Gallbladder And Liver

[Ileinaa]

I'm wondering if anyone has experience with gallbladder and liver issues. This is will likely be a long story so please bear with me.
Fawkes is 11 and had a bout of severe vomiting in August and we ended up at the emergency vet as the vomiting just would not stop. They weren't really able to pinpoint the exact cause. The blood work showed a bilirubin count of 3.1 (normal range is .0 - .9) and lipase of of 2011 (normal 100 - 1400). They gave him fluids and cerenia injection and we took him home. We followed up with our regular vet and she basically wanted to take a wait and see approach so we retested in a week and the numbers had come down.

Last Sunday the vomiting started again and off we went again to the emergency vet. Same deal elevated bilirubin and liver enzymes. Nothing showed on the xray they did. He was given a cerenia injection, pain medicine, fluids and metronidazole 50mg and we went home. Unfortunately I don't have the blood counts at this time. The emergency vet doesn't open until 8pm and I'll call and get them then. His appetite had been completely normal up until the vomiting episodes so hepatic lipoidosis was ruled out. Again we followed up with our vet on Monday. She did an ultrasound and said there was "sludge" in his gallbladder and possible mucocele and that could be causing all the elevated numbers. Kidneys looked fine. She started him on SAMe 100mg for his liver and Ursodiol 75mg for his gallbladder. He also has asthma and is on Flovent for that and a history of constipation so miralax 1/8 tsp twice a day. He's also a tripod and slightly over weight.

Today he has been listless, licking his lips and doing this odd behavior of sniffing the floor. I'm not sure when he last urinated. Some time between yesterday morning and this morning when I cleaned the boxes and nothing since. On Monday she said his kidneys and bladder looked fine. I called the vet and she didn't seem concerned about any of this and said to just watch him.
I'm not sure if this treatment is correct. Dr Google has conflicting information. I contacted another vet and they said they don't really use Ursodiol and would need to see him. He gets so stressed going to the vet but I'm worried something is seriously wrong and its not being caught. Does anyone have any experience with this and guidance to offer? I'm so worried and anxious. I don't know what else to do for him or if I'm even doing the right things. Thanks in advance for any help you can give.

 

[Furballsmom]

Hi!
I'm not experienced in this, but can you get a calming product to help with a trip to the second vet? Even a spray that you could use on and in the carrier, and the car too.

 

[denice]

I know Ursodial is the usual treatment for people when surgery to remove the gallbladder isn't possible. Seems like we are seeing more and more cats here with gallbladder issues, at one time it was almost unheard of for cats. That may be why the vet you called wasn't that familiar with it. The medication dissolves stones and/or sludge in the gallbladder so it will take time to work.

 

[FeebysOwner]

Hi. I don't know if you feel up to it, but I am giving you link to a page of other members who have been discussing gallbladder and liver issues. If you are interested in reading through some, perhaps they might give some additional information or ideas?

Search Results for Query: gallbladder and liver issues | TheCatSite

 

[sidneykitty]

Hi Ileinaa ! I'm chiming in just to say sorry Fawkes and you are going through this! My cat also had gallbladder sludge on a recent ultrasound and I had two vets tell me that was normal for a cat her age (14). But her bloodwork levels were normal as well. I found it hard to find information online about gallbladder issues in cats, so I'm interested to see what pops up here.

As far as Ursodial - I can tell you what I know about it which isn't much. I worked at a cat only vet in the past and we definitely did use Ursodial and prescribed it to a few cats. I don't recall the exact situations, but I do remember hearing it helped one of our patients. So I don't think its an unusual thing to be prescribed, but that is just from my experience.

How is Fawkes doing today?

 

[Ileinaa]

Thanks for the responses! He seems to be ok today. No weird behavior or listlessness. I talked to the Vet this morning and she had me give him a dose of cerenia. She's thinking that he might be nauseous again. I think that stuff makes him sleepy. He definitely seems to be resting comfortably!

I rambled quite a bit in my first post and actually forgot to mention that the emergency vet suggested a liver biopsy and his usual vet said to try the SAMe and Ursodiol first.

I was finally able to get his blood work from the emergency vet. ALP was 99, just barely high. His ALT is crazy high though at >2000, normal is 20-100. and his TBIL was 2.1, normal is 0.1-0.6. That's actually lower than it was back in September at the first emergency vet visit.

I have ready that gallbladder sludge is pretty normal in older cats. I think the concern was there was "some mineralization visualized". My current vet and her practice partner think that the gallbladder is causing the elevated liver values. I'm not seeing that as being a cause no matter what I search for.

I'm at a loss. I love my little guy. We lost his sister 2 years ago to an out of the blue cancer diagnosis pretty much at this exact time. Diagnosed in February and gone on March 21st. It feels like history repeating itself. Am I doing the right thing for him? I wish I had endless funds and could go all out but we haven't even paid off his first emergency vet visit back in September. Gosh this is tough.

 

[Furballsmom]

Hi again!
Keep the calming sprays and treats in mind, those could help for whatever direction you take

Also, maybe there's something here?

Financial Aid for Pets

No Money For Vet Care? How To Find Help And Save Your Cat's Life

 

[FeebysOwner]

My current vet and her practice partner think that the gallbladder is causing the elevated liver values. I'm not seeing that as being a cause no matter what I search for.

Hi. I wish I could help more. But, I can tell you that gallstones** and sludge can affect liver enzyme levels - at least in human beings. So, I don't know why the couldn't apply to cats as well.

You would need to do a search on the actual function of the gallbladder, how it stores and processes bile produced from the liver and then delivers it into the digestive tract for digestion. A proper description of this would also discuss the impacts that are associated (including elevation liver enzymes) when the gallbladder dysfunctions. I wish I could explain the process to you, but I would make a complete mess of it if I tried.

**The mineralization the vet referred to would probably be pretty much the same as gallstones I am guessing.

You could also ask the vet to explain the connection to you, so that you can at least appreciate what s/he is thinking.

Keep up the faith.

 

[Ileinaa]

FeebysOwner I used to be a nurse so I know a bit about general gallbladder function. From my research though cats are a bit different since they different connections/pathways between the gallbladder, liver and intestines or so Dr Google tells me. That seems to be why metabolize medications differently. The little buggers just have to be different lol.

He's super sleepy today and not really wanting to eat a whole lot, even his favorite treats. I've heated his food, have fortiflora and a bunch of other tricks. Just not much interest. That makes giving his medicines tough since I usually hide them in treats and he just gobbles them up. Please keep your fingers and paws crossed for us.

As far as financial assistance we don't qualify for a lot since we aren't under poverty level or on disability things of that nature. We are just stretched thin. I'll keep doing research on it though.

Thanks for all the kind words and help. It's much appreciated.

 

[FeebysOwner]

One for each paw!

 

[daftcat75]

Krista recently went through this. I'm not sure we got a satisfactory explanation of what brought it about. My leading theory, and I'm waiting for the most recent recheck results to confirm, is that it was carryover inflammation from her IBD. She broke a tooth over Christmas and I was feeding her whatever she would eat until we could get a dental for her. That was a number of trigger foods like Tiki Cat Mousse, Fancy Feast, and we came to learn, FortiFlora.

I can tell you that the ursodiol absolutely helped her. Her GGT was also high as well as billirubin, ALT, and one other (ALP perhaps?) A week of urso brought everything back into range except the ALT remained a little high (200's instead of 1400!) I will also tell you that the urso made her nauseated, the Cerenia made her anorexic, and Entyce (appetite stimulant) really twisted her tummy. I gave her a week off all meds and we re-tested and GGT and ALT were creeping up again. So we did a week of just the urso and everything came back into range (except ALT which remained only slightly elevated~200's) What seemed to help was giving the urso with food. Krista had a feeding tube at this time so I'd give her 5 cc of food, then the urso. After getting a little food in her stomach, she'd go off and eat more on her own.

It is my belief, though I'm no vet or expert, that liver and gallbladder inflammation doesn't happen in a vacuum. If Fawkes doesn't already have IBD, he may be having some kind of intestinal inflammation which would cause the vomiting and also cause the bile ducts to backup. Because of the common duct that liver, gallbladder, and pancreas share into the intestines, it's easy for inflammation in the intestines to carry over to the other organs. Also if there was compromised gut permeability as inflammation promotes, then you could have gut bacteria flowing into the liver. This is why urso, antibiotics, and IV fluids were the course for Krista. I don't know that she needed quite as much intensive care as she received. But she had other issues that made it unsafe for her to come home. So as long as she was in their care, I had her on IV fluids, antibiotics, and urso.

Was a needle aspiration and cytology done on the liver? They use an ultrasound to guide a fine needle into the liver to take a sample of the tissue to examine it's appearance as well as look for infection. This would confirm whether a course of antibiotics would be appropriate.

I just re-read your posts. So everything is back in range now except the ALT? ALT seems to be a non-specific marker for inflammation. It could point to intestinal inflammation. Were the intestines examined on the ultrasound? What did the Dr say about that? But it could also point to stress (though usually not that high) or dental inflammation or food allergies. It's my experience that trying to get ALT back into range is like chasing a ghost of something else going on somewhere else.

What is Fawkes eating? Does he eat any dry food?

The cluster of side effects from the medications might make an appetite stimulant necessary. I didn't care for Entyce. Not only did Krista look pained but I didn't think it worked very well. Mirtazapine is an interesting beast. Once you you figure out the right dose for your cat, I found it to be very effective (and kind of adorable.) For Krista, who's hovering between 7.5 and 8 lbs (antibiotics and dental issues set her back), I gave her an 1/8th of a 7.5 mg tablet (basically a crumb) every other day. Anywhere from 2 to 4 hours later, she got a serotonin flush that she just wanted to spend the next 30 minutes purring her head off in my lap, asking for scritches, and basically being a vocal love bug. Once that surge passed, she'd jump off me and head straight for the food. Her appetite would be good all that day and it would start to wane the next evening before the following morning's dose.

Anyway, now I'm the rambling one with the long post. I'll leave it here, let you digest, and answer questions as you have them.

Short version: I think you're on the right track with the liver and gallbladder but you may need an appetite stimulant because urso can cause nausea and Cerenia can cause hyporexia/anorexia in some cats (including my Krista.) I think the vomiting caused the elevated numbers and the "sludge", and not the other way around.

 

[daftcat75]

How's his teeth? When was his last dental? Dental problems can cause vomiting and appetite loss and raise ALT.

Did they test for pancreatitis? It would be the fPL or fPLI on your bloodwork. That would cause nausea, vomiting, lethargy, and a pained-looking crouching cat after eating.

 

[Furballsmom]

Hi!
Consider some music for your baby - classical harp music, there's an app called Relax My Cat, and there's MusicForCats . com.

Also, there's chamomile tea for you

This might help;
18 Awesome Cat Feeding Tips By Thecatsite Staff Members

Also here is a compilation of things, --you've probably already tried some and gotten advice for others so there may be a little bit of duplication;

Try feeding in different locations - really, completely different, and utilize different heights. For example put a couple of books underneath the dish, next time use two thick phone books, or a small-ish box so the heights are varied....

Try sitting with your cat and scoop some food on your finger or a spoon and hopefully your kitty will lick it. Or gently tuck some food inside the cheek.

Try some raw egg yolk. Egg white must always be cooked, and some people cook the white and make a slurry of sorts by adding in the raw yolk.

Also you could try some Nutri-cal or similar product.

Try making these recipes - they're just as viable for an adult cat as for kittens;
Kitten-Rescue.com

These below can be used on their own or combined with food. Also, if you heat the food a little - stir it so there aren't any hot spots from the microwave.

Or you could heat some water, about a tablespoon, and add that to canned food. A small glass works to stir it all up.

• Chicken, beef or ham flavored (pureed) baby food such as Gerber Stage 2 - make sure there is no garlic or onions in the ingredients

• Tuna and/or the juice, a low mercury/low/no sodium brand is called SafeCatch

• Salmon, mackerel

• Sardines (make sure there are no bones)

• boiled cut up chicken or turkey with no seasonings

• canned kitten food any brand

• Try mixing in Kitten Milk Replacer - there are recipes on the internet or store bought

• Fish, tuna or BBQ flavored canned wet food (I personally have never seen BBQ flavors, but...)

• Lickable cat treats or pouch treat 'gravy' poured over the food

• kitten glop (recipes in website link above)
• Bonito flakes
• fortiflora
• fish oil
• green beans, asparagus mushed up, lettuce, applesauce, mashed chickpeas, black olives
• whipped topping such as reddiwhip
• dry pasta

• goat milk, or no lactose cow milk
• whole cooked eggs (the white must always be cooked) or raw egg yolk now and then
• broth with no salt and no garlic or onion or seasonings of any kind
• There are also commercial toppers, Applaws is a brand that can work well as a topper
  
• Some good treats would be freeze dried Purebites, Orijen, Meowtinis, Meowables, Only Natural Pet, Primal

• There are also Lickimats that you could spread types of soft food onto, even plain unflavored yogurt, and even freeze it. Licking something can help a cat to feel better emotionally The LickiMat - Food Puzzles for Cats
• shredded cheddar cheese, string cheese

 

[Furballsmom]

For any upcoming vet trips;
You could try one of these, only a small selection of a fast-growing section of pet products;

Bachs Rescue Remedy - rubbed on the inside of the ears (for pets, or there's even a human version that is less oily), Richard's Organics Pet Calm-this one is drops that you put on the tip of the tongue. Also, Quiet Moments Cat treats, there is Calming Care, Calm-o-mile, Sentry, Natures Miracle calming spray, Vetri-Science's Composure is another item to look at, Pet Remedy (it has valerian) is yet another, as is Essential Pet Pet-ease, Only Natural Pet (brand and website) has a calming product, Pet Naturals also has one I believe.

Also Thunderease has diffusers as does Sentry, and feliway although diffusers are expensive and not always the answer.
You might want to check with your vet, but some people have good results with CBD oil, plus there are vet-prescribed calming products too.
Lambert Vet Supply is a website to look at, and of course chewy, also there's Petwishpros, drsfostersmith, animaleo, Petco and PetSmart, and other pet stores.

This discussion's post talks about some other products;
Calming Treats For A Very Picky Cat

 

[Ileinaa]

Oh gosh! So much information! I'll answer a few questions.

Good news first. He's currently sitting here asking for food! YAY! I am familiar with Mirtazapine as our other cat that had cancer was on it. She had lost a ton of weight. She was a vocal girl, but man that stuff made her beyond chatty. I'll definitely keep it in mind if his appetite really goes downhill.

Fawkes is only on wet food. Hasn't had dry food since he was about 2. Our former vet, who was feline only, stressed that they only should have wet. Sadly we've moved far away from them. Currently he's on Hills prescription digestion sensitive food. He's not digging it lately. I had some of his previous prescription of Hills urinary and stress and he likes it better so I've taken to putting a little of that with his other to get him to eat. As a note here, he was only on the urinary food because a previous vet insisted a bout of constipation was actually bladder related. Clearly it wasn't since all tests were normal and a week later he had to have an enema. We no longer go to that vet.

He's not be diagnosed with IBD. In fact he has a long history of constipation not diarrhea. So I don't think that would be causing this. I could be wrong. Can IBD cause constipation??

He had a dental July 31, 2018. He had a really tough time with that anesthetic. Days and days of sleeping. No extractions.

He is just finishing up a course of antibiotics. 7 days worth. Last one will be Tuesday morning. Should I talk to the vet about continuing that? He gets his antibiotic and ursodiol with food per the prescription. Hopefully that helps with those tummy issues. The SAMe he has to take an hour before a meal. I haven't given him the Cerenia today since it really took a toll on him yesterday. He doesn't seem nauseated today.

His blood levels haven't been checked since our emergency visit last Sunday when ALT and bilirubin were super high. I can post a photo of his blood work if that would be helpful. He will be rechecked the end of this week. Our vet wanted to get some medication in him and then recheck. I don't see any pancreatic numbers on his results from the e-vet. I'll ask our vet about getting that checked.

I have Bach's rescue remedy. I've been hesitant to give it to him since wasn't sure about it with his liver. I didn't know you could rub it on the ears so I'll give that a shot. We tried the VetriScience stress treats. He absolutely hated them. We have Head to Tail Calming treats but he had a half of one the night before the vomiting started so I've been terrified to give them to him again even though the vet said she doesn't think that's what started the vomiting episode. The diffusers don't seem to do much for him. I'll look for the other treats suggested. He also has a thunder shirt but I think that will hurt him right now.

daftcat75 I very much appreciate hearing your experience. It's great to know that the Ursodial can possibly help him. And thanks to everyone else for the awesome suggestions. This is super tough and it's great to have support. <3

 

[FeebysOwner]

Hi. Just what you wanted - more stuff to read (lol)! Here is a link to a previous TCS thread about cats with IBD and constipation. Maybe worth taking a look at, just as FYI. There are probably more, I am sure!

Ibd And Constipation

 

[sidneykitty]

My Amber may have IBD and she is constipated. In fact, the only time she'd ever had diarrhea was after an enema. I understand that IBD CAN come with constipation, although one of the vets I saw didn't seem to think so. In my opinion, cats like humans, are all different and respond to diseases differently. I can't see why constipation couldn't be associated with IBD.

If that's what they think it is, I'd definitely try the B12 shots. Just keep in mind you won't be able to test his blood levels for B12 after you start, so if you're interested in knowing if Fawkes is low in B12/cobalamin or folate, you have to test first. Low B12 levels can be indiciative of malabsorption in the intestines, which can be due to IBD.

Glad to hear he is eating - that's great! It seems lots of people here are coping with IBD in their kitties and they are very helpful, knowledge and supportive!

 

[Ileinaa]

I'll definitely talk to the vet about IBD at our next appointment. He ate a full meal!! YAY!!! I feel like a failure though because I was only able to get half his dose of SAMe in him earlier. Hopefully we have better luck tomorrow. Now that the Cerenia from yesterday is out of his system he seems perkier. I'll take the small victories.

 

[daftcat75]

I know this says hairballs but egg yolk could also be of use with constipation. The choline stimulates gut motility. Get the egg yolk powder they sell because the amount of fresh yolk is too small to keep up with.
How Best to Manage Hairballs

 

[daftcat75]

Hills I/D

There's a lot I don't like about this food. Vegetables, grains, and starches are not necessary in a cat's diet. In fact, cats are famously bad at deriving nutrition from vegetable sources. It is meat protein that sets the right stage for digestion. Vegetable protein and vegetable matter raise the pH making digestive enzymes and bile less effective. Less digestion, less fat solubility, more residue, and fiber to boot. The food is making him constipated.

Is it the Stew or the Pate? I dislike the pate less than the stew but both look pretty bad.

Before I highlight my objectionable ingredients (inappropriate and thus possible irritants or contributors to constipation and/or inflammation), a good recipe should be:

meat (not meal or fat), moisture, organs (byproducts okay--they're just unnamed organs), and supplements.

Anything else is a potential irritant.

Hills I/D Stew (Don't feed this! Too little protein, too many carbs!)

Water, Chicken, Pork Liver, Carrots, Wheat Gluten, Rice Starch, Rice, Powdered Cellulose, Chicken Fat, Chicken Liver Flavor, Potassium Alginate, Calcium Chloride, Monosodium Phosphate, Soybean Oil, Dicalcium Phosphate, Guar Gum, L-Lysine, Calcium Lactate, Calcium Gluconate, Fructooligosaccharides, Psyllium Seed Husk, Taurine, Potassium Chloride, vitamins (Vitamin E Supplement, L-Ascorbyl-2-Polyphosphate (source of Vitamin C), Thiamine Mononitrate, Niacin Supplement, Pyridoxine Hydrochloride, Calcium Pantothenate, Vitamin B12 Supplement, Riboflavin Supplement, Biotin, Vitamin D3 Supplement, Folic Acid), Choline Chloride, Sodium Tripolyphosphate, Magnesium Oxide, minerals (Zinc Oxide, Ferrous Sulfate, Copper Sulfate, Manganous Oxide, Calcium Iodate), Beta-Carotene.

Pate (not as terrible as the stew but you can do better!)

Water, Pork Liver, Chicken, Rice, Potato Protein, Chicken Fat, Chicken Liver Flavor, Powdered Cellulose, Dried Beet Pulp, Guar Gum, Calcium Sulfate, Potassium Chloride, Calcium Carbonate, Taurine, Dicalcium Phosphate, Iodized Salt, Fructooligosaccharides, vitamins (Vitamin E Supplement, Thiamine Mononitrate, L-Ascorbyl-2-Polyphosphate (source of Vitamin C), Niacin Supplement, Pyridoxine Hydrochloride, Calcium Pantothenate, Vitamin B12 Supplement, Riboflavin Supplement, Biotin, Vitamin D3 Supplement, Folic Acid), Choline Chloride, Psyllium Seed Husk, DL-Methionine, minerals (Zinc Oxide, Ferrous Sulfate, Manganese Sulfate, Copper Sulfate, Calcium Iodate), Magnesium Oxide, Beta-Carotene.

So what are some appropriate foods?

Fancy Feast Classic pate (really!), but none of their other lines.
Tiki Cat
Rawz
Pure Vita
Canidade Pure Wild until it got discontinued!

Those are the ones I would feed my IBD cat. Except we figured out there's something in even the turkey recipe of Fancy Feast that is causing an allergic reaction with Krista. Maybe the poultry giblets are still too much chicken.

Can you try a lower fiber food? Fiber requires water and if he doesn't get enough from food and drink, that's constipation. I know miralax is bringing moisture into his stools but I think maybe a less carby/lower residue (undigested or minimally digested material aka most of hte carbs) food wouldn't even need Miralax.

What about Tiki Cat Chicken with Pumpkin? If he does have issues producing enough bulk to poop, the pumpkin will provide both bulk and moisture. Try it as a guest star meal. Transition one meal a day or add one meal and see how he likes it and how it transits through him. If it works out, transition another meal. I don't know that I'd feed him exclusively Tiki Chicken w/ Pumpkin because it's a lower calorie food. I like to feed Krista foods that are at least 1 calorie per gram (or at least 1000 Kcal/Kg ME) so that she can maintain or gain weight; so that I know it's more nutrition than water.

Anyway, I'm opionated and I'll keep going if you let me...