Cat Won't Eat/drink, Has Elevated Liver Enzyme Values/bilirubin

[MightyMinni]

Last month my sweet Minni stopped eating. It seemed to happen out of nowhere. But when I noticed she hadn't gone to the bathroom as much as usual and I was having to clear her wet food off of her plate after meals I got nervous and took her to the vet on 5/3.

On 5/3 her blood panel showed the following abnormal values:

• ALT - 662 (normal range [NR] 10-100)
• AST - 162 (NR 10-100)
• Bilirubin - 2.4 (NR 0.1-0.4)
• Cholesterol - 257 (NR 75-229)
• Slightly above normal RBC and HGB

The vet gave her SQ fluids and had me schedule an Ultrasound.

Minni made a bowel movement after 1 week on 5/4 and urinated on 5/5 morning.

That saturday, 5/5, she seemed really off (before she had been acting normally) and it seemed like she was yellowing a bit so I rushed her to the VCA hospital nearby for an emergency ultrasound. Results are below:

• Abdominal US: there are no nodules or masses in the hepatic parenchyma and liver size is subjectively normal. The gallbladder wall is thin and uniform and the bile is anechoic. There is no bile duct dilation. The muscularis layer is mildly prominent throughout the jejunum. Overall wall thickness is primarily normal (1.6-2.4mm), though at least one segment is mildly thickened (3.1mm). Layering is preserved. The stomach is empty and contracted. The right colic lymph nodes are mildly prominent (2-3mm)

The doctor at VCA gave her Marbofloxacin (antibiotic), Ondansetron (anti-nausea) and Denamarin (Liver supplement). They also gave SQ fluids.

On 5/7, our regular vet also prescribed steroids (Prednisolone) and an appetite stimulant.

The anti-nausea seems to have no effect and the appetite stimulant is worthless because I can tell she is hungry. She begs for her food but she just doesn't want to eat. We tried changing foods but it didn't help.

After 5-7 days on the steroids/antibiotics we didn't see any improvement in her appetite, but her activity levels and general demeanor remained fairly normal (certain times I could tell she was hungry but in pain or nauseous). We did notice that on 5/10 she started eating her dry food and grinding her teeth at the same time; she also started throwing up and has thrown up three times in the past 5 days. These throw ups are small and are mainly her dry food (before all this, last year, the dry food made her throw up and we switched to a primarily wet food diet).

We brought her back to the vet for a second blood test to see if the treatments have made a difference. The 5/12 blood work results showed the following abnormal values:

• ALT - 563 (down slightly from 5/3)
• AST - 138 (down slightly from 5/3)
• Bilirubin - 3.6 (increase from 5/3)
• Cholesterol - 296 (increase from 5/3)
• Amylase - 1221 (NR - 100 - 1200, was 972 on 5/3)
• Slightly abnormal RBC (off by .07 from normal range)

The vet recommended bringing her in for a check-in where we could do an enema to help with her constipation.

On 5/14 Minni had a very normal but small bowel movement, first one since 5/7.

On 5/15 AM I brought her in for a check in and we discussed changing the anti-nausea to Cerenia and continuing the antibiotics but with Baytril instead of Marbofloxacin. She received SQ of fluids, injection of Cerenia and at my request, an injection of B12. We x-rayed and saw backed up poo but ultimately decided against the enema based on my vet's recommendation.

As of this afternoon she finished her entire breakfast of wet food (about 2 oz)!! This is the first time she finished her whole plate since early April!!

The vets have told me this is IBD or lymphoma but I just have a hard time believing that when WBC isn't elevated, intestinal walls are only slightly thickened, no fever, no lethargy - just lack of interest in food and elevated liver-related values that seem to be a bit persistent.

I would very much appreciate any ideas of what this might be that is plaguing our sweet Minni and suggestions as to how I could make her more comfortable. Do you think the Cerenia or B12 worked that quickly and were responsible for her appetite? Really just looking for any one to share similar experiences with.

Thank you so much! This forum has already helped me so much and gave me the idea for the B12 and cerenia.

 

[MightyMinni]

I forgot to include weight #s:

Weight at adoption 1/2015: 7.5 lbs
Weight as of 4/2017: 8.5 lbs
Weight as of 5/3/18: 6.5 lbs
Weight as of 5/5/18: 6.35 lbs
Weight as of 5/12/18: 6.0 lbs
Weight as of 5/15/18: 6.0 lbs

 

[mrsgreenjeens]

Has no one suggested during all this time that you syringe feed her some Hills A/D, which is a higher calorie, extra vitamin food that is extra smooth and can be watered down to work in syringes? Cats are very prone to Hepatic Lipidosis from not consuming enough calories, and if they get it, then they really can't eat or they get sick. I had a cat with it years ago and we had to have a feeding tube installed.
Even though Minni is now eating a little bit on her own, it's not nearly enough, really. I think you need to help her along, unless she continues to eat 2 oz at every meal of the day. But, yes, the Cerenia and B12 should take effect very quickly.

As to what caused the issue in the first place, sometimes it's never known, but I'm wondering if NOW she does have HL, and if she does, the Denamarin will definitely help, as will Sub-q fluids, getting a fair amount of calories into her, but not too many as she first starts getting food again or it can overload her system, so start slowly and work your way up. I would call the Vet and ask if it could be HL and what else you can do if that's what it is? If she doesn't continue to eat well on her own, then a feeding tube is really a great option. It's usually installed into their esophagus rather than into their tummy, so less easy for them to pull out. Believe me, it's SO much easier to syringe them via a feeding tube than try to wrangle them in and pry their mouths open a little bit and slowly syringe some food in. Plus, you can also put most medications in via the feeding tube too. Bonus.

 

[denice]

My kitty that had IBD was the same way. He was prone to constipation, had nausea and was anorexic. I think the liver values are from not eating, cats can go into something called hepatic lipidosis. Prednisolone worked for Patches but it can take awhile to get the inflammation down. Patches was on 10 mg a day until he was doing well then he was tapered down to 5.

If he is cleaned out now you could try a maintenance dose of Miralax to keep things moving. You can start with 1/8 teaspoon twice a day and adjust the dosage to find what works.

 

[ej x]

Try miralax, also try Virbac's Rebound. It is a recovery nutrition formula for cats who can't eat or are too weak (like post-op)

That should prevent any nutrient deficiency while seh stabilizes, also my cats love the taste so no problem there.

Good luck

 

[MightyMinni]

Thank you everyone for your help so far!

mrsgreenjeens - I have been asking my vet about syringe feeding for the past two weeks and they keep discouraging it. I finally went out and bought the syringe and baby food to try it myself yesterday but then Minni actually ate on her own twice yesterday so we will see if I need to supplement her eating with the force feeding today. I did ask the vet if it was HL and they said the ultrasound didn't seem to indicate that it was, but you're right, maybe now the liver is more inflammed/effected. If the values don't go down next week I will get another ultrasound and potentially the aspiration but it costs $1500 here!

denice how long before you noticed improvement with the steroids? I have been giving the miralax since 5/3 and it hasn't helped much. I think she may have made another BM this morning so maybe it is finally starting to work now that she actually is getting more food in her! Here's to hoping!

ej x I will try that rebound because Minni HATED the Hill's A/D! I also purchased some plain chicken baby food to try (at the suggestion of my vet). Thank you for the tip!!

 

[mrsgreenjeens]

Did your Vet say WHY you shouldn't syringe feed? I'm very curious about that.

I use Miralax too when my furkids get constipated, and used it daily just like Denice for the ones who were chronically constipated. It usually takes a couple days to work when they first start on it though.

I wouldn't think you'd need another ultra sound to determine if she has HL. (we never even got ONE Ultrasound when our guy was diagnosed) Bloodwork should show it, however, I don't know exactly what they look for... raised ALT and Bilirubin are two things, but there are others, I'm sure. But Milli certainly has symptoms, including starting to turn yellow. Is she still yellow? Even constipation is one of the symptoms, plus the nausea and vomiting, loss of appetite, weight loss .

OH, and one more thing, since you mentioned she hates the Hills A/D, Royal Canin and Purina also make similar products. I know Purina's is called Clinical Nutrition. They all require a prescription or you need to get from a Vet, and different Vets carry different products, but it might be worth trying different ones to see if she'll eat them. But if you DO have to get a feeding tube, it won't matter which one you use since you'll bypass her tastebuds with it.