The most common cause of liver failure in cats is idiopathic hepatic lipidosis. The next most common cause is cholangiohepatitis. Infectious diseases that involve the liver include feline infectious peritonitis and toxoplasmosis. Feline leukemia and cancers that begin in the liver or spread there from other locations are other causes of liver insufficiency.
This disease, unique to cats, is the most common metabolic cause of liver failure. Although the precise cause(s) may be unknown, this syndrome appears to be a type of anorexia that occurs when a cat has a sustained loss of appetite and stops eating. The liver plays a major role in fat (lipid) metabolism. With starvation, fat accumulates in liver cells. Lipid mobilization (lipid molecules are moved out of storage in the tissues) throughout the body, along with related secondary nutritional deficiencies, seems to be the critical path to disease.
The liver becomes yellow, greasy, and enlarged. Signs of liver failure (especially jaundice) appear as liver function deteriorates. Drooling is common, and the cat may have an enlarged liver on palpation, X-rays, or ultrasound examination. Usually, the loss of appetite has been going on for two to three weeks, but cases do occur in which anorexia is present for just a few days.
Often, hepatic lipidosis is secondary to a systemic problem, such as hyperthyroidism, diabetes mellitus, urinary tract conditions, or upper respiratory infections. Illnesses in which the cat cannot keep down food may also cause the disease. However, anywhere from 15 to 50 percent of cases have no obvious primary cause.
Hepatic lipidosis occurs in cats of both sexes and all ages. Being overweight is a predisposing cause. Often, stress is the initiating factor, but frequently the cause of the anorexia is unknown (idiopathic hepatic lipidosis). Diagnosis is confirmed by liver biopsy and blood work.
Treatment: Early intensive fluid replacement and forced feeding offer the best chance for reversing the process. Cats who receive early and aggressive nutritional support, such as the placement of feeding tubes, have a 90 percent chance of survival. If the cat does not get this quick, aggressive treatment, the survival rate goes down to 10 to 15 percent.
Appetite stimulants may be prescribed by your veterinarian, but they are only effective if the cat is still eating at least a little on his own. In most cases, nutritional support involves special diets and formulas administered by your veterinarian by stomach tube or gastrostomy, an operation in which a feeding tube is placed into the stomach through a small incision in the abdominal wall. Nutritional support is continued until the cat recovers and begins to eat on his own. Any nutritional supplements given through a feeding tube should be warmed to room temperature.
Recovery may take two to three months and requires home nursing care and complete dedication by the owner. Survival of the first four days of intensive treatment is a very good sign, with 85 percent of those cats going on to recovery. If pancreatitis is also present, the prognosis is poor.
When cats stop eating for even a day or two, they are prone to liver disease. Seek veterinary attention whenever your cat refuses to eat for more than two days.
Cholangiohepatitis is the second most common liver disease of cats. This disease involves inflammation of the liver and the bile ducts. Bile is the product of the gallbladder and is important in managing fats and collecting toxins to be removed from the blood. When bacteria from the duodenum (small intestine) come up the bile duct (instead of bile going down), they can gain access to the gallbladder and the liver. This liver infection is often associated with inflammatory bowel disease and/or pancreatitis.
Treatment: Treatment requires supportive care, including fluids and nutritional support-maybe even a feeding tube placed by your veterinarian. Antibiotics are important, as this is a bacterial infection. Antibiotics may be needed for three to six months. SAMe and vitamin E are useful antioxidants that can help the liver heal, and milk thistle is an herb with liver-protectant qualities. If inflammatory bowel disease is also involved, the cat may need immunosuppressive drugs such as prednisone.
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