Nutritional support for dogs and cats with hepatobiliary disease

Nutritional intake in the patient with hepatobiliary disease provides the c ornerstone of balanced medical care. Optimal recommendations require consid eration of general nutritional principles, special species requirements and contemporary needs uniquely related to the patient's medical problem. Alth ough general recommendations follow well-established guidelines developed t o meet metabolic requirements for normal health, there is little informatio n regarding altered requirements in animals that are iii. Consequently, rec ommendations for animals have been derived empirically from studies complet ed in humans, most work having been done in patients with end stage cirrhos is or liver failure complicated by hepatic encephalopathy. This is problema tic because most veterinary patients with liver disease are not in hepatic failure and do not suffer from hepatic encephalopathy. latrogenic malnutrit ion can develop in patients when protein-restricted diets are inappropriate ly recommended. Insufficient energy intake and negative nitrogen balance ca n complicate a patient's condition, impairing tissue regeneration and recov ery from disease. This paper reviews strategies that can be used to individ ualize nutritional management in small companion animals with hepatobiliary disease, Consideration is given to both the known and controversial issues regarding energy requirements, dietary energy distribution, vitamin and mi cronutrient supplementation, the special requirements of the cat with hepat ic lipidosis, as well as strategies effective for palliation of hepatic enc ephalopathy.