Our beloved pet Magnum in December 2007; he's half Bengal, half Abysinnian.

 FELINE LIVER DISEASE 

In June of 1998, one of our dear kitties was diagnosed with "Fatty Liver Disease". Our beloved 6 year old neutered male, Magnum, had just stopped eating, we had noticed, and had gotten quite a bit thinner. Preliminary blood work showed that his liver enzymes were slightly elevated, but that everything else was perfectly normal. His fecal exam came back negative for worms/parasites, and he tested negative for FIV, FELV, and FIP antibodies. We were sent home with a week's worth of Flagyl, a week's worth of Amoxycillin, and fluids (Lactated Ringer Bags) to give by drip daily through an 18 gauge needle under the skin for a week. When we returned to the vet after the prescribed treatment a week later, more blood work showed that Magnum's liver enzymes were now three times as high, and we all agreed a liver biopsy was necessary at this point. From the blood work, the vet could tell that Magnum had liver disease...the question was, which one??? The treatments were very different, and the only way to be sure was to do a biopsy. Our brave boy underwent a needle biopsy without anesthesia, and the tissue sample obtained was read by a certified pathologist. The diagnosis was now without question...our Magnum had "Fatty Liver Disease", or "Hepatic Lipidosis".

There are two types of liver disease that are common to cats. One is "Cholangitis" (cholangiohepatitis), and the other is "Fatty Liver Disease" (hepatic lipidosis).

 CHOLANGITIS 

This type of liver disease can be characterized by sporadic illness that comes and goes, and is generally considered to be less serious than "Fatty Liver Disease". However, left untreated, Cholangitis can result in liver failure. Cholangitis, which is an inflammatory process involving the biliary ducts, can also be associated with both FeLV (feline leukemia) and FIP (feline infectious peritonitis).

Treatment of Cholangitis usually involves antibiotics and supportive therapy such as "dehydrocholic acid" (Decholin Rx) if bilirubin levels are high. Often, appetite stimulants are given ("Valium" is the one most often used in cats), and many vets also recommend administration of corticosteroids or other immunosuppressive medications. It is important to try to determine the cause of the Cholangitis, if possible, as changes in the cat's diet may be helpful, depending upon the exact cause of the liver problems.

Since corticosteroids can be very dangerous for cats with hepatic lipidosis, it is very important before starting treatment, to have a liver biopsy performed. If your vet does not perform this procedure, ask him or her to refer you to a feline internal medicine specialist. It is always a good idea to take blood work and also to perform X-rays prior to doing a liver biopsy to be sure there aren't any other contributing factors to your kitty's condition. Most vets want to try to identify the cause of the liver enzyme increases if possible.

Cats with Cholangitis usually do better on a diet that has very good quality protein in limited amounts. Your vet can assist you in providing the proper nutritional therapy for your cat with Cholangitis. All cats with liver disease seem to do much better with small meals given on a very frequent basis.

 FATTY LIVER DISEASE 

Hepatic lipidosis is the accumulation of fat within the liver, and it may be secondary to some other condition or illness in the animal, or it can just occur on its own. Most cats that develop this disease are somewhat obese at the onset of the disease, and have often led a very pampered life. It is thought (although not known for sure) that STRESS (usually major changes in the home environment of the cat such as moving, adding a new kitten/cat/dog, and for some sensitive kitties, when YOU are under stress because they feel it too) is the main catalyst to bring on this condition, which begins by the cat stopping eating, even for just a day or two. This is the presentation of the cornerstone of Fatty Liver Disease, which is ANOREXIA. The fat, or lipid cells, in the cat then are mobilized in the liver, which is unable to utilize them. The mechanism for the inability of the liver to break down the fat cells is not fully understood, but it may be caused by a deficiency in certain proteins.

There has been some research into the possibility that a deficiency in Arginine , one of the amino acids, may play a role in the development of Fatty Liver Disease. Cats cannot synthesize arginine, and during fasting (anorexia), some cats may be able to obtain some arginine from the break down of muscle protein; however, supplies may be limited. Arginine is necessary for proper function of the urea cycle in converting ammonia to urea; therefore, a deficiency in arginine may cause hyper-ammonemia.

Another possible cause of Fatty Liver Disease may be damage to mitochondria in the liver, due to toxic substances, drugs such as tetracycline, or even severe obesity leading to a high degree of fat accumulation.

Fatty Liver Disease is the most commonly reported liver problem in cats, and the average age for this disease to occur is 8 years, although instances have been reported in cats from ages 1 year old to 16 years old. The signs of Fatty Liver Disease are: anorexia; weight loss; vomiting; loss of muscle (especially in the hind legs and hips); and depression. As the disease progresses, stupor and coma may follow, or the cat may have seizures and excessive salivation with head-pressing. Cats at high risk for contracting Fatty Liver Disease are those cats who are overweight, who experience anorexia from any cause including stress from changes in their environment, and those cats who have any illness resulting in chronic anorexia.

Some of the signs of Fatty Liver Disease can also occur in cats with Cholangitis, FIP, Pancreatitis, and Hepatic neoplasia. All the above conditions can be ruled out by having a liver biopsy performed. Since cats with advanced hepatic lipidosis are often anesthetic risks, most veterinarians prefer to perform a percutaneous or laparoscopic needle biopsy using a Vim Tru-cut needle. A fine needle aspiration with a 22-gauge, 1 in. needle may also provide an adequate specimen for impression smear cytology and presumptive diagnosis.

Cats that are severely ill with Fatty Liver Disease will need to be hospitalized as critical care patients. Outpatient care is definitely preferable with this disease, but requires a great deal of commitment and work on the part of the owners of the cat. Outpatient care involves minimizing stress (which promotes anorexia), and continuous feeding and fluid therapy. The diet therapy is the main focus in the treatment of this disease, and is targeted at reversing the anorexia, and ultimately, reversing the liver disease. A high protein, high calorie diet should be fed in amounts designed to meet the cat's energy needs. Your vet will help you determine what and how much to feed your cat. For most cats with Fatty Liver Disease, vomiting is such a large problem that a stomach tube needs to be surgically inserted in to the cat to enable home care and feeding. There are three types of stomach tubes that can be put in to assist your cat; all go through the esophagus, and one runs through the nose, one comes out the neck, and the third comes out through the abdomen.

If you are fortunate enough to catch the disease in its early stages, a stomach tube may not be necessary. We successfully force fed our Magnum without the need for a stomach tube. We gave him Hill's a/d formula (a prescription feline diet food, which you can get from your vet), which is already in a gruel consistency, and is easily pulled in to a syringe. We added several capsules worth of fish oil to the Hill's a/d, as fish oil has been shown to have beneficial effects on the liver and kidneys. We started with giving him 6 cc of the gruel every four hours around the clock, and after three weeks, we had worked up to 15 cc of the gruel every four hours around the clock. We gave him .10 ml of Reglan Rx for nausea 15 minutes prior to each feeding. (Note: it takes 36 cc of food per day just to sustain life in an adult cat; so obviously, more must be given for the animal to be able to heal and grow.) We first knew we were going to beat this disease for sure when Magnum's coat started looking so magnificent -- especially compared to the rest of him when he was so sick -- which was the result of the added fish oil. But, we knew that if his coat could improve that much.... so could the rest of him!! And, we were right!!

Additionally, we also administered 250 cc of Ringer's fluids per day. I was lucky to have my son help me do this. But, as Magnum's strength returned (which thrilled us, of course), we required the assistance of our vet to get the fluids in our big boy, and ultimately we went to giving the fluids by sub-Q (under the skin at the neck area) three times a week, then once a week for fluid therapy until we were certain he had completely recovered. With continued effort and care, the prognosis is good for a complete recovery, although it may take up to 6 to 8 weeks, or even longer in some cases. You will know that your cat is on the road to recovery when s/he starts to eat on her own again consistently, with genuine enthusiasm and interest. There will be other signs for you that your cat is recovering, if you observe carefully and lovingly -- more lustre and softness to his coat; more joy in his attitude; returned sparkle in his eyes; and so on.

Valium is also used as an appetite stimulant for cats with Fatty Liver Disease (note: there are some newer, safer appetite stimulant medications these days), and another medication is often used to help with nausea. Anti-nausea medications such as Reglan Rx, Propulsid Rx, or Tagamet Rx can be given orally 15 minutes prior to force feeding, to help keep vomiting to a minimum. There are many different anti-nausea medications your vet can prescribe for your cat, so if the one you start with isn't working, ask your vet to recommend and prescribe another. You may have to try a few until you find the one that works best for your cat. Usually, this sort of medication may only need to be given the first 2 to 3 weeks of treatment, or until the cat is better able to tolerate food again.

Cats with Cholangitis and Fatty Liver Disease need to be monitored closely by you and your vet for weight gain or loss, and for hydration status. There may need to be adjustments to the dietary and fluid therapies as the disease remits. Blood work should be done every 1-2 weeks, or as your vet feels is warranted, to know the status of the disease. Your vet will depend greatly upon you and your intuitive feelings as well as your own observations to do much of this care and monitoring, because keeping stress (such as trips to the vet, etc.) to a minimum is very important for the recovery of your cat. If your cat is eating more, throwing up less, and has improved color, etc., you should be able to advise your vet that positive progress is being made, and perhaps the trip to the vet for lab work can be put off another week or so to maximize the improvement and keep the levels of stress down for you and your kitty. You should also keep your recovering cat in an environment where s/he feels very safe and secure, and is not competing with any other cats or animals for food, attention, or territory. Improvement, even if it is a small degree of improvement, in cats with liver disease should be observed within 2 to 3 weeks after initiation of treatment. For cats that have had stomach tubes put in, the tubes can be removed from 5 to 7 days after the cat is eating normally.

Some things to keep in mind to help prevent liver disease in cats are to try to prevent obesity in your cat. Also, any weight reduction plan in an obese cat should be undertaken VERY slowly and carefully. Cats switched to special weight reduction diets should be carefully monitored to be sure they are taking in an adequate amount of food. All cat owners should watch their cats very carefully, especially during periods of family stress such as moving or the addition of a new member to the family, to be sure that each cat is continuing to eat well and adequately. When you know that your cat is in a period of stress (such as during a move, or when there is an addition or loss to the family, etc.), it is perhaps a wise idea to go ahead and force-feed your kitty several times a day during the period of crisis; therefore, not allowing the anorexia any opportunity to take hold again. If you have a cat that has had Fatty Liver Disease, you should try to understand that your kitty is perhaps a bit more sensitive than you may have realized, and will thus need more monitoring and consideration when changes in the family and/or family environment take place.

With aggressive tube (or force) feeding and/or diet therapy and fluid therapy, 60% of cats with primary Fatty Liver Disease survive and return to normal, while without this long-term commitment and follow-through on the part of the owners, less than 10% will recover.

For our ultra-sensitive and sweet Magnum, we instituted a third therapy, not mentioned in any books or research papers...we call it "LOVE THERAPY", and for 3 to 4 hours per day, we got up on the bed with him, and cuddled !! He had our undivided attention -- we napped or watched a little television together, and we told him over and over how very special he is. I know that Magnum and I both benefited from this therapy, and our peacefulness together was extremely positive for both of us. Taking care of a kitty with Fatty Liver Disease is exhausting -- and the human caregivers must also remember to take care of themselves during this critical time. WE ARE THRILLED TO SAY THAT MAGNUM THRIVED ON HIS THERAPIES, AND MADE A COMPLETE RECOVERY FROM HIS ILLNESS. We will always, of course, continue to watch him closely. His close call with Fatty Liver Disease has taught us that he is definitely a sensitive kitty -- a lesson we will never forget. He re-gained all the weight he had lost, and has been completely well for more than 9 years. His total in-home therapy lasted eight weeks, and we never did have to put in a stomach feeding tube. This article comes from our hearts, and details our own very personal experience with Fatty Liver Disease. We sincerely hope that sharing our story will be of help and benefit to other cat owners.

  To date, more than 700 people have written to tell us that they feel our article helped save the life of their kitty. If YOU have a kitty diagnosed with Fatty Liver Disease, please take heart and know that Magnum and I will be thinking about you and praying for you and your kitty to successfully overcome this disease too.

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