Symptoms of Liver Failure in Cats

Liver failure refers to certain diseases and circumstances that alter the correct functionality of the liver in cats. There are many diseases that decrease the functionality of the liver, some are primary while others are secondary due to toxins or extrahepatic diseases.

The feline liver fulfills numerous functions, since it intervenes 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 salts from the conjugation of bile acids with taurine and arginine, it intervenes in the synthesis of ammonia from urea and in its elimination. Therefore, a deficiency of arginine will cause the intoxication by ammonia in our cat, causing a hepatic encephalopathy that, unfortunately, usually has a fatal outcome.

Liver failure in cats can be caused by various factors, including liver diseases, infectious diseases, diseases in other organs. Let's take a deeper dive into the many different causes of liver failure in cats:

Liver disease

There are different liver diseases that can lead to a liver failure:

• Hepatic lipidosis: this is when there is a fat infiltration in the cells of the feline liver causing their dysfunction, being potentially fatal. 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 the 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 must obtain with its diet. The 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 of gastrointestinal bacteria (Escherichia coli, streptococci 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 flow together into the intestine, so diseases in the intestine or pancreas can affect the liver.
• Lymphocytic cholangitis: is a progressive chronic immune-mediated disease with infiltration of lymphocytes.
• Liver cirrhosis: appears at the end of a chronic liver disease and consists of the appearance of fibrosis, abnormal regeneration 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 flow 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 seen more frequently in the Abyssinian, Siamese and Oriental cat.
• Liver tumors: these are rare in cats and the most prevalent being bile duct carcinoma. We can also see lymphomas in the liver, but we can also find them in other locations.

Infectious diseases

There are also infectious diseases that can cause feline liver failure, for example:

• Feline infectious peritonitis: 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. Read more in our article about toxoplasmosis in cats.

Intoxification

Cats present a deficiency in the metabolizing enzyme glucuronyl 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 that present with liver toxicity in cats include methimazole, tetracyclines, diazepam, L-asparaginase, and doxorubicin.

Portosystemic shunt

This consists of an alteration in the circulation of the liver of congenital origin 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. They filter through vascular communication, then go directly to the general circulation, resulting in toxic damage to the brain. Due to this, the liver atrophy reduces in size, causing liver failure.

Among all of them, the diseases that most commonly cause liver failure in the feline species are hepatic lipidosis and cholangitis.

The diagnosis of diseases that can cause liver failure in cats is completed by an anamnesis, clinical examination, blood analysis and biochemistry, ultrasound and biopsies.

Physical examination

During the anamnesis and examination of the feline we must observe the clinical signs that the cat presents, observe their state of hydration, fur, 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 abdominal cavity indicative of ascites. Jaundice and ascites are late signs of liver disease in cats, the most specific being liver failure itself.

Blood test

A blood count and biochemistry of the cat must be performed. It should look for markers of functionality and any type of liver disease:

• Markers of liver disease: an increase in ALT and AST enzymes indicate cellular damage in the liver, although since they have a half-life of a few hours in the cat, if we do not see them increased, it does not have to be liver disease. An increase in the ALP and GGT enzymes leads more to damage in the bile ducts and canaliculi, if only GGT is increased, it leads more to liver damage.
• Markers of liver function: these are altered when liver failure is advanced, being hyperbilirubinemia (increased bilirubin), hypoglycemia (low glucose), hypoalbuminemia (low albumin), hyper or hypocholesteronemia (decrease or increase in cholesterol) and increased times coagulation (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 laboratory test, cats usually present bilirubinuria (bilirubin in urine) which is always pathological in this species. If bilirubin is normal, the most sensitive and specific marker for detecting liver failure in cats is an increase in bile acids on an empty stomach 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 actually has liver disease. In some cases, focal lesions are seen, an enlarged liver with hyperechoic parenchyma (white in the image) that is suspicious of lipidosis, dilation of the bile ducts suggesting 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 pathological study from taking biopsies. However, in cases of lipidosis it can be diagnosed using the previous steps and a liver fine needle cytology (FAP), 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.

The treatment of liver failure in cats is complex and will depend on the disease or diseases that coexist in the animal, each disease must be specifically treated once diagnosed separately and the symptoms.

Treatment of liver lipidosis

Many caregivers wonder if liver 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. In these cases, the cat's therapy is mainly based on:

• Enteral nutrition with esophagostomy or nasogastric tube (it is increased by 25% each day until reaching the daily kcal that the cat needs on the fourth day).
• Fluid therapy with isotonic crystalloids supplemented with potassium if required.
• Nutritional supplements and vitamins: taurine (to prevent or treat deficiency), L-carnitine (to increase the oxidation of fatty acids) and vitamins E (antioxidant), B and K (to treat deficiency coagulopathy).
• If they have hepatic encephalopathy, lactulose should be given orally with antibiotics such as amoxicillin or metronidazole.
• To replenish the lost stores of glutathione that protects against oxidizing agents, N-acetyl-cysteine must 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

Antibiotics should be administered for 4-6 weeks with previous culture and antibiogram (cephalosporins, amoxicillin-clavulanate, fluoroquinolones, metronidazole). If the result isn't good, corticosteroids should be added. Depending on the severity, supportive treatment will include:

• Fluid therapy
• 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 like S-Adenosyl methionine (SAMe) and vitamin E to reduce oxidative stress that causes disease
• Nutritional supplements and vitamins

Treatment of lymphocytic cholangitis

Antibiotics and prednisolone are administered at high doses (2-3 mg / kg / 24 hours) with a progressive reduction of the dose according to the 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 the cases of infectious diseases, the disease should be treated and the liver protected with antioxidants (SAMe, vitamin E), ursodeoxycholic acid administered and symptoms treated with antiemetics, fluid therapy, appetite stimulants or enteral feeding, pain control and nutritional supplements.

Treatment of liver tumors

In cases of neoplasms, chemotherapy protocols adapted to the tumor will be carried out and, in removable tumors, surgery.

Portosystemic shunt treatment

The indicated treatment will be surgery, but it does not always go well. The cat will first need to be stabilized with antibiotics, lactulose and a low protein diet.

As you can see, the treatment and severity of their illness will depend on what caused their liver failure. This is why it's so important to take them to the veterinarian as soon as possible to be professionally examined and treated.

This article is purely informative. AnimalWised does not have the authority to prescribe any veterinary treatment or create a diagnosis. We invite you to take your pet to the veterinarian if they are suffering from any condition or pain.

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