Hepatic (Liver) Failure - Acute

Summary

The liver is a sensitive organ that serves several vital functions. In addition to aiding in the digestion of nutrients as they pass through the gastrointestinal tract and managing the body's many metabolic needs, it also serves to detoxify the blood and provides a source for many important proteins in the blood as well as agents required for the blood's complex clotting mechanism.

As the source of so many functions, the effects of its failure can be spectacular and catastrophic, more so if that decompensation happens suddenly. This sudden cessation of normal liver function is referred to as acute hepatic failure. In some cases, it can also be referred to as fulminant hepatic failure.

The causes of such abrupt loss of function are many and varied but exposure to toxins (xylitol, for example) and infectious disease (such as leptospirosis) are the most common among these. In cats, nutritional deficiencies can also led to acute liver failure via hepatic lipidosis (aka fatty liver disease).

Symptoms and Identification

Dogs and cats who suffer this kind of catastrophic liver insult will experience one or more of the following signs:

• Vomiting

• Diarrhea

• Listlessness

• Loss of appetite

• Neurological signs such as head pressing, stargazing, seizures and depression

• Coma

Depending on the cause of the acute liver failure, abdominal pain and fever may be a feature of its clinical presentation.

To assess the liver's function, the following tests are typically undertaken:

• Blood chemistry analysis (biochemical profile)

• Ammonia concentration (in the blood)

• Bile acid concentration (in the blood)

• Urinalysis

• Urinary bile acid concentrations

• Clotting profile

• Buccal bleeding time

X-rays, ultrasounds and CT scans may also be indicated. Biopsy of the liver is also indicated in many cases to confirm the diagnosis and attempt to identify the cause, if elusive.

Affected Breeds

Any breed of dog or cat may suffer acute hepatic failure as the result of toxic, nutritional or infectious causes.

Treatment

Treatment of any kind of hepatic failure consists of the following basic steps:

• Remove, reverse or otherwise correct the inciting cause(s)

• Offer adequate nutrition and prevent malnutrition

• Provide specific treatment of the liver disease

• Treat any complications secondary to the liver's loss of function

• Offer the patient an environment for optimal return to normal hepatic function.

In the case of acute hepatic failure, pets must be treated swiftly and decisively if they're to survive. For this reason, internal medicine specialists and 24-hour specialty services are typically recommended for these patients.

Intensive care hospitalization for IV fluids, antibiotics, electrolyte correction, plasma transfusions, nutritional management and constant monitoring is strongly recommended.

Because the liver is an organ that has the ability to regenerate, pets can sometimes return to perfectly normal lives even after near-death acute liver failure experiences.

Veterinary Cost

The cost of veterinary care for acute hepatic failure patients will vary depending on geographic locale and level of care elected. Initial assessment may vary between $500 and $2,500, depending on the techniques elected for assessment. Meanwhile, ongoing intensive care may cost upwards of $1,000 a day or more if specialty care is elected.

Prevention

Preventing exposure to toxins, vaccinating against diseases known to cause acute hepatic failure, and either keeping cats lean or preventing rapid weight loss are al recommended means of prevention.

References

Bauer JE. Hepatic disease, nutritional therapy and the metabolic environment: timely topics in nutrition. J Am Vet Med Assoc 1996;209:1850-1854.

Biourge V. Nutrition and liver disease. Sem Vet Med Surg (Small Anim) 1997;12:34-44.

Center SA. Nutritional support for dogs and cats with hepatobiliary disease. J Nutr 1998;125:2733S-2746S.

Marks SL, Rogers QR, Strombeck DR, et al. Nutritional support in hepatic disease. Part II. Dietary management of common liver disorders in dogs and cats. Compend Cont Educ Pract Vet 1994;16:1287-1290.