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