Ghost’s stay in hospital: liver disease

Introducing our beautiful patient “Ghost”, a 6-year-old female neutered domestic shorthair.  Ghost initially presented to her regular vet as her owners had noticed that she appeared lethargic, was not interested in food, had intermittent vomiting and diarrhoea, and as a result had suffered quite a dramatic weight loss.  Ghost’s owners had also discovered that her gums, ears and nose looked quite yellow!!

Ghost had a blood test performed that revealed she had a number of severely elevated parameters, including; aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase (liver enzymes) along with bilirubin – suggesting she had disease of the liver and biliary system. Ghost also had mild electrolyte disturbances (sodium, potassium and chloride) likely as a result of recent vomiting.

A specialist abdominal ultrasound was performed revealing that Ghost had an enlarged liver, thickened gall bladder wall and enlarged right limb of the pancreas.  Her mesenteric (abdominal) lymph nodes were also noted to be inflamed (likely secondary to inflammation of the liver and pancreas).  Ghost was diagnosed with suspected hepatic lipidosis secondary to inappetance due to acute on chronic pancreatitis (inflammation of the pancreas).

When Ghost first came to see us at the Cat Hospital, she was exhibiting severe jaundice (yellowing of the skin, gums and whites of the eyes), was dehydrated and was painful on palpation of the cranial (front) abdomen.  Other causes of hepatobiliary (liver and gall bladder) disease could not be ruled out at this time, including; Cholangitis syndrome: (neutrophilic, suppurative, chronic lymphoplasmacytic, lymphocytic), toxin exposure or a more sinister diagnosis of lymphoma.  A biopsy of the liver and pathologist interpretation is required to obtain a diagnosis in these cases. This would have been immensely beneficial to allow us to more precisely tailor our treatment, however this time it was not possible.

Ghost was admitted to hospital for supportive care, including: intravenous fluids (to help correct dehydration and electrolyte imbalances), pain relief, anti-nausea medication, antibiotics and lots of cuddles.  As she was not eating well on her own, we administered an appetite stimulant.  Unfortunately even with the appetite stimulant, Ghost was still not interested in food.  Due to the critical importance of maintaining dietary intake in cats, a feeding tube was placed into the oesophagus (oesophagostomy tube) through which her daily requirement of a recovery formula could be syringed.

Ghost stayed with us in hospital for 3 days until she was stable enough to go home.  During her time in hospital and at her recheck one week later her liver enzymes were re-tested.  Encouragingly, they appeared to be decreasing back to normal reference range.  Alongside the normalisation of her liver parameters, her jaundice (yellow skin) was also improving dramatically.  Ghost tolerated o-tube feeding really well at home and took her medications well.

Without biopsy, a definitive diagnosis could not be reached, however Ghost responded very well to extended medical treatment.  Given the dramatic improvement with the addition of antibiotics, we suspect Ghost may have had a neutrophilic cholangitis/cholangiohepatitis (inflammatory/infectious disease of the liver of cats).

We recently saw Ghost back to remove the feeding tube as she had been eating really well on her own at home.  Now she is no longer yellow and back to normal cat colour!!

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