Hepatic Lipidosis in Cats (Fatty Liver Disease)

What Is Hepatic Lipidosis in Cats?

Hepatic lipidosis is a common cause of liver failure in cats. Any cat can develop the condition, but it is most commonly seen in middle-aged cats who are (or were) overweight and haven’t been eating much recently.

When cats don’t eat, they can lose weight quickly. As a result, large amounts of fat get sent to the liver and end up inside liver cells—sometimes so much fat that the cells can no longer function normally. This is hepatic lipidosis, which is sometimes also called fatty liver disease.

When cats stop eating, hepatic lipidosis can start developing within just a few days. Don’t let your cat go without food for more than a day or two before you call your veterinarian for advice.

Aggressive treatment is usually needed to reverse hepatic lipidosis, but there is good news: As long as they get the treatment they need, as many as 90% of cats with the condition can be expected to survive.

Symptoms of Hepatic Lipidosis in Cats

Cats with hepatic lipidosis usually have some combination of the following symptoms:

• Poor or no appetite

• Rapid weight loss

• Jaundice (icterus)—a yellow discoloration of the whites of the eyes and other tissues

• Vomiting

• Lethargy and depression

• Unusual behaviors

• Weakness

• Diarrhea or constipation

• Dark urine

• Abnormal bleeding or bruising

Causes of Fatty Liver Disease in Cats

Anything that stops a cat from eating can lead to hepatic lipidosis. Some common causes include:

• Inflammatory bowel disease (IBD): Infiltration of inflammatory cells into the wall of the gastrointestinal tract can lead to vomiting, diarrhea, poor appetite, and weight loss.

• Cholangiohepatitis and other types of liver disease: Poor appetite, weight loss, and vomiting are common symptoms with almost any type of liver disease.

• Cancer: Cancer anywhere in the body can trigger cats to eat poorly and lose weight.

• Pancreatitis: Inflammation of the pancreas is painful and often leads to decreased appetite, nausea, vomiting, and diarrhea.

• Environmental changes: Cats are creatures of habit. Sometimes disrupting their normal routine, such as moving to a new home or adding a new family member, is all that is needed to make them stop eating. Cats that get lost or trapped somewhere without food may also starve and develop hepatic lipidosis.

When an underlying cause can’t be identified, a cat will be diagnosed with idiopathic hepatic lipidosis.

How Veterinarians Diagnose Hepatic Lipidosis in Cats

A veterinarian may suspect that a cat has hepatic lipidosis after learning they haven’t been eating much and they’ve recently lost a lot of weight. A physical exam can also provide evidence, but diagnostic testing is necessary to differentiate hepatic lipidosis from other diseases that have similar clinical signs.

Veterinarians will usually start with a basic panel of bloodwork and a urinalysis. Many cats with hepatic lipidosis will have high levels of bilirubin and very high levels of alkaline phosphatase (a type of liver enzyme) in their blood.

When a cat has hepatic lipidosis, an abdominal ultrasound should reveal that the whole liver looks abnormal, rather than just a specific part. During the ultrasound, the veterinarian can use a needle to remove a small sample of liver cells. If they’re filled with fat, the diagnosis is confirmed.

Additional testing may also be necessary, both to identify hepatic lipidosis and to look for the health problems that may have led to it.

Treatment of Fatty Liver Disease in Cats

At first glance, treatment for hepatic lipidosis seems simple. Get the cat to eat! But in reality, this is much harder than it sounds. Poor liver function makes a cat feel really bad. As a result, they don’t eat, which makes their liver function even worse … and so the cycle continues.

Force-feeding a cat who is nauseated usually backfires. They tend to “blame” the food for how bad they feel and can quickly develop an aversion to eating anything at all. Because we need to get food into a cat with hepatic lipidosis quickly, a feeding tube is usually the best option.

Nasogastric tubes (small tubes placed through the nose into the stomach) can work for a few days, but many cats with hepatic lipidosis require a month or two of tube-feeding. A better long-term solution is an esophagostomy tube. A veterinarian will briefly anesthetize your cat and place the tube into the esophagus through an incision through the skin of your cat’s neck. The tube is then sutured in place so that pet parents can use it for long-term feeding. Other types of feeding tubes may also be considered, based on the specifics of the case.

Next, cats need to be gradually reintroduced to food. Giving too much food too quickly can lead to refeeding syndrome—a potentially fatal shift of fluids and electrolytes within the body. A schedule to prevent refeeding syndrome often looks something like this:

• Day 1 – feed 25% of the cat’s caloric needs divided into 4-6 meals

• Day 2 – feed 50% of the cat’s caloric needs divided into 4-6 meals

• Day 3 – feed 75% of the cat’s caloric needs divided into 4-6 meals

• Day 4 – feed 100% of the cat’s caloric needs divided into 4-6 meals

Cats with hepatic lipidosis may also require treatment with B vitamins, vitamin K, and vitamin E. Fluid therapy with added magnesium, phosphorus, and potassium may be necessary as well.

To support the liver, veterinarians often prescribe nutritional supplements and medications like S-adenosylmethionine, L-carnitine, milk thistle, silybin, and ursodiol. Additional treatments will be based on a cat’s symptoms and underlying health problems.

Recovery and Management for Hepatic Lipidosis in Cats

Cats will usually be hospitalized at the beginning of treatment so that veterinary staff can closely monitor their condition and adjust their treatment as needed. But once they are stable, cats can continue their recovery at home. If your cat has a feeding tube, your veterinarian will provide you with all the training you need to feed your cat, give medications, and maintain the tube.

Tube feedings typically continue for a month or two. Once a cat is no longer nauseated and has started regaining weight, it’s time to start offering them food by mouth. Your veterinarian will likely recommend gradually reducing the amount of food you provide through the tube to give your cat a chance to get hungry. The feeding tube can be removed once a cat is eating completely on their own.

Talk to your veterinarian if you have any questions or concerns about your cat’s health or treatment plan. A full recovery from hepatic lipidosis is definitely possible, so don’t give up even if it takes a while.