Practitioner reality – How I deal with hepatic lipidosis (Proceedings)

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Practitioner reality – How I deal with hepatic lipidosis (Proceedings)

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Apr 01, 2009

  • Hepatic lipidosis accounts for approximately 50% of feline liver disease
  • Excessive accumulation of fat in the liver
  • Can be primary or secondary
  • Early diagnosis makes for the best prognosis!!

Signalment

  • Majority of cats have history of obesity, may still be obese at time of detection
  • Any age, no breed or sex predilection
  • Typically a history of some sort of stress to the cat

o Food change
o Housing change
o Infection/other disease
o Inappetance for days to weeks

Physical exam findings

  • Weight loss
  • Muscle wasting
  • Depression
  • +/- history of vomiting
  • Icterus occurs gradually
  • Dehydration
  • Mild hepatomegaly
  • With severe liver failure, signs of hepatic encephalopathy may be present, clotting disorders may be present

Diagnosis
  • Elevated AlkPhos, NORMAL GGT
  • Alt and Ast typically not as significantly elevated
  • CBC – boring, possible stress leukogram
  • If lipidosis is secondary to other disease process, there may be evidence of primary disease on bloodwork results
  • Rads – mild hepatomegaly
  • Ultrasound – hyperechoic liver
  • Definitive diagnosis is made with biopsy

Differential diagnosis

  • Neoplasia
  • Chloangiohepatits
  • Hemolytic disease?
  • Any cholestatic disease process

Treatment

  • Aggressive nutritional support
  • Manage concurrent disease if present

Prognosis

  • Greater success rate with earlier detection, can be over 80% if caught early and treated aggressively
  • If signs of more significant liver failure are present (hepatic encephalopathy, clotting disorders) prognosis for survival is <40%
  • Once recovered, there is no increased risk of further liver disease or recurrence of lipidosis

Practical management

  • Hospitalize the cat – manage fluid and electrolyte imbalances
  • Place a feeding tube – whichever kind you are comfortable with
  • Control vomiting
  • Feed the cat!

o 50% of nutritional needs (based on a healthy weight) divided among several feedings for the first 1-2 days
o If tolerating feedings well, increase to 100% of nutritional needs by day 4-5.
o Do not offer any food until after day 5-7. Ok to leave water available.
o Make sure hydration needs are being met as well.
  • Weigh the cat weekly
  • Change bandage weekly or as needed
  • Support the client!!
  • Manage concurrent diseases or issues