Expert: Karen Craft - 11/15/2008

Question
My 13 year old male orange tabby seems to have lost his enthusiasm for food and is sleeping an aweful lot.  He is always the first one at the bowls but that's not been the case for the past 3-4 days.  We brought him to the emergency care clinic and they indicated he had a temp of 104 but couldn't give us a definitive answer.  We then brought him to his regular vet and they took blood, gave him meds for the temp and Clavamox to start him on antibiotics.  His blood test came back with very odd results.  They seem to think he either has a gall stone (this is what they are leaning towards) or a liver problem.  Either way, we need to get him to eat.  No matter what flavor we give him, he only takes a few bites (about 1 tbspn) and turns his nose up at it.  Is there something we can put into his food or water that will stimulate his appetite that won't interfere with his treatment? I know there are medications but I want try the natural stimulants first.

Answer
Hi Kim,

I am attaching my recipe for Kitty Glop. This is a highly palatable cat food that is great for sick cats or a KMR, (kitten milk replacement). Feed him this stuff.  I am also attaching a great article on cat liver diseases. You can use this for reference when you talk to your vet. You need to keep up with what your vet tells you. And you need to ask the right questions. As you can see from reading this you need to get some further tests to get a definite answer. Antibiotics are a great start but you really need a more definite answer from your vet. Good luck and let me know how your cat does. The article that follows is from a site called vetinfo4cats. It's a little long but very informative. Below that is the Kitty Glop recipe.

Ciao, Karen

There are five conditions that affect cat livers which could be called
reasonably common. The first is toxic injury -- which may be due a
poisonous substance, to injury from bacterial toxins or from lack of blood
supply to the the liver. The second is hepatic lipidosis. This is a
metabolic condition that occurs when cats do not eat. There are two
problems when this condition occurs, the one that caused the cat not to eat
in the first place and the liver failure that results from it. It helps if
both conditions can be identified and treated but that is not always
possible to do. This condition can appear to come on rather suddenly, much
like toxic injury. The third condition that affects cat livers is
cholangiohepatitis, which can show up in several different variations and
is a chronic condition. The fourth condition is a group of conditions in
which the liver circulation is not functioning correctly, known as
portosystemic shunts. The last condition is cancer of the liver. There are
several cancers which affect cats which have a tendency to spread to the
liver. Figuring out which of these conditions is present involves
understanding each of them a little more and also understanding the
limitations of lab values and diagnostic techniques which can be used to
determine what is happening to the liver.

Lab tests that are commonly used to evaluate liver condition include the
ALT (alanine aminotransferase), AST (aspartate aminotransferase) and ALKP
(ALP, SAP, serum alkaline phosphatase). These tests do not indicate how the
liver is functioning at the present time. They are associated with specific
types of damage to the liver and help to determine if these types of damage
are a current problem. Liver function can be evaluated using bile acid
response testing, which does give an indication of the liver's ability to
do its job at the time the test is done. X-rays and ultrasound can give
indications of the liver's size and ultrasound can sometimes pinpoint
specific lesions in the liver or the gall bladder. Liver biopsy is
currently the only sure way to identify many of the liver conditions that
affect cats. Liver biopsy can sometimes be done simply by inserting a
hypodermic needle into the liver and aspirating contents, a relatively safe
procedure or it may involve specialized biopsy needles or exploratory
surgery to remove a small wedge of tissue from the liver. Each method of
biopsy has its advantages in specific circumstances.

The ALT value is specific to the liver, almost, in cats. A rise in the ALT
occurs when the hepatocytes (liver cells) are damaged enough to leak
through the cell membrane and release this enzyme. This can occur due to
toxins, bacterial infection, blood supply deficiencies, bile duct
obstruction and hepatic lipidosis. When an acute injury to the liver occurs
the ALT rises rapidly as it is released from damaged cells. In general the
level will rise for the first few days and then decrease gradually over two
to three weeks if no further injury occurs. This makes the ALT useful in
determining if a liver condition is due to an acute injury or due to
ongoing damage, making it a chronic condition. There are times when other
systemic illnesses, such as hyperthyroidism or feline leukemia virus
infection, can cause enough liver damage to slightly elevate the ALT
chronically.

Aspartate aminotransferase (AST) is found in the liver and other organs,
including the muscle and brain tissue. Rises in the AST can indicate a
problem in any of the organs it is common in, so it is not as specific to
the liver. However, when it rises in conjunction with the ALT it can help
to confirm that liver disease is present. It may rise faster and to higher
levels than the ALT when obstruction to bile flow is present, which can
also help to differentiate one cause of liver disease. In order for
aspartate aminotransferase to be released, the liver cell usually has to
die. Due to this, there can be situations in which the ALT rises because
cells are damaged, but the AST remains low because they are still alive. A
rise in ALT without any rise in AST would normally be a good prognostic
sign since it would indicate damage without cell death.

Alkaline phosphatase (ALP) is found in many tissues but in cats the
majority of this enzyme in the bloodstream comes from the liver. This
enzyme is excreted in response to bile duct obstruction, making it pretty
specific for this problem in cats. It can take awhile for production of the
enzyme to start and it will be produced as long as the condition persists,
so levels tend to start out low and then rise over the course of an illness
in which bile flow is obstructed. Large rises in the ALP level tend to
indicate pretty severe obstruction to bile flow which has been present for
some time.

These tests show the amount of damage to the liver cells which are present.
The reason that they can not be considered "liver function tests" is that a
liver with only a few normal cells, such as one in which cancer is
widespread or cirrhosis has occurred, may have little or no cell damage in
the remaining cells --- but almost no ability to function. Conversely, a
large number of liver cells can suddenly die due to a blood clot or toxin
and the rest of the liver can function normally. A large rise in ALT, AST
or ALP may occur even though the liver is able to do its job. The test that
is currently used to assess the functional ability of the liver is the bile
acid response test. Bile acids are removed from the circulation by the
liver. If this does not occur, it is a good indication that the liver is
not able to function. Bile acid response testing can help to determine if
disorders have damaged the liver's ability to do its job and are useful in
finding conditions, such as portosystemic blood shunts, in which the
functional amount of liver tissue is decreased.

In our practice, hepatic lipidosis seems to be the the most common liver
disorder that we encounter. Typically, cats with this condition are
refusing to eat. Many of them approach food as if they want it but then
refuse to eat at the last minute. If they do eat they may vomit
immediately. Some cats do eat and manage not to vomit but only eat small
amounts each day, not enough to meet their caloric needs. Cats with this
condition appear to be depressed. Often, they are heavy cats prior to the
onset of the illness but lose weight rapidly once it starts. As time goes
on cats with this condition may develop severe neurologic signs such as
head pressing, seizures or coma. Jaundice develops pretty quickly in cats
affected by hepatic lipidosis. The best treatment for this condition is
aggressive force feeding, often requiring placement of a stomach tube to
allow for adequate caloric intake. Hepatic lipidosis is usually fatal if
untreated but approximately 80% of cats will recover with aggressive
nutritional support. Cats with this condition respond better to high
protein, high carbohydrate diets (like kitten foods), which is the opposite
of diets prescribed for most other liver conditions. Hepatic lipidosis can
often be diagnosed using a fine needle aspirate of the liver, a relatively
safe form of biopsy that most veterinary practices are capable of.

We see a fair number of cats that appear to have had toxic insults to their
liver for reasons we rarely discover. They are often depressed, often
vomiting, sometimes have jaundice and sometimes don't. They also are
reluctant to eat. We tend to suspect this problem when the fine needle
aspirate doesn't look like hepatic lipidosis but we suspect liver disease
based on the lab values and clinical appearance. We look for an underlying
cause we can identify and then  usually try antibiotic therapy and
nutritional support for a few days prior to looking for definite cause
because cats with toxic insults often improve fairly rapidly. If the cat is
seems to be getting worse we may progress to further diagnostic testing
more quickly. It takes a week or two for rises in liver enzyme levels to
start to drop towards normal levels in these cats but their attitude and
clinical condition seems to improve more rapidly than the lab values.

We also see a fair number of cats with cholangiohepatitis of some sort.
There are several types of these disorders. Cholangitis is inflammation or
infection of the bile ducts. This is sometimes the first stage of
cholangiohepatitis, which is inflammation of the bile ducts and liver
tissue. Suppurative cholangiohepatitis is inflammation with pus production.
It can be acute or chronic. Cats with this condition tend to have
unexplained weight loss, sometimes fevers, decreased appetite, sometimes
vomiting and sometimes just a "not doing right" appearance. Antibiotics and
medications to stimulate bile flow may be helpful. Surgery can sometimes
aid in the treatment of this disease, if a way can be increase bile flow.
Another form of this condition is nonsuppurative cholangiohepatitis. This
may be the chronic form of the suppurative condition or it may occur
without evidence that suppuration ever occurred. Cats with this condition
often are losing weight but have normal attitudes. They may have occasional
vomiting or may not. Often, the first sign that owners notice is yellow
discoloration of the white portion of the eyes or the oral tissue. This
condition tends to occur in middle aged or older cats but can occur at any
age.  There are cats with this condition whose liver enzyme levels stay
almost normal or only show slight increases. Anemia is often present and as
the disease progresses protein levels may decrease in the serum. Even
though there is a decrease in protein production by the liver this
condition seems to respond better to a low protein (but high quality
protein sources) diet than to higher protein. Chronically administered
medications are used more commonly in treatment of this condition than in
the other liver diseases. Corticosteroids may be helpful. In the end,
cirrhosis may occur with either suppurative or nonsuppurative
cholangiohepatitis. Diagnosis of the type of cholangiohepatitis and even
whether cholangiohepatitis is present often requires biopsy of the liver.
Suppurative cholangiohepatitis may be apparent on surgical exploration of
the liver area but it usually is a diagnosis made after examination of a
biopsy sample. For this condition biopsy normally requires at least the use
of specialized biopsy needles and may require surgical removal of a small
section of the liver.

Portosystemic shunts are connections between the arterial and venous blood
flow in areas in which that shouldn't occur. This condition is usually
congenital and occurs when fetal circulation does not change after birth
properly, leading to portions of the liver not receiving adequate blood
supply and therefore not functioning properly. Since this occurs at birth
most cats with this condition are diagnosed when they are young but cats
may not show sufficient clinical signs to make a diagnosis until they are
young adults. It has to be considered in cats less than 4 or 5 years old
which have unexplained liver disease. Lab values for ALT, AST and ALP are
often close to normal or slightly elevated but bile acid response testing
shows a severe deficiency in liver function in most cases. Poor growth and
neurological problems such as incoordination, head pressing, blindness and
seizures usually are the reasons this condition is brought to the
veterinarian's attention.

Liver cancer is not especially common in cats and is usually the result of
metastasis of lymphoma or pancreatic tumors to the liver. Some tumors do
grow directly from liver tissue. Tumors may show up on X-rays and
ultrasound exams or may be discovered during surgical exploration of the
abdomen during a biopsy procedure.

Liver disease of any origin can lead to blood clotting problems because the
liver makes most of the clotting elements. Even though this is always
theoretically possible with liver disease actual problems from uncontrolled
bleeding after biopsy are not very common. It is still a good idea to test
blood clotting prior to doing any type of biopsy other than a fine needle
aspirate, though.



KITTY GLOP

INGREDIENTS:
1 can evaporated milk (not sweetened condensed)
2 tbsp. plain yogurt (not low or non fat)
2 tbsp. mayonnaise (real not light or No-Fat)
1 tbs. Karo Syrup (light)
1 pkg. Knox gelatin
1 egg yolk (beaten, )
1 cup Pedialyte (unflavored)
1- 2 jars Stage One Baby food (chicken or turkey)

INSTRUCTIONS:
Mix milk, yogurt, mayonnaise, baby food, and syrup together well. Bring 1 cup pedialyte to boil and mix in Knox gelatin. Set aside. Mix egg yolk with small amount of milk mixture and beat well.

Add gelatin and pedialyte to milk mixture and beat well. Add in egg yolk mixture and beat well. Remember to not use egg substitute and keep egg white to a minimum.

Pour into bowl (with cover) and set in refrigerator. Glop will last for two weeks covered in refrigerator. Try freezing the mixture in ice cube trays and store the cubes in the freezer, thaw as many as needed.
Always warm glop to room temperature ,(milk form), or a little warmer, before feeding.