Chronic liver failure
The liver is a vital organ – animals and people cannot survive without their livers.
The liver performs many complex functions that are essential to life and good health. Its main functions are:
- To convert food into useful substances such as proteins for repair and growth of the body
- To maintain normal functions such as blood clotting, fighting infection and secretion of substances to the bloodstream
- Bile production, which assists with the absorption of fat and certain vitamins
- To store the body’s primary sugar (glucose) as glycogen and be able to release it into the bloodstream when it is needed
- To neutralise and break down toxic substances such as chemicals and some medications, for later elimination in bile or through the kidneys
What is chronic liver failure?
Chronic liver failure occurs due to long-term damage to the liver, resulting in a liver that fails to work. Chronic liver failure can be caused by chronic exposure to toxins, heavy metals (copper, iron and zinc), chronic infections, chronic inflammation/irritation, cancer, blood vessel abnormalities (congenital portosystemic shunt – an abnormal blood vessel that a pet is born with that bypasses the liver), immune disease and fatty liver syndrome in cats.
The liver is very good at regenerating itself (unlike other organs such as the kidneys), but serious ongoing damage to the liver can cause long term failure of its function – this is known as chronic liver failure. Over 75% of the liver is usually damaged before liver failure occurs.
What are the signs of chronic liver failure?
- Reduced appetite
- Increased thirst
- Strange behaviours
- Diarrhoea – occasionally blood in the stools, or dark, tarry stools
- Bloated tummy due to fluid accumulation
- Yellow skin, urine, gums (jaundice)
- Weight loss
Symptoms of acute liver failure include yellow gums and eyes (jaundice)
How is chronic liver failure diagnosed?
Liver failure is diagnosed by blood tests which indicate dysfunction of the liver. Further investigations, such as ultrasound scans, urine cultures, blood cultures or other tests for infections, may be required in individual cases. Samples of the liver may be required to diagnose the cause of liver failure in many cases – these may be obtained through a needle placed in the liver under guidance on an ultrasound scan; alternatively the liver may be visualised by using keyhole surgery (laparoscopy) or by a full surgical procedure. The technique that is chosen will depend on a number of factors, and these will be discussed with you in the event that biopsies are required. In some cases of chronic liver disease the initial cause of the problem may no longer be present at the time of investigation, but the disease itself may still cause symptoms, and the damage to the liver may also continue.
How is chronic liver failure treated?
Chronic liver failure requires multiple treatments. It is important to try to remove the initiating cause (e.g. toxins, infections, cancer etc). Sometimes, this is not possible and it is best to support liver function and make the patient as comfortable as possible. Some diseases e.g. blood vessel abnormalities such as congenital portosystemic shunts (abnormal blood vessels that bypass the liver) can be corrected by Specialist surgical procedures.
Treatments which may be required in chronic liver failure include:
- Removing fluid from the abdomen that accumulates due to scarring of the liver
- Antibiotics to prevent infections
- Antacids to reduce gastrointestinal ulceration
Drugs to support the liver including:
- Anti-scarring drugs
- Drugs that bind to heavy metals i.e. copper and zinc
- Dietary modification to reduce protein and copper levels in some patients
- Nutritional support – an adequate intake of vital nutrients including calories is very important in cases of chronic liver failure.
What is the long term outlook?
Considering the severity of this disease process, this is a challenging condition to treat. Early intervention and aggressive treatment can be successful in some cases where the extent of damage is not too severe. At the present time, liver transplants are not available in veterinary medicine.
If your pet develops chronic liver failure, we will discuss the treatment options in detail with you and give you the help you need in making decisions about what you wish us to do to help your pet.
If you have any queries or concerns, please do not hesitate to contact us.