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The liver is
a large and extremely important organ. It is the site of metabolism of
all major components of nutrition, and the site where toxins are
removed from the blood. It also produces the factors needed for blood
to clot. When the liver is damaged by infection, trauma,
inflammation, parasites, medication, tumors, and fatty infiltration, or
when it has a developmental defect, the enzymes in the cells and bilirubin in
the bile ducts enter the blood stream and are detected by routine
blood tests. Sometimes liver enzymes are elevated when the primary
disease is located in other tissues. Most common of these are thyroid,
pancreatic, and intestinal disease. Routine blood tests do not tell us
what the cause of the damage is, only that there is something going on
and further investigation is needed. In some cases the liver damage is
mild, and the cat continues to eat well and show minimal signs of
disease. In other cases the damage is severe, and the cat is very sick.
The clinical
signs of liver disease are generally not specific. They may include:
1.
Loss of appetite
2. Weight loss
3. Lethargy
4. Vomiting
5. Jaundice
6. Tense or painful anterior abdomen.
Initial
treatment is symptomatic and may include intravenous fluid therapy, a
feeding tube to maintain nutrition while the liver is healing,
medications to control vomiting and pain, and vitamin K injections to
reduce the possibility of bleeding. When the patient is stable,
additional testing is required to determine the cause of disease. This
is important to plan an appropriate therapeutic protocol and to
determine the long term prognosis for the condition. Frequently
radiographs or ultrasound are the first steps in diagnosis. These are
followed by biopsy. The liver sample may be collected by a needle
aspirate, a small ultrasound guided biopsy or by surgical exploration.
There are advantages and disadvantages to all of these options. Fine
needle aspiration provides the smallest sample but is the least
invasive for the patient. It provides some information but sometimes
the sample is too small to make a definitive diagnosis. Ultrasound
guided biopsy allows for focused sample collection, the sample size is
larger and the chance of reaching a diagnosis increases. A surgical
biopsy provides the best sample and also allows the surgeon to collect
samples from other organs (intestine, pancreas, lymph nodes) that may
be involved in the disease process.
The
conditions most likely confirmed by biopsy are:
1.
Hepatic lipidosis
2.
Cholangiohepatitis, non-suppurative
chronic
3.
Cholangiohepatitis, suppurative
chronic
4.
Lymphoma or other types of cancer)
5.
Histoplasmosis or other infectious
agents)
6.
Hepatic fibrosis, biliary cirrhosis
Based on
this information, an individualized protocol is designed for the
patient. Some of the common medications used to manage liver disease
are:
1.
SAMe/ silybin - a hepatic protectant
given orally once daily
2.
Vitamin K – a vitamin given by
injection to aid in clotting
3.
Metronidazole - an antibiotic that also
has some anti-inflammatory properties
4.
L-carnitine – an essential nutrient
that is important in liver metabolism
5.
Ursodeoxycholic acid - an oral
medication that increases the flow of bile
6.
Vitamin E (d- alpha tocopherol form) -
an antioxidant given daily until recovery
7.
Vitamin B-12 - given once weekly by
injection, important for cell repair and regeneration
8.
Lactulose - to avoid constipation and
prevent toxins from producing neurologic signs
9.
Prednisolone – immunosuppression,
anti-inflammatory
General
guidelines:
-
Liver diseases are generally
treated for months and most are potentially lethal
without treatment
-
Recurrences are possible
-
Recovery is monitored by repeat
blood testing
-
Successful recovery involves early diagnosis and
diligent nutritional and metabolic support
Liver
disease causes non-specific signs in cats and additional tests are
required to confirm the diagnosis. When prompt appropriate care is
provided, many cats can return to their comfortable, happy feline lifestyle.
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