Feline Liver Diseases Flashcards
What are the two presentations of hepatic lipidosis?
Primary disease in a fat stressed anorexic cat
Secondary in a normal car with anorexia + pancreatitis, IBD, DM or neoplasia
How is hepatic lipidosis defined?
An acute reversible loss of function due to hepatocyte swelling
What are the symptoms of hepatic lipidosis?
A very sick cat with a palpably enlarged liver, jaundice and hepatic encephalopathy
How can Hepatic lipidosis be confirmed?
They are too sick for anaesthesia, so FNA with 22g needle shows marked swelling of hepatocytes
(compared to lipid accumulation in an anorexic cat)
What biochemical abnormalities are seen with hepatic lipidosis?
Hyperbilirubinaemia, ALT, ALP (low ggt with primary), low urea, haemostatic abnormalities
What should stimulate a search for an underlying cause to hepatic lipidosis?
In secondary hepatic lipidosis, GGT will be high
What treatment is required for lipidosis?
Fluids Food Antiemetic Vitamin K Vitamin E a-adenosylmethionine
What is the pathology of Neutrophilic Cholangitis?
An ascending infection of the bile duct causing bile stasis and sepsis-
recognised as a young hot yellow cat
How is neutrophilic cholangitis confirmed?
Bile cytology, culture & sensitivity.
What clinicipathological findings are seen in neutrophilic cholangitis?
High neutrophils, bilirubin and ALT
What is the treatment for neutrophilic cholangitis?
IV fluids
4-6 weeks of antibiotics
Prevent lipidosis from occurring- feline intestinal diet
What is the pathology of Lymphocytic Cholangitis?
A waxing and waning disease of older cats, with lymphocytes infiltrating the portal tract
What are the clinical features of Lymphocytic Cholangitis?
Jaundice, weight loss and in some cases a high protein ascites (must be differentiated from FIP)
Yellow old thin cat
How is Lymphocytic Cholangitis diagnosed?
US shows dilation of the bile ducts, confirmed with biopsy (bile aspiration not required unless acute onset)
Treatment of lymphocytic cholangitis?
Cholerectic/anti inflammatory ursodeoxycholic acid
Antioxidant SAME and Vit E
Feline intestinal diet
What is the mechanism of Extrahepatic Bile Duct Obstruction?
Combination of extraluminal compression and intraluminal obstruction
What conditions are associated with EBDO in cats?
Inflammation of the biliary tree, duodenum and pancreatitis (triaditis)
Or
Neoplasia of the biliary tree or pancreas
What are the typical signs of cholestasis seen in EBDO?
Icterus Anorexia Depression Vomiting Hepatomegaly
How can EBDO be medically managed? Why?
Cholerectic - ursodeoxycholic acid
Antioxidant - s-adenosylmethionine
Surgical intervention required with acholic faeces but carries a poor prognosis
What is the presentation for Congenital PSS?
Poor growth, waxing and waning neurological symptoms
How is PSS treated?
Surgery
Stabilise with antibiotics, lactulose and liver diet pre- and 2 months post-op
What clinicopathological abnormalities are seen with PSS?
Low urea
Microcytosis
High ammonia or bile acids
What is hepatic amyloidosis?
Formation of inflammmatory amyloid either secondary to an underlying inflammatory process or familial in Siamese or Abyssinian cats
How does Amyloidosis present?
Anaemia and hypotension related to rupture of liver capsule after jumping. Rarely any specific signs of liver disease
What is the appearance of amyloidosis with ultrasound?
Lymphoma, lipidosis, amyloidosis are difficult to distinguish.
How is Amyloidosis managed?
Eliminate underlying inflammatory disorder
Antioxidants
Vitamin K
Prognosis is poor
What are typical signs of primary malignancies?
Older cats with liver disease- lethargy, vomiting, weight loss, ascites, jaundice
What is the most common primary tumour in cats?
Biliary carcinoma
What are common secondary tumours?
Lymphoma, histiocytic, mast cell tumours
What should be checked before biopsy?
Coagulation profiles
If there are coagulation abnormalities how should they be managed?
Vitamin K
In Lymphoma or MCT use FFP
