Please talk to your vet as soon as possible to follow up on this advicehttp://www.vetinfo.com/catliver.html
|ALT rises occur in cats for a number of reasons but the most likely possibilities in a twelve year old cat are hyperthyroidism, cholangiohepatitis, hepatic lipidosis (if the cat is not eating) and pancreatitis leading to secondary blockage of bile flow. There is a condition in cats in which pancreatitis, cholangiohepatitis and inflammatory bowel disease occur at the same time, which is being referred to as "triad syndrome" or "triaditis" at the current time. Keeping this possibility in mind is a good idea. Usually there is vomiting and variable appetite along with weight loss in cats with this condition.
We usually test for hyperthyroidism when there are rises in liver enzymes in older cats which are discovered in lab work but are not causing clinical signs. This is especially true if there is weight loss, an increase in appetite or an increase in heart rate. Your vet may be reasonably certain this is not present based on the examination. If so, it is just something to file away in case further symptoms develop. It is also a good idea to be sure that there is no evidence of feline leukemia virus and to try to rule out liver cancer through X-rays, ultrasound or biopsy of the liver.
We usually try antibiotics early in cholangiohepatitis because they seem to help some cats. We use amoxicillin and sometimes amoxicillin/metronidazole combinations. I think that it is justifiable to try antibiotics without doing a biopsy or culture of bile, but some vets prefer to do this testing first and that is also definitely justifiable. If there continues to be evidence of liver disease after antibiotic therapy and recheck of the lab values in two to four weeks, then we usually do feel best if we can get a biopsy of the liver to see for sure what is happening, if that is possible. Sometimes biopsy results don't help much but it is still worth the effort, I think.
Over the long run, we have had the best luck with ursodiol (Actigall Rx) and have just started using SAM-e within the last six months. I really don't have a feel for how well SAM-e is working, yet, but it is recommended by several veterinarians who are very knowledgeable about liver disease.
Most cats with cholangiohepatitis seem to do well for a long period of time and many of our patients have lived out their normal life span despite having this condition and it is possible to treat hyperthyroidism and the triad syndrome, as well.
Mike Richards, DVM 4/6/2001
From my experiences with vomiting, weight loss and elevated liver enzymes, I would urge you to ask for X-rays, ultrasound, and the special test (SPEC-fPL test) to help diagnose or rule out pancreatitis. The results of all these tests will give you and your vet a very good starting point. (The ultrasound is necessary for finding or being able to rule out liver cancer as well. Unfortunately very important because cancer can also be a possibility.)
Food low in fat or just lower in fat can be helpful, so please talk to your vet about trying a few different things. Do NOT offer ANY high-fat treats, including chicken with the skin on, etc. (For a cat with liver disease even oil containing nutritional supplements can be too much to handle.)