Feline Liver Disease

David C. Twedt, DVM, Diplomate ACVIM, Colorado State University

Liver disease in cats differs from that in dogs. Cats do not develop steroid hepatopathy, and their inflammatory disease is centered on the bile ducts, not the hepatic cells. There appear to be 4 primary categories of liver disease: hepatic lipidosis, cholangitis, neoplasia, and reactive hepatopathies. These disorders made up 87% of liver biopsy results in 1 study. Hepatic lipidosis can be primary or secondary. Although the cause of this disorder is unknown, many theories have been suggested. Animals often have a history of rapid weight loss, and icterus and marked elevation of serum alkaline phosphorus are consistent findings. About one third of affected cats have nonregenerative anemia, hypokalemia, and clotting abnormalities. With aggressive management, including tube-feeding, the survival rate can exceed 80%. Cholangitis, or inflammatory liver disease, can be further divided into 2 groups. Acute neutrophilic cholangitis is usually seen in young (3 to 5 years) cats. It is thought to be caused by an ascending bacterial infection. Chronic neutrophilic cholangitis is seen in middle-aged or older cats that have had a long illness. There appears to be a relationship among chronic cholangitis, inflammatory bowel disease, and pancreatitis. When all 3 occur together it is called triaditis. A consequence of cholangitis syndromes is bile sludging or cholithiasis, which can sometimes block bile flow.

COMMENTARY: The liver has great reserve capacity, so many cats are very ill by the time they present with clinical signs of liver disease. Many of the clinical signs are nonspecific, occasionally making it difficult to diagnose liver disease or to distinguish the type. Management of these cases should be aggressive and includes ensuring that the cats are receiving the proper nutrition, even if that means tube-feeding.