Monday, February 16, 2009

Hepatic Lipidosis

Sorry for the non-Paleo post, but I think this is something everyone should know about:

Have you heard of Hepatic Lipidosis? I hadn’t. And now my cat, Kelty, may have it. Basically it can occur when your cat eats 75-50% its normal amount of food. When this happens a “fatty liver” develops and can cause liver failure. If you have cats, please keep reading.

First, I am not a vet. I am just summarizing information given to me. Please see the references at the end of this post for sources and more information. Always consult your vet immediately if you think there is anything wrong with your pet!

So how can you tell if you cat might have or be developing Hepatic Lipidosis?
The normal cat is middle-aged, was once over weight (or obese) and has lost 25% of its original body weight, has a poor or absent appetite, an upset stomach (38% will have vomiting, diarrhea or constipation). Electrolyte imbalances and vitamin deficiencies may be additional problems due to the liver disease (read more about Hepatic Lipidosis at the end of this post).

In our case, Kelty, is 6 and a half years old, she was 15.80 pounds at the end of October and today weighs 10.75 pounds. So she has lost 1/3 of her body weight. I knew she was loosing weight, but I did not realize she had lost that much! She had not been eating much recently, but we thought it was in protest due to the kitten (she had done this in the past when other cats had been in our home). I guess it is possible she had been eating so much less that we just did not notice. But who would guess that if your cat is eating 75% of its normal diet that it could get sick! She had been puking, but I did not notice that it had gotten so bad until I was home with her all day yesterday and noticed that she cold not keep any of the water she drank down.

I had also let her go outside yesterday to enjoy the sun and I noticed that her lip looked slightly yellow in color (it is normally a healthy pink in color, see picture [ or this picture for a better example]). This set off red flags in my head, so I immediately emailed a friend in vet school, Ewan, who was able to tell me very quickly that this was probably a jaundice issue related to the liver and that we would need to get her to the vet as soon as possible. I ran into a vet tech friend who runs the local cat foster group we work with and she confirmed this and suggested I also look at her ears or eyes for signs of yellow (see picture below). She had both of these and I feel horrible that I missed it. It now seems so obvious (the ears at least)! I immediately called our vet and left a message to find out if they were open today. He was awesome enough to call me back on a Sunday and say yes, they were open, talk to me about the symptoms, and told me to bring her in first thing this morning.

This morning we brought her in, he confirmed that it was jaundice indicating a liver issue. It could be anything from the fatty liver disease, liver failure, an autoimmune issue or a type of cancer. He decided to treat her immediately for the fatty liver disease. If it were also the autoimmune issue he said this would be the same treatment. If they find out it is cancer or liver failure, the prognosis is, obviously, really shitty. He took blood and sent that off to find out, and we should have the results tomorrow. Today he also inserted an esophagostomy tube. He had to sedate her to do this, and it involved sticking a small tube into her throat though a incision on the left side of her neck. It has a cap on it and we are able to send water, food and medication down this tube (see pictures below, click to enlarge). We have to start of slow, but build her calorie intake up fast to get her back where she needs to be. We were given a special prescription food that is high in protein to feed her, along with antibiotics and stomach soothing drugs. We really need to get her weight back up (to at least 12 or 13 pounds) and get her to eat and drink on her own again before they can remove the tube. This could be about 2 weeks, maybe longer (typically 4 to 6 weeks).

Remember the signs:
- your cat may not be eating or not eating as much
- jaundice indicators: yellowish eyes (the part that is normally white), ears and gums.
- Upset stomach, vomiting, diarrhea or constipation

I really wish I had known about this and these signs and maybe I would have been able to get Kelty treated more quickly! I hope you never have to go through this, but if you do, you can take away from my experience the signs to look for and be able to get a good jump on getting it treated!


More information on Hepatic Lipidosis:

It makes since when you think about it. [simple version] Cats are carnivores/predators that evolved eating small meals multiple times throughout the day. Their physiology is geared to a completely carnivorous diet, where, in the wild, they would live lean and never have a chance to get “fat.” Unfortunately, the however many years since we have been domesticating cats has not allowed them to fully adapt to their “new” environment of seeming luxury. If your cats are anything like mine, they sleep, a lot, and do not play or move around that much. This often leads to our fuzzy friends becoming a bit on fluffy bellied side. This usually is not a problem every day, but it can become VERY bad if the cat becomes sick, gets lost, or stops eating with a large amount of weight loss occurring. During starvation fat is moved from the bodies’ storage areas to the liver where they are processed into “lipoproteins.” Unfortunately, the cat liver was never intended to handle excessive/large amounts of mobilized fat, and when this happens, it can fail. To make things worse, protein malnutrition develops fast when cats do not eat.

So why would a cat stop eating in the first place? If it is something easy like your cat was lost or starving for a few days, you know. Otherwise there are a variety of interesting factors. Cornell University looked at 157 cats with lipidosis to see what conditions were primary:

28% had inflammatory bowl disease
20% had a second type of liver disease (usually cholangiohepatitis)
14% had cancer
11% had pancreatitis
5% had social problems (new cat, new home, threatening animal or person – this is Kelty’s case we think/hope, with the new kitten and dog around all since November)
4% had some kind of respiratory disease
2% were diabetic

The key to treatment of lipidosis involves aggressive nutritional support (a high protein diet to reverse the metabolic starvation). If this is done carefully the recovery rate approaches 90%! If you are unable to unwilling to feed your cat through a tube there are other options. Consult your vet! Cats that show an improvement within 7 to 10 days are statistically likely to survive!

They important thing is to get high protein food into your cat and go to your vet immediately! It is treatable with nutritional support but without this aggressive nutritional support most cats will die. Please keep an eye out for the signs and be proactive!

References & other Information:

Most of my information comes from: http://www.vin.com/ My vet gave me a print out about it, but it is a member only, protected site that I can't link to.

Links:

http://www.lbah.com/feline/ftube.htm
http://www.peteducation.com/article.cfm?c=1+2135&aid=217
http://www.healthypet.com/library_view.aspx?ID=42
http://cats.about.com/cs/healthissues/a/fatty_liver.htm
http://maxshouse.com/Feline_Hepatic_Lipidosis.htm

Other References:

Cornelius, LM; Bartges, JW; Miller, CC. CVT Update: Therapy for hepatic lipidosis. In Bonagura, JD (ed.) Current Veterinary Therapy XIII. W.B. Saunders Co. Philadelphia, PA; 2000:686-90.

Day, DG. Diseases of the liver. In Sherding, RG (ed.) The Cat: Diseases and Clinical Management. Churchill Livingstone. New York, NY; 1994: 1312-16.

Dimski, DS; Taboada, J. Feline idiopathic hepatic lipidosis. In Dimski, DS (ed.) The Veterinary Clinics of North America Small Animal Practice: Liver Disease. W.B. Saunders Co. Philadelphia, PA; 1995: 357-73.

Johnson, SE; Sherding, RG. Diseases of the liver and biliary tract. In Birchard, SJ; Sherding, RG (eds.) Saunders Manual of Small Animal Practice. W.B. Saunders Co. Philadelphia, PA; 1994: 749-51.

Twedt DC. Feline liver disease. Veterinary International. 1994 (3):33-43.

© ReBecca K. Hunt-Foster

9 comments:

Silver Fox said...

I hope Kelty gets well soon! Is not eating a symptom or a cause? I guess both from your description. And if a cat stops eating from having a new kitty around - well, it can be difficult to get a cat to eat or eat more - they can be so persnickety sometimes!

ReBecca Foster said...

Not eating, for enough time to get them sick is the problem. She would try to eat, I guess I shoudl have separated her out so she could eat.

William said...

Best luck, I know how tough it is to have a sick friend and have been through G.I. tube feeding of a cat pal with fatty liver disease but who also had intestinal cancer that was undiagnosed and we lost the battle. The cancer likely made eating painful, so fatty liver disease was a symptom in this case. My wife and I are now wary of any loss of appetite our two orange tabby cats.

ReBecca Foster said...

Thank you William. I am sorry your cat. I had never heard about this before so I wanted to pass the information also.

ScottE said...

In 2003, I lost my cat Bartlett, who had been diabetic for many years. I know what it's like to suddenly lose a friend like this. Hopefully all will be well with your kitty!

And thanks for the info. My current kitty, Kutuzov, is quite healthy at the moment, but it never hurts to learn more about your cats' health.

ReBecca Foster said...

Hi Scott,

Thanks. I am sorry to hear about your kitty. I really hope this information will keep someone and their cat from going through what we are.

schrodinger said...

I bet this is the handout that your vet gave you:

http://www.veterinarypartner.com/Content.plx?P=A&S=0&C=0&A=1455

This site is open to the public. I'm a vet tech and we refer clients to veterinarypartners all the time. It's a really good source of truthful information.

How is Kelty doing?

ReBecca Foster said...

Kelty is doing great. We let her eat separate from the other cats now, so she does not have to fight for food. I keep a close eye on her now, and try to tell anyone I know how has cats about this so they will know what to look for. Thank you for the link to the article!

ReBecca Foster said...

BTW, here is a post I wrote on her progress: http://rebecca-hunt-foster.blogspot.com/2009/03/another-kelty-update.html