Changes

==Signalment==

==Signalment==

Indoor cat more prone to primary hepatic lipidosis

Indoor cat more prone to primary hepatic lipidosis

==Description==

==Description==

Hepatic lipidosis is the derangement of lipid and protein metabolism, which occurs cats and dogs, but more clinically significant in cats.  It is important to differentiate primary (idiopathic) hepatic lipidosis from secondary hepatic lipidosis.   

Hepatic lipidosis is the derangement of lipid and protein metabolism, which occurs cats and dogs, but more clinically significant in cats.  It is important to differentiate primary (idiopathic) hepatic lipidosis from secondary hepatic lipidosis.   

'''Primary hepatic lipidosis''' is most recognised in obese indoor cats following anorexia in North America.  The mortality rate is high unless the disease is treated aggressively.  The pathogenesis includes a number of factors:

'''Primary hepatic lipidosis''' is most recognised in obese indoor cats following anorexia in North America.  The mortality rate is high unless the disease is treated aggressively.  The pathogenesis includes a number of factors:

*Deficiency of dietary proteins and other nutrients, which reduces the liver's capacity to produce transport proteins and to metabolise fat.  Recognised nutrient deficiencies include arginine, carnitine, taurine and methionine.

*Deficiency of dietary proteins and other nutrients, which reduces the liver's capacity to produce transport proteins and to metabolise fat.  Recognised nutrient deficiencies include arginine, carnitine, taurine and methionine.

*Disturbances in the neurohormonal control of appetite resulting in inappropriate anorexia.

*Disturbances in the neurohormonal control of appetite resulting in inappropriate anorexia.

'''Secondary hepatic lipidosis''' is a common response in dogs and cats to other diseases for example, pacreatitis, diabetes mellitus, inflammatory bowel disease and primary hyperlipidaemia.  The effect on dogs is less clinically significant.  Aggressive intervention of the hepatic lipidosis and the underlying cause is required.

'''Secondary hepatic lipidosis''' is a common response in dogs and cats to other diseases for example, pacreatitis, diabetes mellitus, inflammatory bowel disease and primary hyperlipidaemia.  The effect on dogs is less clinically significant.  Aggressive intervention of the hepatic lipidosis and the underlying cause is required.

Up to 50% of cats have an underlying disease which leads to anorexia.  If treated aggressively, it is often a reversible process.

Up to 50% of cats have an underlying disease which leads to anorexia.  If treated aggressively, it is often a reversible process.

==Treatment==

==Treatment==

*Nutritional support for 4 - 6 weeks

*Nutritional support for 4 - 6 weeks.

**This is the most important treatment in hepatic lipidosis.  It is vital to ensure that the diet is of adequate calorific content with an increase in protein content.  Specific nutrients such as arginine, taurine, or carnitine may also be added.

**This is the most important treatment in hepatic lipidosis.  It is vital to ensure that the diet is of adequate calorific content with an increase in protein content.  Specific nutrients such as arginine, taurine, or carnitine may also be added.

**This can be done via different feeding systems such as naso-oesophageal tube, oesophagostomy tube, gastrostomy tube.

**This can be done via different feeding systems such as naso-oesophageal tube, oesophagostomy tube, gastrostomy tube.

*Treat for [[Hepatic Encephalopathy #Medical Management|Hepatic Encephalopathy]] if presented.

*Treat for [[Hepatic Encephalopathy #Medical Management|Hepatic Encephalopathy]] if presented.