The incidence of liver disease in pets has shown a significant upward trend in recent years. This change has not only caused concern among pet owners, but also brought new challenges to veterinary clinical work. In the process of clinical diagnosis, it is necessary to accurately determine the condition from multiple dimensions and use multiple methods to lay the foundation for subsequent effective treatment.

Primary fatty liver occurs most often in obese cats with anorexia and stress triggered by some non-disease factor.

Secondary fatty liver is caused by anorexia and rapid weight loss triggered by disease factors and can occur in cats of any size.

The rationale for the development of lipid deposition in the liver of cats is not entirely clear, but given the high nutrient requirements of cats for diets, it is hypothesized that the disease may be caused by a deficiency of certain nutrients (methionine, carnosine, taurine) resulting in the inability of the liver to properly utilize and translocate fat. The triggers are anorexia and stress, and the risk factor is obesity.

Clinical signs in cats with fatty liver disease are based on acute (reversible) hepatic insufficiency and secondary intrahepatic cholestasis. Affected cats usually present with jaundice, dehydration, and intermittent vomiting, as well as diarrhea or constipation. In severe cases, hepatic encephalopathy may develop, with coma and salivation.

In most liver diseases, the main idea of treatment is to address the primary problem, relieve symptoms and supportive therapies, i.e., dietary modification + medication + specific nutritional support.

Physical examination after the onset of the disease typically examines the following items:

(1) Blood counts

Blood smear microscopy may show anomalous red blood cells as well as ruptured red blood cells, and the red blood cell count shows mild nonregenerative anemia.

(2) Blood biochemistry

Elevated values of liver-related biological enzymes, including alkaline phosphatase (ALP), aspartate aminotransferase (AST), alanine aminotransferase (ALT), and gamma-glutamyltransferase (GGT), are the main manifestations. In addition, bilirubin (bilirubin) and bile acid tests performed before and after meals in cats, respectively, have elevated values, all of which are indicative of damage and dysfunction of the hepatobiliary system.

(3) Urinalysis

Bilirubinuria may be present in the urine as a result of the persistence of hyperbilirubinemia.

(4) Other tests

• Blood coagulation test: As the liver is an important organ for the production of clotting factors, liver dysfunction will lead to abnormal blood clotting in cats, and the results of the blood coagulation test may show “prolonged clotting time”.

• Pathohistologic examination: Fatty vesicles can be observed in more than 80% of the hepatocytes in biopsy-sampled liver tissue.
  

• Imaging

1. Hepatomegaly is visible on x-ray, but this is not seen in all affected cats and is not specific

2. Diffuse hepatic parenchymal echogenic enhancement as well as hepatomegaly can be seen on ultrasound, which can be used as a more important diagnostic method when pathohistologic examination is not possible.

The 13-year-old male cat “Mimi” suffers from diabetic ketoacidosis, fatty liver, pancreatitis, the owner describes a few days ago began to appear more drinking and urination, appetite has been abolished for two days, the day before yesterday are vomiting once, weight loss of about 0.5kg.

Test results: red blood cells were high and dense, white blood cells were increased with anemia, blood glucose was high, cholesterol was high, liver and bile enzymes were high, urea nitrogen was high, and SAA was high.

Hospitalization with enrofloxacin and maropitant citrate injections as well as essential nutrients with Gambutrol Hepsame and diet change to prescription food.

The results of another blood test on the fifth day of treatment showed:

You can clearly see that the liver indicators are already at normal values and the inflammatory condition has improved.

The results of the ninth day of infusion plus diet therapy are shown:

Functional indicators of the liver (alanine aminotransferase/alkaline phosphatase/total bilirubin) and kidney (creatinine/blood phosphorus) are basically restored to the normal range, and the state of the organism is stabilized, but not yet fully restored to health, and still need to be consolidated through dietary supplementation.

Mimi's condition has stabilized enough for her to be processed for discharge home to continue her recovery, which will focus on ongoing recovery through dietary planning.

Suggested diet planning for cats coming home is as follows:

According to the daily amount, cat food, goat milk powder 30g, nutritional cream 5ml, Gambisan Hepsame 2 capsules.

Thanks Guangzhou Aino Best Animal Hospital for providing the case!