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Hepatic lipidosis in cats is a condition that causes accumulation of fat in the liver. There is no known cause in dogs or ferrets. Other names for this condition include hepatic lipidosis, parenchymal lipidosis, fatty liver, and hepatic steatosis.
Signs, diagnoses and differential
A low-grade fever and lack of appetite may be present. Occasionally, there is a history of vomiting. Anorexia is the most common sign seen in these animals. There may be jaundice or a dark-colored urine. Fat accumulation is usually mild in the liver. A diagnosis of hepatic lipidosis is confirmed by clinical signs, physical exam findings, and liver biopsy. Liver biopsies are generally not performed, as there is little change in the liver that occurs from this condition.
Diagnosis is made based on clinical signs, physical examination, and lack of response to therapy. The most common presenting sign is a lack of appetite. A dark-colored urine and anorexia are other signs, but are less common. There may be jaundice. Other presenting signs may include vomiting and a dark colored mucous membrane. A physical examination may reveal a distended abdomen. Liver and spleen palpable within the abdomen may be present. A blood analysis may show a mild anemia and elevated serum bilirubin. An ultrasound of the liver and spleen may be performed.
Differential diagnosis may include other conditions, such as hyperbilirubinemia of any cause.
Treatment is the same as that for hyperbilirubinemia of any cause. The cause of hyperbilirubinemia must be determined and corrected before attempting to treat hepatic lipidosis. If no cause for the bilirubin elevation can be determined, then no treatment is recommended.
Once an etiology is established, treatment may include the following:
Supportive care. Treat the underlying cause, if present.
Lactation support. For nursing mothers. Breast feeding can be discontinued if no other lactation support is available.
Parenteral nutrition (PN). If liver failure is present, the need for PN must be considered. The use of PN may allow treatment of other underlying problems to be performed.
Dietary modification. Consider a low-energy diet. Decreasing calories will decrease the need for bile. Bile that may be produced is not as rich in the fat-soluble vitamins A and D.
Medication. Anorexia may improve with medications. The specific type of medication to use is determined by the underlying cause. The choice of medication will vary depending on the cause of hyperbilirubinemia.
Physiologic support. If hemodynamic instability develops, then the use of medications for circulatory support and/or fluid and electrolyte replacement is necessary. Medications that may be needed include dopamine and dobutamine.
Treatment of the hepatic lipidosis can vary depending on the cause of the hepatic lipidosis. For a list of possible treatments, see Treatments of Liver Disease: Hepatic Lipidosis (p. 14-17)
Nutritional support. With the exception of total parenteral nutrition, patients who have developed hepatic lipidosis may require nutritional support. Because these patients usually have poor appetite, they may be fed enterally or parenterally. Enteral nutrition is particularly helpful because it provides nutrients to the intestines, which may then be bypassed when the patient is given PN. It is more convenient for the patient than parenteral nutrition. However, if the patient is not on a parenteral diet and does not tolerate a fat-free diet, enteral nutrition is limited. Fat-free enteral formulas may be offered to supplement oral intake.
For more information on managing liver disease, consult the sections on Causes and Diagnosis of Liver Disease (p. 10-12), Hepatic Encephalopathy (p. 40-42), and Treatments of Liver Disease (p. 14-17).