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

• 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