Q: I HAVE A FRIEND WHO HAS A CAT THAT DIED OF A "FATTY LIVER". MY FRIEND SAYS THAT HER CAT GOT THE DISEASE BECAUSE SHE DID NOT EAT. MY CAT FLUFF SOMETIMES WILL NOT EAT FOR A DAY OR SO. I'M WORRIED THAT FLUFF WILL GET "FATTY LIVER". WHAT CAN I DO TO PREVENT THIS?

A: Hepatic lipidosis or fatty liver is a syndrome that is commonly seen in cats. It is most commonly seen in obese cats that have anorexia for at least two weeks. Fat accumulates in the liver and causes damage to the liver. Sometimes there is a second disease that predisposes the cat to developing hepatic lipidosis. These include diabetes mellitus, cancer, pancreatitis and other liver diseases. Stressful situations such as introduction of new pets or people into the household, boarding and dietary changes are also associated with anorexia and the development of hepatic lipidosis. In 50% of the cases of hepatic lipidosis, no predisposing disease or factor is identified.

The most common clinical signs seen in this syndrome are anorexia, weight loss, vomiting and icterus (yellow color to skin and mucous membranes). Less often, behavioral changes such as drooling, blindness, coma, and seizures may be seen.

Suspicion of hepatic lipidosis is based on history, physical exam findings and supportive laboratory work. Radiographs (x-rays) and ultrasound help to define the appearance of the liver and rule out other disease states. Definitive diagnosis requires identification of fat globules in liver cells. The liver cells may be obtained by liver biopsy or fine needle aspiration.

Once hepatic lipidosis develops, treatment depends on the severity of the disease and the presence of other diseases. Treatment requires aggressive nutritional support. Force feeding is usually not adequate and may cause the cat to develop an aversion to the food being offered. Placement of a feeding tube into the esophagus or the stomach for long-term nutritional support has reduced the mortality rate in this disease from over 90% to 30%. Often the tube must be used for several weeks.

Unfortunately, despite aggressive therapy, many cats will succumb to this disease. Therefore, prevention is essential. Any anorexic cat should be evaluated by a veterinarian. Therapy for prevention may include use of appetite stimulants and offering tempting foods, as well as elimination of predisposing factors, if possible.

Q: MY DOG RALPH HAS BEEN VOMITING FOAM. I TOOK HIM TO MY VETERINARIAN AND HE TOOK X-RAYS AND SAID THAT RALPH HAS AN ENLARGED ESOPHAGUS. HE RECOMMENDED DOING A LOT OF TESTING TO TRY TO FIND OUT WHY THIS IS HAPPENING. RALPH DOESN'T SEEM TO BE HAVING OTHER PROBLEMS AT THIS TIME SO I AM NOT CERTAIN ABOUT WHAT I SHOULD DO. WHAT DO YOU THINK?

A: The esophagus connects the pharynx, or back of the mouth, to the stomach. It transports food and water to the stomach. Usually the esophagus contracts to move substances to the stomach. In megaesophagus (enlarged esophagus) the esophagus dilates and becomes weak and is unable to propel food or water to the stomach.

Animals with megaesophagus will regurgitate food or water. This process involves food or water coming out from the esophagus and is often confused with vomiting. Vomiting occurs when food or water comes from the stomach or duodenum. Other signs include weight loss, but the most life threatening side effect of the syndrome is leakage of food or water from the esophagus into the trachea (windpipe) and the lungs. This leakage into the lungs is called aspiration and results in pneumonia (infection in the lungs). Sometimes signs of aspiration pneumonia, such as fever, cough, and labored breathing may occur without regurgitation being observed. Sudden dealth may occur if large amounts of food and water are aspirated.

Diagnosis of megaesophagus is made by taking radiographs (x-rays) of the chest, sometimes with administration of a contrast agent. Radiographs are an important diagnostic tool because other medical conditions can cause similar symptoms, but require different therapy.

Megaesophagus has devastating effects. Clinical signs usually are progressive and most animals die of aspiration pneumonia. Since there are many recognized causes of megaesophagus, a search for the underlying cause is recommended. Unfortunately, an underlying cause is found in only about 25% of cases. When no underlying cause is found the syndrome is called idiopathic megaesophagus. In cases of idiopathic megaesophagus, therapy is symptomatic and management is aimed at preventing side effects, such as aspiration pneumonia. In cases in which an underlying cause is found, the underlying cause is treated and the megaesophagus may be reversed.

Medical management of megaesophagus consists of trying to assist food and fluid flow into the stomach. Feeding the animal in an upright position and maintaining that position for 5 to 10 minutes after feeding is helpful in some cases. Feeding a gruel may allow the food to flow more easily into the stomach. Other animals tolerate solid food better than gruels. Small feedings several times a day are also recommended.

Sometimes a gastrostomy tube (stomach tube) may be placed for feeding. This allows food and water to be given directly to the stomach. Although this decreases the risk of aspiration from feeding, it does not entirely remove the risk of aspiration since the animal will still swallow saliva.