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Feline Hepatic Failure: Symptoms Causes Diagnosis and Treatment

Hepatic failure in cats is a severe and potentially fatal condition characterized by the sudden and acute destruction of liver cells. This condition can be caused by many factors, including infectious agents, toxins, hypoxia, hepatotoxic drugs, and heat exposure, among others.

If left untreated, hepatic failure can result in a host of systemic complications, including renal failure, hemolytic anemia, pancreatic inflammation, and even multi-organ failure.

Symptoms of Acute Hepatic Failure in Cats

The symptoms of acute hepatic failure in cats can vary depending on the severity of the condition. However, some common symptoms seen in cats with hepatic failure are vomiting, diarrhea, hepatic encephalopathy, and jaundice.

When the liver fails to perform its normal functions, it can cause a buildup of toxins in the blood, leading to gastrointestinal issues such as vomiting, diarrhea and even blood in the stool. Additionally, hepatic encephalopathy may develop, which is a condition that causes neuropsychiatric abnormalities like confusion, lethargy, and seizures.

Jaundice, a yellowing of the skin and eyes, is also common, often appearing as a result of liver cell destruction.

Causes of Hepatic Failure in Cats

Hepatic failure in cats can occur due to many different factors. Infectious agents like feline infectious peritonitis and feline leukemia can cause hepatic failure.

Many toxins, including acetaminophen, xylitol, and antifreeze, are also known to cause liver damage. Hypoxia, a lack of oxygen to the liver, can occur due to trauma, respiratory failure, or anemia.

Hepatotoxic drugs, such as certain antibiotics or chemotherapy drugs, can also cause hepatic damage if not used properly. Additionally, heat exposure can cause hepatic damage due to hyperthermia and dehydration.

Diagnosis of Hepatic Failure in Cats

To diagnose hepatic failure in cats, veterinarians will perform a series of tests, including hematology, biochemistry, urine analysis, biopsy, ultrasound, and radiology imaging. Hematology can provide information about red and white blood cell counts and help detect anemia.

Biochemistry is used to evaluate liver enzyme levels and assess liver function. Urine analysis can help determine if the cat is excreting abnormal levels of phosphorus, magnesium, or calcium, which are indicators of kidney damage.

Biopsy and ultrasound can provide more detailed information on the cause and severity of liver damage or other organ damage. Radiology imaging can also help detect abnormalities in various organs, including the liver.

Treatment of Hepatic Failure in Cats

Immediate hospitalization of cats with hepatic failure is vital to prevent systemic complications. Treatment with fluids, electrolytes, colloid replacements, and oxygen supplementation is necessary to stabilize the cat’s condition.

To prevent the cat from becoming further stressed or agitated, restricted activity is typically recommended. To maintain nutrition, catheter feeding or enteric feeding may be necessary.

A normal protein diet, as well as supplements of vitamins E and K, antioxidants, and hepatoprotectants, are often included in treatment protocols. Antiemetics and drugs for hepatic encephalopathy are prescribed to handle vomiting and seizures, while drugs for coagulopathy can control blood clotting disorders.


Hepatic failure in cats is a severe condition that can rapidly develop and lead to serious complications if left untreated. Symptoms such as vomiting, diarrhea, and jaundice can be indicators of the onset of hepatic failure.

Essential diagnosis tests include hematology, biochemistry, urine analysis, biopsy, ultrasound, and radiology imaging. If you observe any symptoms of hepatic failure, it is critical to seek veterinary attention as soon as possible to provide the cat with the best chance of survival.

With prompt hospitalization, fluid therapy, and specialized treatment, many cats with hepatic failure have a positive outcome. Hematology/Biochemistry/Urine Analysis

Hematology, biochemistry, and urine analysis are important laboratory tests for diagnosing various health conditions.

In the context of hepatic failure, these tests can show important indicators such as anemia, thrombocyte irregularities, high liver enzyme activity, and impaired protein synthesis.


Anemia refers to a condition where there is a low red blood cell count or reduced hemoglobin concentration in the blood. Cats with hepatic failure commonly present with anemic conditions that result from the liver’s inability to produce or recycle red blood cells effectively.

Anemia requires prompt and aggressive management to avoid any life-threatening complications.

Thrombocyte Irregularities

Thrombocytes are blood platelets that play a crucial role in initiating blood clotting. When there is liver dysfunction due to hepatic failure, cats can develop clotting problems due to thrombocyte irregularities, which can cause chronic bleeding due to a decrease in the body’s clotting ability.

These abnormalities in clotting factors can lead to more severe bleeding that can cause severe and life-threatening consequences.

High Liver Enzyme Activity

High liver enzyme activities, such as alanine transaminase (ALT), aspartate transaminase (AST), and alkaline phosphatase, are common in hepatic failure cases. ALT and AST are enzymes used to assess the liver’s efficiency in moving amino acids, while alkaline phosphatase is an enzyme used to assess the liver’s ability to process bile acids.

Increased levels of these enzymes in the bloodstream indicate liver damage.

Impairment of Protein Synthesis

The liver is responsible for synthesizing proteins essential for several body functions, including blood clotting, transporting substances, and maintaining fluid balance, among others. In hepatic failure cases, the liver may be impaired, leading to decreased synthesis of essential proteins.

This condition can lead to excessive accumulation of fluids in the body, which can lead to the swelling of organs and an increase in blood pressure, among other complications.

Low Blood Sugar

Hepatic failure can cause hypoglycemia, a condition where there is low blood sugar in the body. This can result from the liver’s inability to synthesize or release glucose into the bloodstream for energy production by the body’s tissues.

If left untreated, low blood sugar can lead to serious complications, such as seizures or unconsciousness.

Low Blood Urea Nitrogen Concentration

The urea nitrogen concentration (BUN) in the blood can be an important indicator of liver function. A low BUN level in urine analysis can indicate liver dysfunction, a condition seen in hepatic failure.

Bile pigment and hemoglobin, another waste product of red blood cells, can also be detected in the urine and indicate that there is an underlying liver problem.

Bilirubin in the Urine

Bilirubin is a yellow pigment derived from the breakdown of hemoglobin. In hepatic failure patients, it can be detected in the urine, indicating liver cell destruction or damage.

Bilirubin’s accumulation in the body can result in jaundice, a condition characterized by yellowing of the skin and eyes.

Ammonium Urate Crystals in the Urine

Ammonium urate crystals in the urine appear as crystal deposits and indicate liver dysfunction in the cat. The presence of these crystals in urine tests is typical for severe hepatic diseases like hepatic failure.

There may also be combined findings of membranous amyloidosis in the kidney in conjunction with these crystals.

Lab Tests

High Total Serum Bile Acid Concentrations

Total serum bile acid (TSBA) concentrations are an important laboratory test for diagnosing hepatic insufficiency and other hepatic diseases. When hepatic dysfunction occurs, bile acid concentration in the bloodstream increases, which can lead to significant damage if left untreated.

High TSBA concentrations are often seen in hepatic failure cases and should be closely monitored during treatment.

High Plasma Ammonia Concentration

The liver is responsible for processing and removing ammonia from the bloodstream. In hepatic failure, the liver’s function may be impaired, leading to accumulations of plasma ammonia levels that reach toxic concentrations resulting in progressive systemic damage of the cat’s wellbeing and overall health.

Abnormalities in Blood Platelets and Coagulation Factors

Hepatic failure can also lead to abnormalities in blood platelets and coagulation factors, leading to clotting or bleeding disorders. These abnormalities often result from liver dysfunction, which limits the liver’s ability to produce clotting factors and activate the platelets.

Tissue Necrosis and Cell Pathology

Tissue necrosis and cell pathology studies are crucial for diagnosing hepatic failure. A biopsy of the liver can provide important information about the extent of liver damage and assist with the diagnosis of hepatic failure.

Zonal involvement is a clinical pathological feature identified in tissue samples through histopathology, indicating the volume of the liver affected which can determine the extent of damage. In conclusion, evaluating hematology, biochemistry, and urine analysis alongside lab tests is vital for diagnosing hepatic failure and establishing the severity of the disease.

These laboratory tests are crucial in confirming the diagnosis, uncovering the disease’s causes, and overall guiding the effective treatment of the cat. Providing quick and comprehensive medical care helps the cat recover faster and prevent fatal complications.

Imaging Tests

Imaging tests are an integral part of the diagnosis and management of hepatic failure in cats. X-rays and ultrasound are often used to evaluate the liver’s size, detect hepatic abnormalities, and in the case of ultrasound, detect non-liver conditions.


X-rays are often the first imaging test used to evaluate liver size and assist in diagnosing hepatic failure in cats. X-rays are often helpful in detecting gross changes in the liver’s size and shape, such as an enlarged liver or nodules.

X-ray also helps identify other underlying problems that may be causing hepatic dysfunction, such as the presence of masses that can compress the liver or cause biliary obstruction. Computed tomography (CT) scans can provide a more detailed view of the liver, including volumetric assessments of the organ.

These scans can also detect the presence of nodules or masses within the liver and surrounding structures. CT scans should be reserved for complicated cases where additional information is needed to inform patient care.


Ultrasound is a widely used imaging technique that is safe and non-invasive. It is often preferred over X-rays because it can provide more precise and detailed information about the liver and surrounding organs.

This technique is invaluable for detecting hepatic abnormalities, such as cystic structures, abscesses, and tumors, and is also useful for diagnosing non-liver conditions that may be causing hepatic dysfunction.

Ultrasound is particularly useful in identifying changes in liver size and texture, as well as evaluating the liver for lesions or nodules.

Ultrasound can also accurately assess the liver’s blood flow, which is important in diagnosing conditions like hepatic vein thrombosis and portal hypertension.


Magnetic resonance imaging (

MRI) is a more advanced imaging test that can provide even more detailed information about the liver and surrounding organs. Like CT scans,

MRI can help identify nodules, masses, and other conditions that may be causing hepatic failure.

MRIs are particularly useful in identifying changes in the liver’s texture and distinguishing between different types of hepatic tumors. With the help of contrast agents,

MRI can provide additional information about blood flow within the liver, which can be helpful in diagnosing complicated cases of hepatic failure.

Benefits of

Imaging Tests

Imaging tests are beneficial in detecting hepatic failure and indicating areas that require treatment. X-rays and ultrasounds are more affordable than other imaging modalities like CT scans and

MRIs. However, these tests can provide only limited views of the organ, and some abnormalities may be missed, which is why these tests are often used in conjunction with other diagnostic tests.

CT scans and

MRIs are more comprehensive, providing greater detail and accuracy, enabling the detection of microscopic changes in the liver cells and allowing for the visualization of areas behind other organs. These imaging modalities are more useful in diagnosing tumors and cysts that could be causing the liver’s failure and determining the exact location and size of the lesion.

Risks and Limitations of

Imaging Tests

X-rays and ultrasound are generally safe for pets and have minimal risks of complications. CT scans and

MRIs require sedation which can be challenging for the cat and is not recommended for cats with breathing problems due to the risk of compromise to the airways.

Imaging tests can provide results that suggest different outcomes that may be difficult to understand without veterinary advice, which is why it is vital to consult with a licensed veterinarian to interpret the results properly. These tests can also be inaccurate in some instances, with false-positive results being particularly common in imaging results.


Imaging tests, including X-rays and ultrasounds, are essential diagnostic tools in diagnosing hepatic failure in cats. These tests are often used to evaluate the liver’s size and shape, detect hepatic abnormalities, and identify non-liver conditions that may be causing hepatic dysfunction.

CT scans and

MRIs provide more detailed information about the liver, including volumetric assessments of the organ, detection of nodules or masses, and other changes in liver texture and blood flow. While these imaging modalities can be more expensive and require additional sedation, they are more useful in diagnosing tumors and cysts.

While imaging tests are highly beneficial in diagnosing hepatic failure, there are risks involved, and limitations should be closely monitored by the veterinary team. Veterinary consultation is highly recommended, especially if multiple forms of imaging tests were performed, to ensure that any necessary follow-up care is may be implemented as soon as possible.

In conclusion, the diagnosis and management of hepatic failure in cats require an understanding of the symptoms and laboratory tests that can provide a definitive diagnosis and identify the underlying cause of the disease. Hematology, biochemistry, and urine analysis laboratory tests examined by experienced veterinarians are crucial in confirming the diagnosis, uncovering the disease’s causes, and guiding effective treatment of the cat.

Imaging tests like X-rays and ultrasounds help in detecting hepatic abnormalities like nodules, cystic structures, and tumors, and diagnose non-liver conditions that may be causing hepatic dysfunction. Overall, prompt diagnosis, and early and effective management of hepatic failure through a combination of laboratory tests, imaging tests, and veterinary consultation are vital to ensuring a positive outcome for cats with this condition.

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