Hepatic lipidosis: Clinical review drawn from collective effort

Abstract

Practical relevance: Hepatic lipidosis (HL) is the most common form of liver dysfunction in cats. If recognized early and treated appropriately, the prognosis is good; if not, the prognosis is grave. Clinical challenges: Distinguishing HL as idiopathic or secondary is critical since the presence of a concurrent disease affects the therapeutic plan and the prognosis.

Audience: Despite the unique and severe nature of a cat's response to anorexia and the complexity of the metabolic changes underlying this condition, the clinical acumen and technical ability to effectively diagnose and treat HL are readily available to all small animal practitioners. Patient group: Although many species develop a 'fatty liver', the cat is one of relatively few species that suffer from HL. The classic presentation is that of an overweight cat that stops eating for days to weeks, losing weight in the process. Equipment: Abdominal ultrasound is frequently employed in the diagnostic work-up of an anorectic cat; ultrasonographic findings often support a presumptive diagnosis, provide samples for cytology and, perhaps most importantly, help identify concurrent conditions that must be addressed for therapeutic success. All of the equipment necessary for essential nutritional intervention in an anorectic cat is readily available and easily affordable. Evidence base: The material for this review draws heavily on a relatively large number of original studies, excellent reviews by recognized experts, and informative communication with experienced clinicians, hence the term 'collective effort'.

Figure 1

Icteric sclera (a), mucous membranes (b) and pinna (c) in a 7-year-old female neutered domestic shorthair cat presenting with a 2 week history of anorexia and lethargy

Figure 2

Enlarged pale liver lobes (laparoscopy) consistent with feline hepatic lipidosis. Courtesy of Dr David Twedt, Colorado State University

Figure 3

Spinal needle (16 G) used to aspirate the gall bladder during laparoscopy. Courtesy of Dr David Twedt, Colorado State University

Figure 4

Liver histopathology consistent with a diagnosis of feline hepatic lipidosis. Courtesy of Dr David Twedt, Colorado State University

Figure 5

Final nasoesophageal tube placement secured with sutures

Figure 6

Measure the feeding tube from where it will exit the neck to the 7th–8th intercostal space

Figure 7

Place blunt-tipped curved forceps through the oral cavity to the mid-point of the cervical esophagus and raise the tip to create a visible bulge to help determine where the tube will exit

Figure 8

Grasp the tip of the feeding tube with the forceps and draw it through the opening and out of the cat’s mouth until the pre-measured mark is at the surface of the skin

Figure 9

Reinsert the tube tip into the mouth and back down the esophagus until the exterior portion ‘flips’, indicating that the end of the tube has passed the exit site and moved into the lower esophagus

Figure 10

Wrap the external portion of the feeding tube, bearing in mind that easy access is required to allow the exit site to be checked daily