The liver processes all of the blood that comes from the intestines and 20% of the blood that the body pumps with each heart beat. It is responsible for the metabolism of fats, proteins and carbohydrates; the storage of vitamins and minerals; food digestion; and clearing toxins from waste. Some of the proteins that the liver is responsible for making are responsible for blood clotting and maintaining blood pressure, among other things. Additionally, the liver also stores these proteins and monitors the supply and demand within the body. The liver also regulates blood sugar levels and turns glucose, the body's most important source of energy, into glycogen and stores it until it is needed. Fats are also stored and released when the body needs them. This allows a cat to survive and not die of starvation, even if a completely balanced diet is not fed every day.
Additionally, all vitamins (except Vitamin C) are either made, stored in or regulated by the liver. For this reason, it is very important to supplement vitamins in the diet of a cat with liver disease.
Another important task of the liver is the manufacture of a substance called bile, a greenish material which is then transported to the gall bladder via the small bile ducts, and then to the intestines. Bile consists of waste products that need to be execreted from the body, but it also aids in digestion.
The liver is responsible for over 1,000 different tasks, many of which could not be completed elsewhere in the body and are essential for life. When part of the liver is damaged, has a bacterial infection, or has cancer, the rest of the liver works overtime to complete the necessary tasks. For this reason, liver disease is often hard to detect at first.
Thankfully, the liver has an incredible ability to heal itself with supportive medication and nutrition. Sections that no longer function can often completely recover.
Common causes of liver failure:
Hepatic lipidosis, also known as "fatty liver syndrome." When a cat loses weight too quickly, the liver cannot process the fat rapidly enough; this is the most common cause of liver failure in cats. For more information, see the Veterinary Information Network (VIN) for details about the causes and treatment of hepatic lipidosis.
Cholangiohepatitis - a bacterial infection of the liver. This can also be the underlying cause of hepatic lipidosis. For more information from VIN, see their article on cholangiohepatitis in cats.
To distinguish between the different conditions and determine the appropriate treatment, it is necessary to view a sample of the liver. Ideally, this would be a biopsy, which can often be obtained during an abdominal ultrasound.
Treatment of liver failure/disease:
A bile acid blood panel will let us know if the liver is still able to function correctly or not. If this panel shows malfunction, then hospitalization and more aggressive treatment of the liver injury is recommended. This test is done by not feeding your pet after dinner, then coming in the next morning for us to take an initial baseline blood level. We then feed your pet and retest the bile acid level with a second blood sample, 2 hours after being fed. Here is an article from Cornell University with more technical information about the bile acid blood test.
Since the liver is responsible for producing factors that help blood to clot when needed, liver disease can result in a lack of these factors. This can then lead to a potentially life-threatening bleeding disorder. We need to check and see if this is an issue for your pet at this time by doing a coagulation blood panel. If there is a problem affecting the blood's ability to clot, then Vitamin K supplementation can help to counteract this. It also lets us know that any further tissue damage, such as a blood draw or biopsy procedure, could lead to serious bleeding complications. This information is very important in helping determine your cat's treatment plan.
Abdominal ultrasound - to better assess the liver. This is a non-invasive procedure that can give us a wealth of information about the organs in your pet’s abdomen. Your pet can be awake for this procedure. Hair is shaved from the lower abdomen and a probe is run over the belly that allows us to visualize your pet’s insides and see if there are any abnormalities noted. If a thickening or mass is found, a fine needle aspirate (FNA) can be done to collect tissue samples for a diagnosis. While an FNA is an excellent way to obtain the necessary information without surgery, anesthesia is often needed. This procedure is performed by a board-certified radiologist, either in our hospital or at a specialty clinic.
Diet and Nutrition:
Feed a highly digestible diet that decreases the work load of the liver, such as Hill's i/d, Eukanuba Low Residue or Purina EN diets. For more severe liver failure, Hill's l/d is a better choice. All of these diets are sold in our Pet Nutrition Center.
It is essential that your pet receives enough nutrition each day to keep the body in a positive caloric balance; otherwise the liver condition can continue to deteriorate. Please feed your cat at least 250 kcal per day . A can of Hill's i/d or Eukanuba Low Residue has about 165 kcal. A cup of i/d dry has 483 kcal and a cup of Low Residue dry has 369 kcal. The Feline EN has 118 kcal per pouch of semi-moist food.
Please let us know if you are unable to get your cat to eat enough food. Supplemental hand feeding or placement of a feeding tube may be needed, and well as injection of electrolyte fluids.
If your pet is nauseous please feed smaller, more frequent meals throughout the day. You can also try giving Pepcid AC, 5mg orally once a day. This is sold as a 10mg or 20mg tablet at any human drug store. The only active ingredient should be Famotidine.
Give Denamarin daily: Denamarinincludes SAMe, an antioxidant nutritional supplement which helps to reduce further damage to liver cells. It also has anti-inflammatory properties and promotes liver regeneration. It also may improve bile flow, protect from bile-induced injury and inhibit liver cell death. Denamarin also includes silybin, the most biologically active component of an extract from milk thistle. This is another antioxidant, as well as a free-radical scavenger that helps protect liver cells from toxins that build up in liver cells. It also helps to chelate (bind) iron and promotes the passing of harmful bile buildup into the urine. Denamarin is sold in our Pet Nutrition Center and in our online store. Give a 90mg tablet orally once a day on an empty stomach. Do not break up this pill since it is designed to be a time-released tablet. This supplement can be given indefinitely to help support the liver.
Medications:
Antibiotics to help control infection of the liver. Since the liver acts like a filter in the body, it is prone to catching bacteria that is in the body, such as bacteria from the mouth that can infect gums. When the liver is damaged, it is more susceptible to becoming infected itself. Therefore, antibiotics are indicated to help prevent this from occurring and to treat any infection that may already be there.
Actigall is a medication that improves bile flow and reduces bile sludging within the liver. Bile build-up, which frequently occurs in liver disease, can lead to liver cell damage and gallstones. We work with a pharmacy that can formulate the medication to a dose that is appropriate for your cat.
If there are neurologic symptoms due to elevated blood ammonia levels as a result of liver failure, lactulose is recommended. Lactulose is a liquid soluble fiber that helps excrete ammonia in the gut.
Other recommendations that are less essential, but strongly advised are:
Consider also letting us give your cat an injection of Vitamin B12 (cyanocobalamin) once a week. This vitamin is often low with liver disease; this can then lead to a poor appetite, gastrointestinal malfunction and poor digestion of many other important vitamins.
Supplement L-Carnitine. This is an amino acid that helps to protect the liver against lipid and ammonia accumulation, which frequently occurs in cats with liver disease. The recommended dose is 250-500mg per day.
Supplement Vitamin E as another anti-oxidant to help protect liver cells against further damage. The dose is 100-400 IU per day. The water-soluble formulation is better absorbed. Please do not over-supplement this vitamin since it can be toxic at high doses.
We know this is a lot of information and asking a lot of you to give all of these medications and supplements. If your lifestyle or your pet’s attitude simply does not allow this type of intensive supplementation, we will need to re-evaluate your pet’s treatments and see what we can do to make the treatments easier.
Please consult with a veterinarian before implementing any of these recommendations.
Processing ....
tabolism of fats, proteins and carbohydrates; the storage of vitamins and minerals; food digestion; and clearing toxins from waste. Some of the proteins that the liver is responsible for making are responsible for blood clotting and maintaining blood pressure, among other things. Additionally, the liver also stores these proteins and monitors the supply and demand within the body. The liver also regulates blood sugar levels and turns glucose, the body's most important source of energy, into glycogen and stores it until it is needed. Fats are also stored and released when the body needs them. This allows a cat to survive and not die of starvation, even if a completely balanced diet is not fed every day.
Common causes of liver failure:
