Page 1119 - Small Animal Clinical Nutrition 5th Edition

Hepatobiliary Disease 1165

Box 68-1 continued
VetBooks.ir

fortified with this amino acid. Homemade vegetable-based foods Figure 2. Interrelationships between the complications of cirrho-
and human enteral foods fed to cats with encephalopathic clinical sis. (Adapted from Abrams GA, Fallon MB. Cirrhosis of the liver
signs should be supplemented with arginine.Arginine levels in food and its complications. In: Andreoli TTE, Bennett JC, Carpenter
CCJ, et al, eds. Cecil Essentials of Medicine, 4th ed. Philadelphia,
should always be above the minimum dietary allowance for adult
PA: WB Saunders Co, 1997; 341.)
maintenance (>0.5% dry matter [DM] in dogs, >1.0% DM in cats).
A dietary arginine level of 1.2 to 2.0% DM in dogs and 1.5 to 2.0%
DM in cats seems appropriate for most patients with liver disease.

The Bibliography for Box 68-1 can be found at www.markmorris.org.

Bile Duct Obstruction in Dogs and Cats adult maintenance-type foods are generally indicated after re-
Extrahepatic bile duct obstruction, which is rarely seen in com- covery. Patients with inflammatory bowel disease, exocrine
panion animals, can be caused by a number of conditions and pancreatic insufficiency or concurrent pancreatitis may require
pancreatitis is thought to be the most common cause in dogs a food with an altered nutrient profile (Chapters 57, 66 and 67,
(Table 68-5) (Neer, 1992). Cholestasis associated with occlu- respectively).
sion of the major bile ducts leads to serious hepatobiliary injury
within a few weeks (Center, 1996d). Obstructed bile flow and Metabolic Alterations in Hepatocellular
the resulting stagnation of bile acids and other compounds in- Dysfunction
jure cell membranes and organelles. Bacterial cholecystitis may Hepatocellular dysfunction is responsible for a number of
develop due to biliary reflux of intestinal bacteria or lymphohe- metabolic disturbances that alter usage of various nutrients
matogenous dissemination. Biliary injury is associated with (Table 68-6). Changes in protein, carbohydrate and fat metab-
cytokine-mediated inflammation and free radical injury. Long- olism are particularly prominent in the fasting state (Marks et
term changes include biliary epithelial hyperplasia, cholangitis, al, 1994; McCullough and Tavill, 1991; Latfi et al, 1991; Bauer,
multifocal parenchymal necrosis, fibrosis and cirrhosis (Center, 1986, 1996; Chang et al, 1996). Attempts to correct these alter-
1996d). Coagulopathies associated with vitamin K deficiency ations by manipulating nutrient supply represent an important
may develop within three weeks. strategy in the management of patients with significant hepat-
Most patients with bile duct obstruction are candidates for ic disease.
exploratory celiotomy and corrective surgery. Enteral- or par- Impaired hepatic metabolism and storage may result in vita-
enteral-assisted feeding is often used before and after surgery min and mineral deficiencies. A combination of these metabol-
while the patient recovers (Chapters 25 and 26). Appropriate ic and storage problems usually exists in patients with hepatic