Exam 4: Feline Liver Diseases

what are the major liver diseases in cats

• hepatic lipidosis

• neutrophilic cholangitis

• lymphocytic cholangitis

• fluke associated cholangitis

• portosystemic shunt or other vascular anomalies

generally define hepatic lipidosis in cats

• the most common liver disease

• metabolic syndrome that manifests with hepatocellular lipid overload

• cytosolic distension with triglyceride causes intracellular dysfunction and extracellular compression of the canaliculi → cholestasis

what is the pathophysiology of hepatic lipidosis in cats

• obligate carnivores

• anorexia causes negative energy balance

• lipids are mobilized to the liver to compensate for the energy deficit, but some cats inefficiently metabolisze triglycerides

• occurs more in heavier cats

what defines primary hepatic lipidosis

• anorexia due to decreased food availability , administration of non-palatable food, or stressful event

what defines secondary hepatic lipidosis

• most common form

• underlying disease such as pancreatitis, diabeters, cholangitis, chronic enteropathy, CKD, neoplasia causing anorexia

• hospitalization causing anorexia

what is the typical clinical presentation of cats with hepatic lipidosis

• middle aged (can occur in any age)

• history of hypo/anorexia, vomiting, weight loss, diarrhea or lethargy

• PE showing lethargy, mental obtundation, dehydration, hhepatomegaly, icertus

what is the adapted west haven grading scale for hepatic encephalopathy in cats

• I= mild decrease in mobility and/or apathy

• II= severe apathy (including mental obtundation) and or mild ataxia

• III= combination of hypersalivation, severe ataxia, head pressing, blindness, and circling

• IV= seizures and stupor or coma

how might hepatic lipidosis present on CBC

• non specific changes

• RBC= mild non-regenerative anemia ± poikilocytosis ± Heinz bodies

• WBC ± mature neutrophilic leukocytosis

how might hepatic lipidosis present on biochemistry

• most common and earliest abnormality is very increased ALP

• hyperbilrubinemia, increased ALT and AST occur as progresses and with other disease

• decreased K, Mg, Phos and mild hyperglycemia

• GGT normal unless other disease

• mild/moderate low albumin and high globulin may be present

how are ancillary diagnostics used for hepatic lipidosis

• urine sediment frequently contains lipid

• coagulation parameters may become progressively abnormal

• ultrasound shows characteristic diffusely hyperechoic and large liver

what disease is this a characteristic appearance for

hepatic lipidosis (hyperechoic)

how does hepatic lipidosis present on cytology

• >80% hepatocytes contain lipid

• unless there is a concern for primary hepatobiliary disease, a biopsy is not needed

• give K1 before performing FNA

how is cholangitis generallyd escribed in cats

• most common necro-inflammatory hepatobiliary disease

• involves the portal system and biliary tract

• inflammation of the bile ducts

what are comorbidities seen with cholangitis in cats

• pancreatitis

• inflammatory bowel disease

when a cat has cholangitis, pancreatitis, and IBD, what is the term used

Triaditis

what are the three subtypes of feline cholangitis

• Neutrophilic (acute or chronic)

• lymphocytic

• Chronic fluke associated

what are the clinical signs of neutrophilic cholangitis

• acute= fever, vomiting, inappetence, dehydration, jaundice, abdominal discomfort, hepatomegaly

• chronic= overlaps clinically with acute but may be more insidious with waxing and waning clinical course

what lab abnormalities are seen with neutrophilic cholangitis

• decreased PCV

• increased WBC with left shift

• Increased AST/ALT

• increased GGT

• ± increased ALP

• hyperbilirubinemia

• ± hyperglobulinemia, coagulopathy

how does neutrophilic cholangitis present on ultrasound

• non-specific and may be normal

• hyperechoic gallbladder contents, hyperechoic liver, enlarged pancreas

how does neutrophilic cholangitis present on bile cytology and culture

• paired bile cytology and culture usually match but not always

• E. coli most common

• others include Enterococcus, Streptococcus, Clostridium, ect

what supplies are needed for pericutaneous ultrasound guided cholecystocentesis

• 22 g 1.5in needle or spinal needle

• extension line

• 12-35cc syringe

• EDTA tube for cytology

• red top tube and culturettes for cultures

what is the technique used for percutaneous ultrasound guided cholecystocentesis

• heavy sedation or general anesthesia

• sterile surgical skin preparation

• ultrasound guidance

• right transhepatic approah

• empty the gall bladder

• check for leakage 2-6hrs later

what are the potential complications of cholecystocentesis

• vasovagal response (be ready with IV cath, EKG monitoring, Blood pressure, ET tube, laryngoscope, atropine)

• bile or septic peritonitis

• hemorrhage → avoid the cystic artery

what are the pros to cholecystocentesis for cholangitis

• confirmation of the diagnosis

• necessary tool to design a treatment targeted correctly

what are the cons to performing a cholecystocentesis

• complication risks

• expensive

what is the etiology and association of lymphocytic cholangitis

• loss of immune tolerance and targeting of bile ducts by the adaptive immune system

• chronic pancreatitis often present

what is the typical presentation of lymphocytic cholangitis

• cats of any age, breed or sex

• history of chronic presentation with waxing and waning nonspecific clinical signs including lethargy, weight loss, hypo/anorexia, vomiting, polyphagia

• PE showing hepatomegaly, icterus, ascites, poor body condition and muscle wasting, occasionally neuro signs

how does lymphocytic cholangitis present on bloodwork

• ± mild anemia

• poikilocystosis commo

• moderate to marked increased ALT and AST

• ± increased ALP and GGT

• mild hyperglobulinemia

• cyclic hyperbilirubinemia

how is lymphocytic cholangitis diagnosed

• imaging, cytology of liver and bile non-specific

• liver biopsy for histopathology required for definitive diagnosis

what is the occurance and signalment of cats presenting with congenital portosystemic shunts

• less common than dogs

• may occur in all breeds, though purebreeds may be at higher risk

what is the typically clinical presentation of cats with congenital portosystemic shunts

• association with copper colored irius

• neurological abnormalities present in most cats, but may wax and wane and induce or deteriorate after feeding

• marked ptyalism is common

what are the lab abnormalities seen with congenital portosystemic shunts

• CBC shows microcytosis

• chem panel sees low BUN and infrequently low albumin and glucose. ALT and ALP can be normal to moderately increased

• prolonged clotting times but often not correlated with clinical coagulopathy

• UA shows low SG, ammonium biurate crystal s

how are congenital portosystemic shunts diagnosed inc ats

• serum bile acids

• abdominal ultrasound requires accuracy of operator

• CT angiography standard imaging