I am not a veterinarian and can not diagnose or treat your birds. Do not self-diagnose or attempt to self treat your birds, even if they fit the symptoms of liver disease perfectly. If your bird shows any signs of illness, take him or her to a vet immediately.

Liver disease in birds

Liver disease is very common in birds, especailly cockatiels and budgies, and has caused many deaths. Whether this is due to a species-specific tendency towards it or due to the poor diet many small birds have been raised on is unknown, but either way it is very hard to see birds die from liver disease because it is a preventable and easily treated illness. The liver is the one organ in the body that can completely regenerate, but it needs help to do so.

Causes and birds that are at risk to develop liver disease
Symptoms of liver disease
Diagnoses
Treatment
Warnings
Prevention
Sources and further reading

Causes and birds that are at risk to develop liver disease

Causes:

• Obesity
• High fat, low nutrient diet (such as an all seed diet)
• Poisons in water supply
• Ingesting spoiled food
• Aflatoxins
• Salmonella
• E coli
• Pseudomonas
• Chlamydia psittai
• Polyoma virus

Also, birds that have diabetes or are undergoing long term medication for another condition have an increased risk of liver disease. Older birds are more likely to develop liver disease, but it can be found in birds as young as a few months. Some color mutations such as albino and lutino cockatiels are also at increased risk.

Symptoms of liver disease

Note: Unlike mammals, jaundice (the yellow tint in mucous membranes and fingernails from the build up of bile under the skin) is very rare in birds with liver disease.

• Lethargy
• Poor appetite
• Weight loss
• Poor feather quality
• Irritability
• Overgrowth of nails and beak
• Poor coordination
• Easy bruising
• Bruising on beak or toes without a fall
• Increase in water intake
• Increase of water in droppings
• Bright green urates (the avian equivalent of jaundice)
• Feather plucking

In very severe cases there may also be seizures, difficulty moving, jaundice, feather loss, a visible lump under the skin on the lower torso, regurgitation due to the pressure on the digestive system from the enlarged liver, or trouble breathing due to the pressure on the respiratory system from the enlarged liver.

Diagnoses

• Physical exam
  • Your veterinarian or vet tech will examine your bird, looking at the condition of the beak, feathers, and nails, looking at the droppings, looking inside the beak and at the eyes, weighing your bird, taking your bird's temperature, and feeling for bumps, bruises, or an enlarged liver.
• History
  • Your veterinarian or vet tech will take a history of your bird, where you got him or her, what the cage is like, what the diet is like to look for possible causes or items that may put your bird at risk
• Blood work
  • Blood work is the best way to diagnoses liver disease in birds. There are six "liver enzymes" that will show up on a blood panel: AST, GDH, GGT, AP, LDH, and ALT. AST is the enzyme that is most often raised in liver disease. The others are usually normal even in severe liver disease. A type of protein, globulin, may be increased, and another type of protein, albumin, as well as glucose (sugar) and triglycerides (a type of essential fat) may be decreased. Cholesterol and bile acids (a digestive acid produced by the liver) are usually abnormal, either increased or decreased.
• Other tests
  • An x-ray or ultrasound will show the size of the liver, searching for an enlarged liver. They can also search for discoloration and uneven walls of the liver to determine how severe the liver disease is. A liver biopsy (a simple surgical procedure where a small piece of liver tissue is removed and then examined) can give a wealth of information about the cause and severity of the liver disease. Viral tests are normally done to search for viral causes such as polyoma, aflatoxins, and chlamydia.

Treatment

• Diet
  • A low fat, high vitamin B diet is the main way to treat liver disease. The diet should be based on a high-quality, uncolored pellet and nutrient rich vegetables with only a small amount of high-quality seed, preferably sprouted. Roudybush make a pelleted diet for birds with liver disease called Formula AL Liver care which is available only through your veterinarian. A diet high in the B vitamins choline and biotin and the amino acid methionine also help the liver to regenerate and prevent further damage. Eggs, brewers yeast, legumes, and whole grains are high in choline. Brown rice, nuts, fruit, and brewer's yeast are high in biotin. Animal sources are the only sources of methionine, and eggs, fish, and milk are high in methionine
• Wheatgrass
  • Wheatgrass is high in biotin, choline, magnesium, and potassium, all can help with liver function. It is also high in nutrients and enzymes, helping a bird who is eating little or not digesting very well to get the nutrients he or she needs. Some studies show that it may be able to increase the size of blood vessels and increase oxygenation of the blood, helping prevent and treat blood clots and anemia and helping the body cleanse itself of toxins. It is also very high in chlorophyll, which may be helpful in repairing damaged livers as well as the damage caused to the rest of the body by chemicals in the environment and the toxins a diseased liver is unable to filter out. It is also cheap and easy to grow, as well as being enjoyed by birds. How to grow wheatgrass
• Exercise
  • Since liver disease is most commonly caused by a build-up of fat in the liver, it is very important to keep the bird at a healthy weight. Excess weight will only worsen the disease. Exercise should be started immediately, under the orders of your vet. Gentle flight is the best exercise, but if your bird can not fly or refuses to fly, you can also hold your bird's feet on your hand and slowly move your hand up and down, forcing your bird to flap his or her wings. Keep exercise in moderation, however. The last thing you want is an exhausted bird.
• Avoidance of chemicals
  • Since the liver is one of the main organs that filter chemicals out of the body, liver disease will increase the amount of chemicals traveling through your bird's blood stream. This could cause other problems much worse them liver disease, and the liver will still attempt to filter the blood, weakening it. Your bird's diet should be organic, free from commonly chemical-ridden foods such as peanuts, corn, and soy, and free from colors or harsh preservatives such as ethoxyquin. A bird with liver disease will also be more sensitive to chemicals and toxins in their environment, such as bleach, fragrances, cleaning chemicals, mold, and those found in tap water. If mold is found to be the cause of your bird's liver disease and you do not feed raw peanuts, your house should be tested for mold in order to protect you and other pets as well as your bird.
• Beak and nail trimming
  • The beak and nails tend to become overgrown in a bird with liver disease, which will worsen the coordination of a bird and often make it difficult to eat or move around. Nails can be trimmed at home with either a nail file or nail clippers and styptic powder, just in case the get trimmed too far. The beak should only be trimmed by an avian veterinarian as mistakes in beak trimming can lead to permanent disfiguration or even death.
• Lactoluse
  • Lactoluse is a combination of two sugars, fructose and galactose. Birds and mammals are unable to digest this sugar, so therefore it travels to the lower intestine where it is digested by beneficial bacteria. The bacteria then produce three types of acids which draw fluid and ammonia into the bowels. The removal of ammonia reduces the stress on the diseased liver and keeps it from building up in the body and possibly causing other problems. It is also a laxative, and diarrhea is a common side effect, however.
• Other mainstream treatments
  • Since poor appitite, weight loss, and anorexia are common in bird's with liver disease, an ill bird may need to be force fed through a tube. Excess iron storage may occur with liver disease, and a diet low in iron as well as regular phlebotomy (removal of a small amount of blood) is used to treat this. Vitamin K supplementation is used for blood clotting trouble.
• Milk thistle and other alternative treatments
  • Since mainstream treatments for liver disease are limited to diet modification and treating the symptoms, many people turn to alternative or holistic treatments and have great success doing so. It is very important, however, to not start any treatment, especailly holistic treatment, without your vet's approval. Milk thistle is most often used for liver disease and may even stimulate production of new liver cells. It also protects other cells from damage from the chemicals the liver in unable to filter out. Dandelion is used to stimulate bile flow from the liver, helping a diseased liver to function normally, but should never be used for more then three weeks at a time as it may overstimulate bile production, causing the body to destroy helpful fats. Tumeric, red clover, psyllium, chlorella, and lemon water strengthen the body and may remove common toxins, reducing stress on liver.

Warnings

• Falls
  • A bird with liver disease will be more likely to fall and more likely to be injured in a fall. If the wings are trimmed, they should be only trimmed lightly so that the bird can glide to the ground if they fall. Providing platform perches and removing cage grates can greatly decrease the chance of falls, and placing a small towel underneath the cage lining can decrease the chance of injury.
• Diabetes
  • Keep a close eye on the attitude and water intake of a bird with liver disease because he or she will be at a greatly increased risk of developing diabetes. Early detection and treatment as well as a good relationship with your avian vet can reduce the risk.
• Infections
  • A bird with liver disease will have a reduced immune system and will be at a greater risk of catching minor infections. Be sure to keep your bird's living area as clean as possible, quarantine all new birds in a different air space from your ill bird for at least a month, and keep a close eye on your bird for early symptoms of illness such as sleeping on both feet, reduced appitite, tail bobbing, or lethargy. Take your bird to the vet for treatment immediately if you see any of these signs. Honestly, this should be done for birds that are perfectly healthy as well.
• Weight loss
  • If your bird begins to refuse to eat or starts losing weight drastically, he or she will need to be force fed to keep their weight up. Be sure to weigh your bird at least weekly.
• Excess bleeding
  • Many birds with liver disease will have problems with blood clotting. If your bird injured him or herself and starts bleeding, apply styptic powder (on toenails only) or cornstarch to the injured area immediately to stop the bleeding. Flour can work in a pinch. If a blood feather is broken, it must be pulled even if the bleeding seems to stop on it's own. If the bleeding does not stop, your bird has been found already bleeding for a while, or if you do not feel comfortable treating the injury on your own your bird needs to be taken to an avian or emergency vet immediately. Supplementation with vitamin K under a vet's supervision can help with this. Do not attempt to bandage your bird or apply products intended for mammals such as neosporin, your bird may feel that their feathers are not in the right order and start to panic or you may accidentally injure your bird.
• Temperature intolerance
  • A bird with liver disease is often less able to tolerate changes in temperature or cold weather. Heated perches, heat lamps directed at a section of the cage so that your bird can get away from the heat if he or she wants to, and heating pads underneath the cage can help an ill bird recover.
• Other birds
  • If other birds detect illness or weakness in your bird, they may act aggressively towards him or her. If you have more then one bird, do not allow them to be together without supervision unless they are bonded.
• Contagious causes
  • Unless there is an obvious cause for liver disease such as obesity or poor diet, make sure your bird is tested for other causes such as chlamydia psittai, pseudomonas, mycobacteriums, e-coli, salmonella, and aflatoxins

Prevention

The prevention of liver disease in birds is surprisingly easy. Birds are more hardy then they seem and will not develop liver problems unless there is a cause.

• Keep your bird at a healthy weight
• Do not feed a seed based diet
• Make sure your bird eats plenty of vegetables
• Peanuts should be fed sparingly or not at all. If they are fed, they should be human grade and cooked.
• If your water supply is high in chemicals, give bottled water to your parrot only
• Remove all fresh food before it spoils
• Clean food dishes well with soap and water daily
• Clean cages at least once a week
• Keep chemicals such as bleach, hair spray, perfume, fragrances, carpet cleaners, pesticides, cleaning chemicals, Febreeze, glue, and nail polish and far away from your bird as possible, at least in another room with the door closed.
• Only get birds from sources such as reputable breeders and rescues
• Wash your clothing and body before handling your bird after going to a pet store or bird show.
• Thoroughly clean all toys and bags of food purchased at a bird show before putting them near your bird
• Quarantine all new birds as far away as possible from your bird, preferably in a seperate air space, for at least a month.
• Take your bird for regular physical exams, annually for young, healthy birds and twice annually for old or sick birds
• Follow your vet's advice exactly and get a second opinion for the treatment of any major illnesses

Sources and further reading

Provet Health Care
Winged Wisdom: Fatty Liver Disease in cockatiels
Avian Web: Liver Disease
Holistic Bird: Fatty Liver Disease
Antech Avian and Exotics Corner: Liver Disease
LifeLearn.com: Avian Liver Disease
Exotic PetVet.com: Diabetes in Birds
Exotic PetVet.com: Common Illnesses in Small Parrots
Merck Veterinary Manual
Marvista Vet: Lactulose
Medline: Lactulose
Wheatgrass for pet birds

This article is dedicated to Peter, a wonderful budgie scamp whose life was eventually claimed by liver disease that went untreated for far too long, and to Diana, a young lutino cockatiel whose liver is currently healing quite spendidly.