Hepatic Lipidosis in Cats:
Clinical Experiences at SouthPaws
Dr. James C McConnell

Hepatic Lipidosis is the most common liver disease diagnosed in cats at SouthPaws Veterinary Referral Center. With its typical clinical presentation of anorexia, weight loss and clinical jaundice, the patient is frequently referred for an evaluation including hepatobiliary ultrasound examination to either our internists or to our  radiologist.  On ultrasound the condition is  characterized as a diffuse hepatopathy, often with organ enlargement, rounding of liver borders, increased echogenicity  of the liver parenchyma, and increased attenuation of  the ultrasound beam. Confirmation of the diagnosis requires liver biopsy.

With increasing veterinary expertise in abdominal ultrasound and increased use of minimally-invasive biopsy techniques including  ultrasound-guided needle core biopsy and laparoscopic cup biopsy, diagnosis of feline hepatic lipidosis (HL) has become less a challenge than its successful treatment. The challenge surrounding treatment of HL lies in its all or nothing clinical outcomes: complete recovery or death. This must be compared with many other feline internal disorders which are often characterized as chronic or waxing and waning (eg., inflammatory bowel disease, cystitis, feline airways disease, pancreatitis, gingivitis/stomatitis). HL puts additional pressure on veterinarians to improve treatment strategies simply because of the dire consequences of treatment failure.

Some personal observations arising from my experiences in diagnosing and treating HL follow:

-The most common historical finding is the absence of the owner due to travel or other obligations for several days to several weeks prior to identification of clinical signs of HL.

-Presentations including frequent or intractable vomiting in affected cats carry with them a much more guarded prognosis.

-The degree of icterus does not correlate with prognosis.

-The severity of signs of hepatoencephalopathy does not correlate with blood ammonia levels.

-Cytologic diagnosis tends to provide less clinical certainty in the overall diagnosis and often results in less aggressive (and subsequently less successful) management in severely affected patients.

-Presurgical evaluation of bleeding times (platelet count plus either ACT or PT/PTT) does not predict which patients will have bleeding complications from liver biopsy.

-Administration of Vitamin K1 and plasma does not completely alleviate the potential for bleeding complications of liver biopsy. Operator experience seems to have the most significant influence on complication rates.

-Survival rates in cats in which PEG tubes are placed for treatment and fluid and nutritional support are ~65%. Survival rates in patients maintained with hand feeding are <10%. Survival rates in cats treated with nasoesophageal or nasogastric tubes alone are <50%.

-Complication rates in PEG tube placement in cats is very low. Tolerance of PEG tubes in cats is very high.

-Inflammatory bowel disease is only rarely identified in cats with HL. All patients at SouthPaws receiving PEG tubes have gastrointestinal biopsies submitted. (However, we do see pancreatitis and GI lymphoma not uncommonly in affected cats).

-Early treatment of cats with sAME (Denosyl SD4) seems to increase survival and speed recovery (if this oral medication is tolerated).

-Use of ursodiol does not seem to alter the clinical outcome in HL.

-Treatment with metoclopramide does not tend to result in reduction of vomiting in severely affected cats. However, some  cats tolerate bolus feedings much better with the addition of metoclopramide (available as a liquid which can be administered through the feeding tube before some or all meals).

-Rehospitalization of cats with HL in which vomiting is the limiting factor in successful home treatment, for continuous rate infusion of nutrition through the PEG or NG tube for several days, often results in resolution of vomiting and eventual successful outcome.

-Successful outcomes typically become evident within 2 weeks of treatment in most affected cats. However, with pet owner and clinician perserverance, many cats can recover completely given appropriately aggressive nutritrional support for as long as two months. (Don't give up).

-The singlemost important determinant of successful outcome is the tenacity and dedication to followup of the pet owner (and the clinician). As with the treatment of diabetes mellitus, not all pet owners are up to treating this disorder.

-Aggressive treatment of feline HL is quite expensive and very stressful for pet owners. Extra attention must be paid to owners during treatment, and personal followup with owners of pets who succumb to this disease is essential.

-In speaking with owners of successfully and unsuccessfully treated cats with HL, I receive the strong impression that owners of pets with both outcomes feel equally strong that the aggressive treatment required was "worth it." They felt grateful for the time and effort their veterinarian(s) provided their pet.