Page 1139 - Small Animal Clinical Nutrition 5th Edition

Hepatobiliary Disease 1185

Table 1. Laboratory data from a miniature poodle with steroid hepatopathy.
VetBooks.ir Parameters Day 0 Day 12 Day 19 Day 56 Day 110 Day 142 Day 214 Reference values
106
10-80
3,080
313
4,990
4,960
26
>400
Alkaline phosphatase (IU/l)
Alanine aminotransferase (IU/l)
10-70
45
0.3
1.8
<1.0
na
na
1.4
Cortisol, resting (µg/dl) 1,380 1,600 1,450 >500 184 236 12.3 0.5-4.0
Cortisol, post-ACTH (µg/dl) na na 0.5 <1.0 1.9 1.7 17.5 8.0-20.0
Key: na = information not available.
the day to help control nausea and vomiting.
3. Physiologic doses of oral hydrocortisone may be given to alleviate glucocorticoid deficiency (and control clinical signs such as
lethargy and vomiting) while not exacerbating the liver disease. The patient should also avoid stressful environmental situations
because it cannot respond normally to these events.
4.Serum liver enzyme activity and plasma cortisol concentrations (resting and post-ACTH) should be monitored every two months
until they return to normal. The clinical signs of lethargy, vomiting and hepatomegaly should resolve as biochemical parameters
improve.
Progress Notes
The dog made an uneventful recovery from surgery and was discharged to the owners’ care three days later. Other than the single
triamcinolone injection, no other sources of exogenous corticosteroids were identified.
b
In the hospital, the dog began eating a moist specialty brand dog food formulated for senior dogs (Science Diet Canine Senior ).
This food was nutritionally balanced compared with the combination of commercial dog food, chicken and cottage cheese offered
at home. The DER was estimated to be 1.2 to 1.4 x resting energy requirement (RER) for an ideal weight of 4.5 kg (250 to 290
kcal [1.0 to 1.2 MJ]; two-thirds to three-fourths can daily). The food was offered in small frequent meals throughout the day. The
owners were also instructed to add water to the food or warm the food in a microwave oven if it was necessary to encourage accept-
ance.
No other treatment was given because the secondary hypoadrenocorticism and steroid hepatopathy were expected to resolve as
the effects of the injectable triamcinolone decreased over the next several months. Recheck examinations over the next six months
documented clinical improvement and gradual reduction in liver enzyme activity (Table 1, Days 56 to 214). Plasma cortisol con-
centrations returned to near normal by Day 214. The dog remained normal for the next three years before it died from complica-
tions of immune-mediated thrombocytopenia.
Endnotes
a. Vetalog Parenteral. Solvay Animal Health, Mendota Heights, MN, USA.
b. Hill’s Pet Nutrition, Inc., Topeka, KS, USA. This food is currently available as Science Diet Mature Adult 7+ Canine.
Bibliography
Center SA.Vacuolar hepatopathy/glucocorticoid hepatopathy. In: Guilford WG, Center SA, Strombeck DR, et al, eds. Strombeck’s
Small Animal Gastroenterology, 3rd ed. Philadelphia, PA: WB Saunders Co, 1996; 782-788.

CASE 68-3

Anorexia and Icterus in a Domestic Shorthair Cat
Rebecca L. Remillard, PhD, DVM, Dipl. ACVN
MSPCA Angell Animal Medical Center
Boston, Massachusetts, USA

Patient Assessment
A six-year-old neutered female domestic shorthair cat was referred for a one-month history of weight loss and a week-long histo-
ry of vomiting, icterus and anorexia.The cat was kept exclusively indoors.The family had relocated to the state two months before
the cat was presented to the referring veterinarian. The referring veterinarian treated the cat with intravenous fluids.
Physical examination revealed a depressed, cachectic cat (body weight 3.1 kg, body condition score [BCS] 1/5).The cat’s mucous
membranes, sclera, inner pinnae, lips and nose were icteric. Mild hepatomegaly was detected by abdominal palpation. Dehydration