Sammi, a 7 year old domestic long haired cat, presented to us in December with a history of not eating for approximately 1 week.
On physical examination, she was found to be very lethargic, very dehydrated, had lost weight and was jaundiced or icteric. The term jaundice means yellow discolouration of the skin, sclera (the white part of the eye), and the mucous membranes and gums. It is caused by an over abundance of bilirubin in the blood, and generally occurs when the bile duct is blocked, preventing the flow of bile into the gall bladder. Sammi was very nauseous, and would gag and wretch when presented with food. She was admitted to our hospital for some diagnostic tests and supportive care.
Bloodwork performed on Sammi indicated that, as suspected, her bilirubin was four times the normal level! Radiographs of her abdominal organs showed a slightly enlarged liver. The gall bladder is nestled among the lobes of the liver, and when something causes the lobes to become enlarged, they can pinch off the bile duct, preventing the normal flow of bile. When the bile duct becomes obstructed, the patient becomes icteric. While we continued to work on obtaining a diagnosis for Sammi’s icterus, she was started on IV fluids and supportive medications to help her liver to function, control her nausea, and improve her appetite.
Over the next few days, Sammi’s bilirubin levels continued to climb and a diagnosis of hepatic lipidosis or fatty liver syndrome was made. Hepatic lipidosis (HL) is a disease that is unique to cats. The typical cat with HL is overweight, and has recently gone through a period of a severely decreased appetite. In an effort to support itself through this period of calorie and nutrient reduction, the body responds by rapidly breaking down the body’s fat stores and attempts to use the fat as an energy source. The sudden accumulation of large amounts of fat overwhelms the liver and the fat is stored in and around fat cells, gradually leading to liver failure and bile duct blockage. There are many reasons why a cat’s appetite might suddenly drop, but in many cases, that specific reason is never found. HL is a treatable disease, but the most important part of treatment is nutritional support until the appetite returns. Processing of the excessive fat in the liver takes time, and nutritional supplementation may be required for a period of several weeks.
In order to support Sammi nutritionally, a feeding tube was placed in order to deliver a high quality diet, without having to actually force feed her and compound her nausea. Initially, a naso-esophageal (NE) feeding tube was placed. An NE tube is inserted into one of the nostrils, down through the back of the throat and into the esophagus (the tube that carries food from the mouth to the stomach). This type of tube is great because it can be placed quickly, with the patient awake. It does however, have the limitations of being narrow (therefore only allowing liquid diets), and if left longer than a few days, it can be very irritating to the nose. Once a diagnosis was established, and we knew Sammi was going to be supplemented for a significant period of time, we elected to place an esophageal feeding tube, which is inserted thru the side of the neck, directly into the esophagus. This type of feeding tube requires general anesthetic for placement, however it can be left in place for several weeks, and allows a great deal of flexibility in terms of the type of diet that may be fed through the tube. The best part about an esophageal tube is that feeding through it is very easy for owners to do and Sammi was able to leave the hospital and go home to recuperate!
Sammi’s owners tube fed her 4 meals per day for almost 4 weeks before she started eating on her own. After about 7 days of eating all of her daily caloric requirements on her own, Sammi’s feeding tube was pulled and she was declared 100% healthy again!! Her bilirubin was retested and had returned to normal levels. Sammi’s family is very happy to have Sammi home, healthy and back to normal!