History: Found out in march that kitty had liver problems after he went from 13.2lbs to 9.3lbs in a pretty short period of time. Liver test results weren't terrible then, but were elevated - notably the ALT test which was at 265 when normal range was 20-100. 6 months later went in for tooth extraction (infection) because he had issues eating, bloodwork showed liver tests WAY off the chart. ALT was at 447 - 4.5x the normal range. Went for follow-up bloodwork a month later because tooth infections increase liver enzyme levels. ALT now 414, which is better but quite bad. ALP and AST both dropped by about 10% also. BTW between the massive weight loss and tooth extraction I could only get his weight from 9.3lbs to 10.1lbs. Improvement, but he barely eats some days.
My friend's dad knows a feline liver specialist so I sent him the bloodwork from march/september/october to get his opinion. He thinks it's chronic active hepatitis but can't be sure without a biopsy. I have a follow-up with my vet in a few months to see where things are.
Tried a liver medicine that was pills and after 12 failed attempts at giving him pills I ended up getting a prescription for a liquid milk thistle + SAM-e. I'm able to give the liquid to him pretty easily, but he's not terribly happy when he gets it. Since the liquid Rx, his vomiting decreased from daily to weekly so that's good so far. His eating had not been great at all and he could never finish a larger meal. I hadn't been able to get him to put on weight, so now I am feeding him small meals 4x daily (which also happens to be part of a treatment for liver issues). He refuses all dry food, so it's kind of a pain but have a working system now where the last few days he's eating a majority of his 4 small meals (60 calories each) and is showing more energy.
I'm a bit worried because I'm going to California for 4.5 days next week and my parents will feed them at my house. He takes a full 2 hours to eat his small meals while girl cat can finish hers in 20 seconds. She'll often eat some of his meals, so might have to have them overfeed a little bit to make sure he gets enough food. It'll be the first time they've been left alone for more than 12 hours in 4+ years, so we'll see how that goes.
Hope your cat gets better man.