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-   -   12-year-old tabby with very high liver enzyme levels, at death's door (http://www.pets.ca/forum/showthread.php?t=60524)

lizzyville February 5th, 2009 01:05 PM

12-year-old tabby with very high liver enzyme levels, at death's door
 
Hello everyone,

I'm new to this forum but really need some support during this tough time. My 12-year-old cat, who was a stray found on the streets of Cyprus, is seemingly at death's door. Her liver function is well below normal and an ultrasound showed a mass, though only a biopsy can confirm what is going on, and she is so thin that we haven't done this. For awhile, her liver enzyme functions were normal, but in January the tests showed large jumps in all enzyme levels.

For several months she has thrown up almost every day. She's now on a special diet for her liver, but is still throwing up, just not as much. While this seemed to suggest improvement, yesterday she looked increasingly morose and today had problems walking. She cried out a little and showed a lack of interest in food. She's been given two steroid appetite-stimulating injections over the past couple of months. They seemed to have helped, but the last one has since worn off.

She's now at the vet on an IV drip, which has made her more alert and comfortable. But this is pretty much the end for Tenga. I wanted to know whether anyone else has had similar experiences. Would surgery have helped her? Or is it better to let this take its course?

Part of my frustration is that she is in Cyprus. I don't doubt the vet's knowledge, but I wish this had all been apparent sooner. In blood tests, it just wasn't obvious what was going on. All we had to go on was the vomiting. The vet says he has not seen this kind of thing often. But he agreed that she has been steadily losing weight for as much as a year, maybe more. I myself have noticed her getting thinner for about 3 years.

Any last-minute suggestions would be greatly appreciated. Is there anything more we can do for her???

Thanks,
Liz

RUSTYcat February 5th, 2009 01:47 PM

Hopefully, Dr. Lee can make a "housecall"!

However, we do need the patient's name:)

lizzyville February 5th, 2009 02:02 PM

My cat's name is Tenga.

RUSTYcat February 5th, 2009 02:11 PM

It was Tenga's name I was after!!! You might want to edit your post and delete the rest!

Dr Lee February 5th, 2009 10:57 PM

Liz,

A couple of questions: "The liver function is well below normal" - is this based off of a pre and post Bile Acids test? If so, this is troubling. Are the liver enzymes still elevated? How much? Can you get a copy of the blood tests and post them?

"Would surgery have helped her?" What surgery? If you mean biopsy, then the answer is 'maybe'. A biopsy will not fix anything of course but might help explain the underlying cause and whether or not there are any therapies that might help. It is an important step and may provide peace of mind.

At the current time, hospitalized and supportive care needs to get her through this period. She needs to eat on her own. Is she being force fed? Feeding tube? Denamarin or denosyl and marin are helpful additions to any liver problem. Some veterinarians, myself included, like adding vitamin B to the fluids or as an injection as they can help facilitate carbohydrate metabolism and increase 'energy'. Anti-vomiting medications and injectable famotidine (pepcid) are also beneficial. Possibly some or all of these are already being used.

Finally, I am concerned regarding the existence of a mass in the presence of weight loss. This raises my concern of an aggressive malignancy.

Please let me know if there is anything else I can do. Feel free to PM me. And thanks again for the heads up RUSTYcat. :pawprint:

lizzyville February 5th, 2009 11:25 PM

Dr. Lee,
Thank you so much for answering. Tests for liver functionality were done in the early fall and showed slight elevation of enzymes. Tests in October showed normal levels. Tests in January showed very elevated levels. Because this was all done in Cyprus, the numbers are different than in the US. Suffice it to say there were big jumps. IN early Jan a biopsy showed a mass in the liver. Yesterday morning she seemed out of it, sort of "drunk," but granted she now weighs just under 4 pounds and has lost A LOT of muscle mass. So my dad took her into the vet.

She is now on an IV but has not eaten for about 24 hours. She is not being given anything other than the IV. She will be waking up in a few hours and my dad will be visiting her (I'm in the US, but I assure you I am all studied up on her case). I sent him your suggestions about what to give her. A vet here in New York also recommended a daily dose of a steroid pill starting as soon as possible.

Yes, she has steadily lost weight over the past year, but it has not accelerated dramatically. More background:

Three years ago she began throwing up normal cat food occasionally. Born on the street, she always wolfed down food without chewing it thoroughly and overate. So the vet recommended draining the gravy from the food (whiskas). But she would still occasionally throw it up. So two years ago she was put on a food known as "Intestinal I/O" or something to that effect. Very occasionally she would throw it up, so we began mashing the food down. In the fall of 2008 she started throwing up pretty much daily. Once the liver enzyme tests were done in January, she went on a special food for liver function.

Let me just say that I do not have much faith in the vet she has been seeing. He never even thought to do an ultrasound until I and a vet in NY recommended it. He did an x-ray in the fall that showed a thickened stomach wall. A thickened intestinal wall was also viewed in the ultrasound, along with the liver mass. But no biopsy or aspiration has been done. This is all the information I have.

I really appreciate your help and will read this first thing in the morning (I'm on EST). Thank you.

Liz

Dr Lee February 6th, 2009 01:42 AM

[QUOTE=lizzyville;743811] ...in January showed very elevated levels. ...there were big jumps. IN early Jan a biopsy showed a mass in the liver. Yesterday morning she seemed out of it, sort of "drunk," but granted she now weighs just under 4 pounds and has lost A LOT of muscle mass...

She is now on an IV but has not eaten for about 24 hours. She is not being given anything other than the IV. She will be waking up in a few hours and my dad will be visiting her (I'm in the US, but I assure you I am all studied up on her case). I sent him your suggestions about what to give her. A vet here in New York also recommended a daily dose of a steroid pill starting as soon as possible.

...He did an x-ray in the fall that showed a thickened stomach wall. [/QUOTE]

A few thoughts...

Elevated liver enzymes. These indicate liver inflammation (Alk Phos will rise with cholestasis and steroid drugs and ALT, AST will rise with hepatocellular damage, etc...) however these do not indicate liver function. Bile acids (both pre and post - pre is a fasted sample and post is 2 hours after a protein meal. If the pet's health does not allow this, then a resting bile acids test can be useful). Liver function can be spectacular in the face of high liver enzymes and liver function can be near non-existent with normal liver enzymes. Both the tests give us important pieces of the puzzle. Just do not confuse elevated liver enzymes with lack of liver function. It may be or it may not be.

Nothing but IVs. Cats do not do well with out eating. Some nutritional support is important. Also when I hear, nothing but IV's I do worry that it means a cat, a cage and an IV bag without any additives. Even worse - intermittent fluid therapy. I hope we are evaluating electrolytes and glucose and supplementing appropriately with additives to the IV bag. I hope that famotidine or a similar medication is on board. What about antibiotics? In the face of a deteriorated state, antibiotics are justified.

The 'drunk' state. This is likely hepatic encephalopathy and is a serious situation. Hepatic encephalopathy occurs with liver dysfunction when toxins are not being processed by the liver, they build up in the blood stream, cross the blood brain barrier and affect neurologic function of the brain. If this is occuring then 'nothing but iv's" is highly inappropriate. Lactulose should be administered to help reduce blood ammonia levels. Metronidazole is often used in conjunction. There are other medications, but something needs to be done to help protect the brain function. Also as long as the brain is being affected by toxins, the pet is never going to want to eat. IV fluids are extremely important and do help, but they are not the only therapy available. All of the medications that I have mentioned in my responses to you are commonly used in veterinary medicine, readily available and inexpensive.

The oral steroids. I am going to have to disagree with this unless it is a 'last ditch effort'. Steroids without knowing the underlying process of liver disease may improve the situation, do nothing or make the situation worse. When playing with steroids, lets know what we are treating first. If it is between 'steroids' and quitting, then I can support its use but know that it does have risks.

Again, I would like to reiterate Denamarin or denosyl and marin.

Finally, you cannot state that the stomach wall is thickened off of a routine X-Ray. The gastric wall diameter changes with contraction and amount of ingesta present, etc... A stomach wall might 'look thick' on a X-Ray but it may be because it is empty and contracted, has food or water in it, etc.... It can be evaluated for stomach masses as a cause of thickness if a barium study was performed. On ultrasound, intestinal wall thickness can be measured easily.

Best of luck. Please keep us informed.

growler~GateKeeper February 6th, 2009 01:51 AM

I wonder if she has been tested for Kidney failure as well?

Please have the vets feed her any way possible, not eating for 24 hours will only worsen her situation :sad:

:goodvibes:


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