DIAGNOSIS
Hepatic lipidosis needs to be distinguished from other causes of hepatomegaly.
Vascular congestion: underlying cardiovascular disease.
Toxins: mycotoxins, pesticides, heavy metals
Infectious diseases: herpesvirus, adenovirus, Salmonellaspp., mycobacteria, Gram‐ negative bacterial infections, abscesses/ granulomas, protozoa.
Tumor: lymphoma, hepatoma
DIAGNOSTICS
Imaging
Radiographs ± contrast, ultrasound, CT, and MRI.
There may an enlarged hepatic silhouette on radiography.
Ultrasound may reveal a brightly reflective, enlarged, rounded liver.
CT provides measurements of radiodensity of the liver.
CT values lower than 20 HU are compatible with hepatic lipidosis in red‐footed tortoises (Chelonoidis carbonaria).
Hematology and Biochemistry
Serum biochemistry: lack of species‐specific reference ranges make interpretation challenging.
In general, decreased plasma proteins; increased triglycerides, cholesterol, AST, and LDH; glucose and bile acid levels vary; blood is often noticeably lipemic.
PATHOLOGICAL FINDINGS
The gross appearance is of an enlarged, friable liver, pale tan to yellow, and typically has a greasy feel.
Biopsy and/or necropsy histopathology: the hepatocytes will be variably enlarged, and supporting cytoplasmic vacuolization with HE stain.
Additional stains will demonstrate the prominent oil red O‐positive lipid droplets in all the hepatocytes.
APPROPRIATE HEALTH CARE
Administration of oral medications is recommended.
NUTRITIONAL SUPPORT
Placement of an esophagostomy tube for feeding is recommended.
Maintain at appropriate temperature and humidity; exercise.
Caloric reduction with a nutritionally complete, low‐fat, high‐quality protein, liquid diet (Lafeber’s Emeraid®, EmerAid, LLC, Cornell, IL; Oxbow Critical Care®, Oxbow Animal Health, Omaha, NE; or Oxbow Carnivore Care®, Oxbow Animal Health, Omaha, NE).
Hydration
CLIENT EDUCATION/HUSBANDRY RECOMMENDATIONS
N/A
DRUG(S) OF CHOICE
Antibiotic of choice in reptiles if needed: ceftazidime.
Nutriceuticals such as silymarin and milk thistle are reported to be an anti‐ inflammatory and antioxidant; however, there are no studies to support claims for hepatic benefits.
PRECAUTIONS/INTERACTIONS
Avoid hepatotoxic agents in reptiles:
antibiotics: doxycycline, clindamycin, erythromycin
antivirals: acyclovir
antifungals: itraconazole, ketoconazole
antiparasitic: metronidazole, dichlorvos, tiabendazole, ivermectin
PATIENT MONITORING
Regular checkups to assess body weight, change in serum biochemistries, and possibly rebiopsy.
EXPECTED COURSE AND PROGNOSIS
After support through any acute crisis, the long‐term prognosis depends on associated conditions and whether these can be changed.
COMMENTS
N/A
ZOONOTIC POTENTIAL
N/A
SYNONYMS
Fatty liver
Vacuolar hepatopathy
ABBREVIATIONS
AST = aspartate aminotransferase
CT = computed tomography
HE = hematoxylin and eosin
LDH = lactate dehydrogenase
MRI = magnetic resonance imaging
POTZ = preferred optimal temperature zone
Suggested Reading
1 Divers SJ, Cooper JE. Reptile hepatic lipidosis. Semin Avian Exot Pet 2000;9(3):153–164.
2 Knotková Z, Dorrestein GM, Jekl V, et al. Fasting and postprandial serum bile acid concentrations in 10 healthy female red‐ eared terrapins (Trachemys scripta elegans). Vet Rec 2008;163(17):510–514.
3 Marchiori A, da Silva ICC, de Albuquerque Bonelli M, et al. Use of computed tomography for investigation of hepatic lipidosis in captive Chelonoidis carbonaria (spix, 1824). J Zoo Wildl Med 2015;46(2):320–324.
4 Martínez-Silvestre,
