educ Pract Vet 22 (10), 910-922 VetMedResource.
- Center S A (1999) Chronic liver disease - current concepts of disease mechanisms. JSAP 40 (3), 106-114 PubMed.
- Willard M D, Weeks B R, Johnson M (1999) Fine needle aspirate cytology suggesting hepatic lipidosis in four cats with infiltrative hepatic disease. J Fel Med Surg 1 (4), 215-220 PubMed.
- Dimski D S (1997) Feline hepatic lipidosis. Semin Vet Med Surg (Small Anim) 12 (1), 28-33 PubMed.
- Akol K G, Washabau R J, Saunders H M et al (1993) Acute pancreatitis in cats with hepatic lipidosis. JVIM 7 (4), 205-9 PubMed.
- Center S, Crawford M, Guida J et al (1993) A retrospective study of 77 cats with severe hepatic lipidosis: 1975-1990. JVIM 7 (6), 349-59 PubMed.
Other sources of information
- Holan K M (2008) Feline hepatic lipidosis. In: Kirks's Current Veterinary Therapy XIV Small Animal Practice, Ed Bonagura J, Twedt D, Missouri, Elsevier Saunders. pp 570-575.