Hepatic failure in cats appears as a result of liver diseases that affect liver functionality such as hepatic lipidosis, cholangitis, amyloidosis or tumors, but it can also be due to extrahepatic diseases or toxic substances. The symptoms of all these diseases are non-specific and include, among others: lethargy, weight loss, loss of appetite, increased water intake and vomiting. In advanced stages of liver damage, jaundice (yellow mucous membranes), hepatic encephalopathy and even ascites (accumulation of fluid at the abdominal level) appear.
Do you want to know more details about liver failure in cats, its symptoms and treatment? Keep reading this article on our site and you will learn more about the diseases that can cause liver failure in your little feline.
What is liver failure in cats?
With the term feline liver failure we refer to all those diseases and circumstances that alter the correct functionality of the liver of cats. There are many diseases that reduce the functionality of the liver, some are primary and others are secondary due to toxins or extrahepatic diseases.
The feline liver performs numerous functions, since it is involved in digestion, in the synthesis of bilirubin, glycogen, lipoproteins, albumin and filters toxic compounds. In addition, it is adapted to the carnivorous nature of cats because through meat they obtain, among other nutrients, taurine and arginine, which are two essential amino acids for cats. The feline liver forms bile s alts from the conjugation of bile acids with taurine and arginine, it intervenes in the synthesis of ammonia from urea and in its elimination, so an arginine deficiency will cause ammonia poisoning in our cat, causing a hepatic encephalopathy that usually has a fatal outcome.
Causes of feline liver failure
Liver failure in cats can be caused by various causes, including purely liver diseases, infectious diseases, diseases in other organs or by toxins:
Liver diseases
There are different liver diseases that can leave the liver affected in cats and thus develop a more or less severe insufficiency:
- Hepatic lipidosis: also called fatty liver, there is an infiltration of fat in the cells of the feline liver causing its dysfunction, potentially being deadly for our cats. It usually occurs in overweight cats that stop eating for two or three days for some reason, releasing fat from their body deposits into the blood and reaching the liver. Its cause may be that, when they stop eating, they do not synthesize low-density lipoproteins that mobilize triglycerides out of the liver or the impediment in the oxidation of fatty acids due to carnitine deficiency, which is obtained through two essential amino acids that the cat should obtain with its diet. Secondary causes that can produce it are cholangitis, pancreatitis, gastrointestinal or endocrine disease (hyperthyroidism, diabetes mellitus).
- Neutrophilic cholangitis: inflammation of the bile ducts of the liver due to infection with gastrointestinal bacteria (Escherichia coli, streptococcus or clostridia). Normally, it is associated with inflammatory bowel disease and/or pancreatitis, this is common in cats and is called feline triaditis, because the hepatic and pancreatic ducts empty into the intestine together, so diseases in the intestine or pancreas can affect the liver.
- Lymphocytic cholangitis: This is a chronic progressive immune-mediated disease with lymphocyte infiltration.
- Liver cirrhosis: appears at the end of chronic liver disease and consists of the appearance of fibrosis, abnormal regenerating nodules and vascular anastomoses of the portal vein.
- Amyloidosis: consists of the deposit of amyloid protein in the liver, which can break it causing blood to leak into the abdomen (hemoabdomen). It also usually occurs in other organs such as the kidney and is usually a response to chronic inflammation. It has been described more frequently in the Abyssinian, Siamese and Oriental cat.
- Hepatic tumors: they are rare in cats, the most prevalent being carcinoma of the bile ducts. We can also see lymphomas in the liver, but generally we would also find them in other locations.
Infectious diseases
As infectious diseases that can cause feline liver failure we highlight:
- PIF: due to the formation of pyogranulomas in the liver in the dry form of the disease.
- Toxoplasmosis: due to hepatocyte necrosis (death of liver cells) and inflammation.
Toxic
Cats show a deficiency of the metabolizing enzymeglucuronyl transferase, which is responsible for the conjugation of certain drugs or their metabolites with glucuronic acid in order to proceed with their metabolism and elimination. Some drugs that use this route and should not be administered to our cats because they are very toxic, and can cause liver necrosis, are: paracetamol, ibuprofen and aspirin. Other drugs with liver toxicity in cats include methimazole, tetracyclines, diazepam, L-asparaginase, and doxorubicin.
Portosystemic shunt
Consists of a congenital alteration in the circulation of the liver due to the existence of an additional blood vessel that connects the portal vein and the caudal vena cava (systemic circulation), so that certain toxic substances from the intestine reach the liver but are not filtered through the vascular communication, then they pass directly into the general circulation, resulting in toxic damage to the brain. In addition, due to this, an atrophy of the liver is produced, reducing its size and causing liver failure.
Among all of them, the diseases that most commonly cause liver failure in the feline species are hepatic lipidosis and cholangitis.
Symptoms of Liver Failure in Cats
The signs of feline liver failure are nonspecific, depending on the process that originates it and its severity we can find:
- Inappetence
- Weightloss
- Lethargy
- Vomiting
- Diarrhea
- Anorexy
- Polydipsia
- Dysuria
- Depression
- Apathy
- Jaundice
- Ascites
In cases of hepatic encephalopathy due to an increase in toxins not filtered by the liver, seizures, blindness, hypersalivation, behavioral changes, aggressiveness, stupor and even coma will be seen.
Feline Liver Failure Diagnosis
The diagnosis of diseases that can cause liver failure in our cats is completed by a good history, clinical examination, blood analysis and biochemistry, ultrasound and biopsy.
Physical exploration
During the anamnesis and examination of the feline we must observe and ask the tutor the clinical signs that it presents, observe its state of hydration, coat, state of the mucous membranes to assess jaundice and body condition, as well as palpation of the animal and look for the presence of fluid in the abdominal cavity indicative of ascites. Jaundice and ascites are late signs of liver disease in cats, the most specific being liver failure.
Blood test
A blood count and blood chemistry are performed on the cat. Function and liver disease markers should be sought in it:
- Markers of liver disease: an increase in ALT and AST enzymes indicate cell damage in the liver, although as they have a half-life of a few hours in the cat, if we do not see them increased, there is no reason why he does not have liver disease. An increase in the enzymes ALP and GGT points more towards damage to the bile ducts and canaliculi, while if only GGT is increased, it points more to liver damage.
- Hepatic function markers: they are altered when liver failure is advanced, being hyperbilirubinemia (increased bilirubin), hypoglycemia (low glucose), hypoalbuminemia (low albumin), hyper or hypocholesterolemia (low or high cholesterol) and increased clotting times (due to vitamin K deficiency). Increases in bilirubin in the absence of hemolytic anemia or pancreatic disease are a good indication of liver failure. In addition, before appearing increased in the analysis, cats usually present bilirubinuria (bilirubin in urine), which is always pathological in this species. If the bilirubin is normal, the most sensitive and specific marker for detecting liver failure in cats is the increase in fasting bile acids and after two hours of food intake.
Diagnostic imaging
Specifically, the useful technique in these cases is abdominal ultrasound, although it is common not to find alterations even when the cat really has a liver disease. In some cases, focal lesions are seen, an increase in the size of the liver with hyperechoic parenchyma (white in the image) that is suspicious of lipidosis, dilation of the bile ducts that suggests cholangitis or we can look at the vascularization for the diagnosis of portosystemic shunts.
Liver biopsy
The definitive diagnosis of many diseases that cause liver failure in cats is achieved through a anatomopathological study by taking biopsies. However, in cases of lipidosis, it can be diagnosed through the previous steps and a liver fine-needle cytology (FNA), where numerous cells with fat will be seen, although it must be taken into account that it can coexist with other diseases, so it will not always be definitive, requiring a biopsy. In suspected cases of cholangitis, bile can be obtained from these ducts for cytology and culture, without requiring a biopsy in cases of neutrophilic cholangitis.
Feline liver failure treatment
The treatment of liver failure in cats is complex and will depend on the disease or diseases that coexist in the animal, it is must specifically treat each disease once diagnosed separately and the symptoms.
Hepatic lipidosis treatment
Is hepatic lipidosis curable in cats? Lipidosis is a very serious disease that must be diagnosed and treated early in order to save our cat, only then can it be cured. His therapy is mainly based on:
- Enteral nutrition with esophagostomy or nasogastric tube (increased by 25% each day until reaching the daily kcal the cat needs on the fourth day).
- Fluidotherapy with isotonic crystalloids supplemented with potassium if required.
- Nutritional supplements and vitamins: taurine (to prevent or treat deficiency), L-carnitine (to increase fatty acid oxidation) and vitamins E (antioxidant), B and K(to treat coagulopathy due to its deficiency).
- If you have hepatic encephalopathy, lactulose should be administered orally associated with antibioticssuch as amoxicillin or metronidazole.
- To replenish lost glutathione stores that protect against oxidizing agents, N-acetyl-cysteine should be administered intravenously slowly. Antiemetics, gastric protectors, appetite stimulants, and buprenorphine should also be given to control pain if there is associated pancreatitis.
Treatment of neutrophilic cholangitis
Antibioticsshould be administered for 4-6 weeks with prior culture and antibiogram (cephalosporins, amoxicillin-clavulanate, fluoroquinolones, metronidazole). If the response is not good, add corticosteroids Depending on the severity, support treatment will be requiredwith:
- Fluidotherapy.
- Enteral nutrition.
- Antiemetics.
- Ursodeoxycholic acid to stimulate bile secretion, but as long as there is no obstruction, it is also anti-inflammatory, immunomodulatory and antifibrotic.
- Antioxidants such as S-Adenosyl methionine (SAMe) and vitamin E to reduce the oxidative stress that causes the disease.
- Nutritional supplements and vitamins.
Treatment of lymphocytic cholangitis
Antibiotics and prednisolone are administered at high doses (2-3 mg/kg/24 hours) with progressive reduction of the dose according to response and supportive treatment similar to neutrophilic. If the response to prednisolone is not sufficient, immunosuppressants such as chlorambucil can be added.
Treatment of infectious diseases
In cases of infectious diseases, treat the disease and protect the liver with antioxidants (SAMe, vitamin E), administer ursodeoxycholic acid and treat symptoms with antiemetics, fluid therapy, appetite stimulants or enteral feeding, pain control and nutritional and vitamin supplements.
Treatment of liver tumors
In cases of neoplasms, chemotherapy protocols will be carried out adapted to the tumor and, in resectable tumors, surgery.
Portosystemic shunt treatment
The indicated treatment will be surgery, but it does not always go well and must first be stabilized with antibiotics, lactulose and a low-protein diet.
