FELINE
Welcome to the Feline NAVLE Notes: Internal Medicine section on AllVetsLink.
This section provides in-depth insights into feline internal medicine, focusing on the diagnosis, treatment, and management of a variety of conditions. Explore topics such as chronic kidney disease, hyperthyroidism, diabetes mellitus, feline infectious peritonitis (FIP), and more. These notes are designed to help you deepen your understanding of feline-specific health challenges and enhance your clinical decision-making.
Thoroughly prepare for the NAVLE with targeted resources to master essential concepts in feline internal medicine.
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Flashcards
Question 1:
A 6-year-old obese domestic shorthair cat presents with 10 days of anorexia, lethargy, vomiting, and obvious icterus. Bloodwork reveals marked increases in ALT and ALP, elevated total bilirubin, but normal GGT. What is the most likely diagnosis?
Options:
A. Feline Hepatic Lipidosis
B. Lymphocytic Cholangiohepatitis
C. Primary Biliary Obstruction
D. Hepatic Neoplasia
Question 2:
On abdominal ultrasonography of a cat suspected of hepatic lipidosis, which of the following findings is most supportive of the diagnosis?
Options:
A. Hypoechoic liver with prominent portal vein walls
B. Diffuse hyperechoic hepatic parenchyma compared to falciform fat, beam attenuation, and hepatomegaly
C. Heterogeneous echotexture with multifocal hypoechoic nodules
D. Normal echogenicity with focal mass lesion
Question 3:
What definitive diagnostic test confirms Feline Hepatic Lipidosis and what is the expected cytologic/histologic finding?
Options:
A. Liver biopsy showing lymphoplasmacytic infiltrates
B. Fine‑needle aspirate (FNA) cytology revealing >60‑80% hepatocytes with lipid vacuolation
C. Coagulation profile indicating prolonged PT/aPTT
D. Serum cholesterol measurement showing hypercholesterolemia
Answer:
Answer 1:
A. Feline Hepatic Lipidosis
Explanation:
This cat's presentation—prolonged anorexia in an obese feline leading to significant icterus and characteristic laboratory findings—strongly points to Feline Hepatic Lipidosis (FHL). The key biochemistry hallmark is elevated ALT and ALP due to hepatocellular injury and cholestasis, but a normal GGT helps differentiate FHL from biliary tract diseases like cholangiohepatitis or bile duct obstruction, where GGT would more likely be elevated. Underlying pathophysiology involves triglyceride accumulation in hepatocytes due to insufficient hepatic β‑oxidation and impaired VLDL export.
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Important links:
Feline Abdominal Ultrasonography
Answer 2:
B. Diffuse hyperechoic hepatic parenchyma compared to falciform fat, beam attenuation, and hepatomegaly
Explanation:
In FHL, fat-laden hepatocytes increase hepatic echogenicity, making the liver appear brighter than falciform (abdominal) fat. Additionally, beam attenuation (sound cannot penetrate deeply), rounded liver margins (hepatomegaly), and diminished visualization of portal vein walls are common. Option A suggests other diseases (e.g., lymphoma or congestion), while Option C implies nodular, neoplastic or chronic inflammatory changes—not characteristic of FHL. Option D is unhelpful for diffuse disease.
Answer 3:
B. Fine‑needle aspirate (FNA) cytology revealing >60‑80% hepatocytes with lipid vacuolation
Explanation:
Diagnosis of FHL is often confirmed via ultrasound-guided fine-needle aspirate, which demonstrates hepatocytes with marked lipid vacuolation in over 60–80% of cells—a characteristic and diagnostic finding . Liver biopsy can be used if other hepatic diseases are suspected, but FNA is less invasive and typically sufficient. Coagulation profiles and serum cholesterol levels are supportive, but not diagnostic.
