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Hepatic Lipidosis

VetBooks.ir ABOUT THE DIAGNOSIS cats require general anesthesia). Biopsy samples can be obtained
via abdominal surgery—an operation—or using minimally invasive
methods: ultrasound-guided core biopsy, or using a camera and
Hepatic lipidosis is a very serious but potentially curable liver
disease of cats. This disease occurs most commonly in cats that small openings into the abdominal cavity—laparoscopy. Depending
are overweight to obese and have undergone a period of abruptly on the extent of the required liver specimen, cats may comfortably
decreased appetite (inappetence) or excessively rapid weight loss. In undergo the procedure awake (if just a fine-needle aspiration is
the healthy cat, the liver performs many functions that are critical to sufficient) or may require anesthesia if a true solid tissue biopsy is
life. These functions include making, breaking down, and temporarily required. The decision about which type of procedure is best varies
storing fats. If the cat does not eat for a period of time, fat that from case to case and is made based on the information derived up
is stored elsewhere in the body is moved to the liver where it is to that point; generally a biopsy is preferred but very ill cats who are
broken down or metabolized into energy that the body uses as poor anesthetic candidates may only tolerate a fine-needle aspirate,
fuel. However, the liver can become overwhelmed by the amount for example. Some cats with hepatic lipidosis are too unstable to
of fat that it suddenly receives from the rest of the body. If this undergo liver sampling, and the diagnosis may be suspected based
happens, fat accumulates in the liver and interferes with many other on the blood tests and ultrasound exam findings.
functions that the liver is required to perform to keep a cat healthy.
LIVING WITH THE DIAGNOSIS
Causes: There are many reasons why cats lose their appetite with Hepatic lipidosis can become life-threatening if left untreated. There-
no apparent underlying illness. Any change in the cat’s environment fore, initial treatment usually involves intensive care. It is common
such as a diet change, the presence of new pets in the household, for hepatic lipidosis to take several days of treatment before it is
or moving to a new house or apartment can negatively affect a cat’s clear whether the situation is improving or deteriorating, and even
food intake. Situations that may not seem stressful to people can then, a hospital stay of several more days is commonly necessary
actually be very stressful for cats, and many cats respond by not before a cat is self-sufficient and able to go home. Discharge
eating. Some diseases can predispose or occur at the same time to home care is sometimes possible after several days if close
as hepatic lipidosis and cause a sense of nausea or unwillingness attention and treatment can be provided in the home, but even
to eat; they include intestinal diseases such as inflammatory bowel under the best circumstances, hepatic lipidosis is a disease that
disease, various types of heart disease, constipation, diabetes requires extensive and intensive initial treatment (hospitalization for
mellitus, and pancreatitis. Cats that consume diets deficient in 3 to 6 days is typical). For this reason, your veterinarian may want
certain building blocks of proteins (amino acids) may be at risk of to discuss with you whether a second opinion with a veterinary
developing hepatic lipidosis. In many cases, the specific cause of internal medicine specialist is desirable, and may refer you to a
hepatic lipidosis in an individual cat is never known. board-certified small animal internist for that reason (directories:
www.acvim.org or www.vetspecialists.com [North America] and
Symptoms: Outward symptoms (clinical signs) of hepatic lipidosis www.ecvim-ca.org [Europe]).
are often not very specific and simply reflect a cat that is not If the cat responds well to treatment and hepatic lipidosis is
feeling well. These symptoms may include weakness, decreased cured, it does not commonly recur. The exception is if there is
alertness or hiding, a new onset of vomiting, excessive drooling/ persistent obesity or other unrelated illnesses that can flare up
hypersalivation, and a yellow tinge to the skin and/or the white of and trigger periods of appetite loss, initiating hepatic lipidosis once
the eye (icterus/jaundice). again. There are no known long-term adverse effects of hepatic
lipidosis after it is treated successfully.
Diagnosis: To help your veterinarian determine if your cat has
hepatic lipidosis, it is important to for you to provide what you know TREATMENT
of your cat’s recent medical and environmental history, including Hepatic lipidosis is a potentially critical illness that often requires
diet, any changes in the household, periods of loss of appetite, and intensive care and good nutrition (not too little, not too much)
if your cat has ever been diagnosed with another medical problem as the cornerstones of immediate treatment. Unfortunately, liver
or is taking medications. Your veterinarian will likely need to perform diseases in general often make cats unwilling to eat, and failure to
tests, since the initial symptoms of hepatic lipidosis are nonspecific eat causes hepatic lipidosis to worsen. The goal of treatment is to
and may easily be confused with symptoms of other, completely put the cat in a positive calorie balance (meaning it is consuming
different problems. A blood sample is usually drawn to assess how more calories than it is burning). Occasionally, cats that are still
the liver and other organs are functioning, and to help pinpoint the eating even a small amount may respond to appetite-stimulant
liver as the source of the problem. X-rays of the abdomen (belly) medications, feeding tubes placed through the nose, warming of the
often are needed to screen for abnormalities that could influence the food, coaxing, and other measures to encourage appetite. These
liver and contribute to its malfunction. An ultrasound examination measures make it possible to avoid placing a feeding tube and are
may be performed since it is the test of choice for looking within worth trying only in cats with very mild cases of hepatic lipidosis.
the liver tissue. An ultrasound exam of the liver in a cat is exactly However, most cats require the placement of a temporary feeding
the same as a sonogram (ultrasound) for a person, except that a tube as a way of allowing the cat to maintain a positive calorie
cat’s hair usually needs to be shaved from the abdomen for clearer balance, thus allowing the cat to regain strength and overcome
ultrasound images. Together, these tests help to pinpoint the liver the disease. This allows both food and medications to be given
as the source of the problem, or identify impostor diseases and without handling the cat’s head and mouth and force feeding,
avoid the wrong treatment if in fact the cat has a disease other than which many sick cats resent and which can trigger nausea. Such
hepatic lipidosis. The definitive diagnosis of hepatic lipidosis requires a feeding tubes are temporary; they can be left in place for a few
small needle aspirate or biopsy sample of liver tissue (which in some days, or as long as several weeks, as needed.

From Cohn and Côté: Clinical Veterinary Advisor, 4th edition. Copyright © 2020 by Elsevier Inc. All rights reserved.