Feline hepatic dz

Question 1

Feline idiopathic hepatic lipidosis

Answer 1

Hepatocellular lipid accumulation
Anorectic obese cat
Any cat with anorexia causing a catabolic state

Question 2

Factors leading hepatic lipidosis

Answer 2

Loss of essential fatty acids, protein, taurine, arginine, methionine, cysteine and Vit B
Needed lipid and protein metabolism

Question 3

Pathophysiology of feline idiopathic hepatic lipidosis

Answer 3

Excess mobilization of fat
Inability of liver to secrete products of lipid metabolism
Intracellular buildup of lipid products
Hepatocellular swelling
Intrahepatic biliary stasis and hepatocellular dysfuction

Question 4

CS of feline idiopathic hepatic lipidosis

Answer 4

Anorexia, lethargy, WL, V/D, dehydration
Enlarged abdomen, fever, tachycardia and jaundice
HE: ptyalism, lethargy and depression
Ventroflexion of neck

Question 5

Dx on feline idiopathic hepatic lipidosis

Answer 5

Bile acid assay
Amylase lipase
Coagulation profile
Fine needle aspirate (live, bile)
Liver bx

Question 6

Lab findings of feline idiopathic hepatic lipidosis

Answer 6

Non-regen anemia with stress leukogram
↑ bile acids, ALP and ALP and BR
Azotemia (↑ BUN and creatinine)
Hypokalemia

Question 7

Imaging of feline idiopathic hepatic lipidosis

Answer 7

Enlarged liver and preservation of abdominal fat on rads
Hyperechoic liver on US
Bx to rule out
Oil red: excess fat
Liver bx: hepatocellular vacuolization and cholestasis without hepatic necrosis

Question 8

Tx of feline idiopathic hepatic lipidosis

Answer 8

Tx underlying cause
Supportive therapy: hydrated, ↓ BR, taurine, carnitine and vit E, K, B
Don’t sedate until stable

Question 9

Most important part of tx for feline idiopathic hepatic lipidosis

Answer 9

Get the cat eating!
Appetite stimulants (cyprohepatadine, B vitamins)
Feed small meals multiple times per day
High protein if no HE
Low protein with high CHO with HE

Question 10

Methods of feeding

Answer 10

Nasoesoph, esophagostomy, gastromy or jejunostomy ube

Question 11

How do you begin the force feeding?

Answer 11

Begin with 1/3 of diet initially (high protein)
Follow daily ↑ of 1/3rd diet
Be careful of refeeding syndrome (hypophosphatemia)

Question 12

Hepatic Encephalopathy tx

Answer 12

Oral abx (ampicillin, neomycin)
Cleansing/ retention enemas
Oral lactulose
Feed low protein, low fat and high CHO

Question 13

Cholangitis

Answer 13

Chr. progressive inflammatory disorder of bile ducts and adjacent hepatocytes
Low grade interstitial pancreatitis

Question 14

What are the 3 forms of cholangitis

Answer 14

Neutrophilic with cholecystitis= primary neutros (bacterial infection)
Lymphocytic= lymphos (immune mediated)
Chr. cholangitis= liver flukes

Question 15

CS of cholangitis

Answer 15

Anorexia, polyphagia, V, WL, PU/PD, fever, jaundice, hepatomegaly, lymphadenopathy, ascites

Question 16

Lab findings of cholangitis

Answer 16

Non-regen anemia and neutrophilia with left shift
↑ liver enzymes, ammonia intolerance
↓BUN, albumin
Hyperglobinemia in lymphocystic form
Ascites (high protein with small lymphos and neutros)
Bleeding tendencies

Question 17

Rads and US findings of cholangitis

Answer 17

Rads: hepatomegaly, ascites
US: hepatomegaly, lymphadenopathy, enlarged cystic duct and GB abnormalities

Question 18

Liver histopathology of cholangitis

Answer 18

Suppurative: neutros within and surrounding bile ducts
Non sup: lymphos and plasma cells in bile ducts
Chr. cholangitis: biliary cirrhosis, hyperplasia and distention of bile ducts

Question 19

Tx for all forms of cholangitis

Answer 19

Ursidiol for biliary stasis
Antioxidants, Vit. E or milk thistle

Question 20

Tx of specific forms of cholangitis

Answer 20

Suppurative: abx (ampicillin, metro)
Non-sup: corticosteroids
Obstruction: cholecystojejunostomy