Liver: chronic disease

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Sections available in full article Introduction, Presenting signs, Acute presentation, Age predisposition, Cost considerations, Special risks (e.g. anesthetic), Pathogenesis, Etiology, Pathophysiology, Diagnosis, Presenting problems, Client history, Clinical signs, Diagnostic investigation, Confirmation of diagnosis, Gross autopsy findings, Histopathology findings, Differential diagnosis, Treatment, Standard treatment, Subsequent management, Sequelae, Prognosis, Expected response to treatment, Reasons for treatment failure, Sources, Publications, Vetstream contributor(s),
Contributors Dr Kyle Braund BVSc MVSc PhD FRCVS DipACVIM
Dr Philip K Nicholls BVSc BSc PhD MRCVS FRCPath
Ms Penny Watson MA VetMB CertVR DSAM DipECVIM MRCVS

Introduction

  • Cause : malformation, toxicity, neoplasia, endocrinopathy, metabolic (lipidosis), auto-immune (lymphocytic cholangitis), infection.
  • Signs : non-specific - lethargy, anorexia, vomiting. Signs of hepatic encephalopathy.
  • Diagnosis : biochemistry, hepatic function tests, ultrasonography, hepatic biopsy.
  • Treatment : elimination of cause, supportive.
  • Prognosis : depends on severity and treatment of inciting factor.
  • See also Liver: acute disease  Liver: acute disease  .
    Print off the owner factsheet Liver problems in your cat  Liver problems in your cat  to give to your client.

Diagnosis

Clinical signs

  • Unkempt hair coat.
  • Ascites  Ascites 01: whole cat   Ascites 02: whole cat   Ascites 03: whole cat  .
  • Icterus.

Signs of hepatic encephalopathy

  • May occur with portosystemic shunt  Portosystemic shunt  , acute or end-stage liver disease.
  • Behavior changes - dementia, dullness, aggression.
  • Neurological abnormalities - circling, ataxia, head pressing, aimless pacing, seizures.
  • Ptyalism  Ptyalism in a kitten with a portosystemic shunt  .
  • Coma.

Diagnosis

Differential diagnosis

Primary liver diseases
  • Cholangiohepatitis and lymphocytic cholangitis  Liver: cholangitis  .
  • Neoplasia, eg lymphosarcoma  Lymphoma  , bile duct carcinoma, systemic mastocytosis.
  • Portosystemic shunts  Portosystemic shunt  .
  • Toxic hepatopathy (see Liver: acute disease  Liver: acute disease  ).

Secondary liver diseases

  • Feline infectious peritonitis (FIP)  Feline infectious peritonitis  .
  • Toxoplasmosis  Toxoplasmosis  .
  • Hyperthyroidism  Hyperthyroidism  .
  • Neoplasia - metastatic.
  • Hepatic lipidosis  Liver: lipidosis  - idiopathic, secondary to obesity  Obesity  , endocrine disorders.
Causes of jaundice
  • Jaundice  Jaundice  .
  • Causes of hemolytic anemia: Hemobartonella felis  Mycoplasma haemofelis, 'Candidatus Mycoplasma haemominutum' and 'Candidatus Mycoplasma turicensis'  , auto-immune hemolytic anemia  Anemia: immune-mediated hemolytic  , FeLV  Feline leukemia virus disease  .
  • Hepatocellular disease (see primary and systemic causes of liver disease).
  • Obstructive: intrahepatic, eg neoplasia, inflammation; extrahepatic, eg pancreatic neoplasia or inflammation  Pancreatitis  , bile stones.

Causes of ascites

  • Primary hepatic disease.
  • FIP  Feline infectious peritonitis  .
  • Bacterial peritonitis  Peritonitis  .
  • Glomerulonephritis (nephrotic syndrome)  Glomerulonephritis  .
  • Congestive heart failure  Congestive heart failure  .
  • Chylous ascites.
  • Other fluids (hemorrhage, bladder  Bladder: trauma rupture  , or biliary rupture).

Sequelae

Prognosis

  • Depends on underlying cause and degree of hepatic damage.

Expected response to treatment

  • Clinical improvement.
  • Resolution of hepatic pathology.

Reasons for treatment failure

  • Development of hepatic cirrhosis  Liver: cirrhosis  .

Sources

Publications

Refereed papers

  • Godfrey D R & Rest J R (2000)Suspected necrolytic migratory erythema associated with chronic hepatopathy in a cat.JSAP41(7), 324-328.
  • Center S A (1999)Chronic liver disease - current concepts of disease mechanisms.JSAP40(3), 106-114.

Other sources of information

  • Johnson S E (2000)Chronic hepatic disorders.In:Textbook of Veterinary Internal Medicine.5th edn. Ettinger S J & Feldman E C (eds). W B Saunders, Philadelphia. pp 1298-1325.
  • Laflamme D P (2000)Nutritional management of liver disease.In:Kirk's Current Veterinary therapy XIII.Bonagura J D (ed). W B Saunders, Philadelphia. pp 693-697.
  • Center S A (1996)Feline hepatic disease - Current therapeutic concepts.Proceedings of BSAVA Waltham Symposium on liver disease.pp 56-63.
  • Watson T (1996)Nutritional management of canine liver disease.Proceedings of BSAVA Waltham Symposium on liver disease.pp 42-46.
  • Michel R (1995)Nutritional management of liver disease.Vet Clin North Am Small Anim Pract25, 485.

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