Hepatic lipidosis in a cat

22 Hepatic lipidosis in a cat

Case contributed by Nicki Reed

Initial presentation

Anorexia, weight loss, vomiting, lethargy, gulping

Signalment: 8-year-old, male neutered domestic shorthair cat, body weight 5.8 kg

Case history

The cat presented with an eight-day history of anorexia and rapid weight loss. The cat had also become very dull and lethargic and did not always appear to be aware of his surroundings. He had vomited brown fluid twice in the 24 hours prior to presentation. In addition, the owners reported that the cat seemed to make exaggerated swallowing/gulping motions. The cat’s defecation appeared normal.

In the 3 days prior to presentation the cat had become progressively quieter and less interactive with the owner. The owner felt the cat seemed weak, particularly on its hind limbs. No seizures were reported.

The cat had initially been presented to the referring veterinary surgeon 4 days previously who, unable to find anything specific wrong with the cat, had administered dexamethasone and long-acting penicillin (doses not known). When no improvement was seen after 48 hours, the penicillin injection was repeated and a blood sample obtained, but the results had not been received when referral was deemed necessary.

The cat had been in the owner’s possession since he was a kitten, was fully vaccinated (including against feline leukaemia virus) and wormed every 6 months with a combination of pyrantel and praziquantel.

He was the only cat in the household and had outdoor access via a cat flap. He was fed a complete dried diet ad lib. The cat had always eaten well and had been overweight at 7 kg when last weighed 3 months prior to presentation. The cat’s appetite had declined gradually for about a week prior to him becoming completely anorexic 8 days before presentation.

Although water was always available, the cat was rarely seen to drink and the owner assumed that the cat drank from the pond outside. Recently the cat had developed the habit of drinking out of the toilet. A litter tray was offered in the house, but was rarely used. In the week prior to presentation the cat had become reluctant to go outside and had used the litter tray daily. The owner did not notice any abnormalities in the cat’s urine.

Physical examination

The cat appeared obtunded (reduced mental awareness) but was still responsive. His body condition score was still reasonable (body condition score 4/9), but the cat weighed 5.8 kg, indicating a 17% body weight loss. The oral cavity and muzzle appeared moist.

His mucous membranes appeared slightly icteric and the capillary refill time was prolonged at approximately 3 seconds. There was marked gingivitis, with osteoclastic resorptive lesions associated with the upper pre-molars and some evidence of pyorrhoea. His skin tent test result was approximately 1.5 seconds, giving an estimated 7% dehydration.

His submandibular lymph nodes were palpably enlarged, but the pre-scapular and popliteal lymph nodes felt normal. Thoracic auscultation was unremarkable (heart rate was 188 beats per minute and respiratory rate was 24 breaths per minute). On abdominal palpation the liver was palpably enlarged and renal palpation elicited an apparently painful response. The bladder was small and the intestines felt empty. Rectal temperature was normal at 38.7° C.

With the exception of weakness and altered mentation, no neurological deficits were detected, although a full neurological examination was not possible. The cat was bruised around its previous venepuncture site.

Problem list and discussion of problems

This cat had an extensive problem list, namely: anorexia, weight loss, possible polydipsia, vomiting, exaggerated swallowing/ptyalism, altered mentation, weakness, lethargy, dental disease, dehydration, icterus, hepatomegaly, renal pain and bruising. Whilst some of these problems are non-specific, such as lethargy, others, such as dehydration and weakness, are likely to be a consequence of the disease process.

Differential diagnosis

Differential diagnoses lists were done for the anorexia, weight loss, vomiting, hepatomegaly, icterus, ptyalism, altered mentation, renal pain and ecchymoses. For the most significant problems in this cat these include:

• oral disease

• oesophagitis

• pancreatitis

• hepatic disease

• renal disease

• unpalatable diet

• Weight loss

• secondary to anorexia

• hyperthyroidism

• diabetes mellitus

• liver disease

• renal disease

• intestinal malassimilation (malabsorption, maldigestion)

• Hepatomegaly

• hepatic lipidosis (HL)

• cholangiohepatitis

• hepatic neoplasia

• hepatic cysts

• feline infectious peritonitis

• pre-hepatic causes, i.e. haemolysis

• hepatic disease (e.g. HL, cholangiohepatitis, feline infectious peritonitis)

• post-hepatic biliary obstruction (e.g. bile duct carcinoma, pancreatitis)

• dental disease

• oral ulceration

• oesophagitis

• hepatoencephalopathy

• Altered mentation

• hepatoencephalopathy

• hypoglycaemia

• thiamine deficiency

• encephalitis

• space-occupying brain lesion

• head trauma

• pyelonephritis

• nephrolithiasis

• hydronephrosis

• feline infectious peritonitis

• lymphoma or other tumour

Tags: Solutions Veternary Practice Small Animal Gastroentrology

Sep 22, 2016 | Posted by admin in SMALL ANIMAL | Comments Off

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