Hepatic lipidosis in cats is a condition where fat accumulates in the liver and causes severe damage. Treatment of hepatic lipidosis is essential to save the cat's life. Hepatic lipidosis in cats is a common liver disease where fat accumulates within the liver and causes severe damage and subsequent liver failure. Disease progression is rapid and cats with this condition are generally debilitated with their liver function degrading rapidly. If a cat has been diagnosed with hepatic lipidosis, immediate treatment should be sought by a veterinarian, who will perform diagnostic tests on your pet and give treatment as necessary. If you notice symptoms of hepatic lipidosis in your cat such as loss of yellowing to the skin and eyes, loss of appetite, weight loss, or lethargy, contact your veterinarian immediately to assess what diagnosis is best for your cat. Hepatic lipidosis is the most common liver disease diagnosed in cats in North America and it is uncommon in dogs.
What are the causes of hepatic lipidosis (fatty liver syndrome) in cats?
Fatty liver disease in cats often develops secondarily to other diseases but can also be idiopathic (i.e. no distinct reason why it occurs). The most prevalent underlying diseases in one research study of 71 cats with hepatic lipidosis were gastrointestinal disease, inflammatory bowel disease (IBD), pancreatitis, and cholangitis (inflammatory liver disease). In that study of feline hepatic lipidosis, idiopathic causation was indicated in 28% of the cases.
Cats are prone to developing fatty liver disease, which most commonly occurs in anorexic, obese cats. When obese cats become anorexic (i.e. stop eating), this will cause the fatty stores throughout the body to mobilize fats to the liver to be used for energy, therefore, resulting in fatty liver disease. Fats accumulate within the liver faster than they can be converted and used for energy. The individual liver cells called hepatocytes swell and their membranes become damaged. The flow of bile throughout the liver also becomes compromised secondary to compression from the enlarged hepatic cells on the bile ducts. Damage to hepatic cells is severe and the liver becomes unable to function effectively.
Symptoms of fatty liver disease (hepatic lipidosis) in cats
Clinical symptoms of fatty liver disease may include:
- anorexia (loss of appetite)
- jaundice and icterus (yellowing of the skin and eyes)
- vomiting
- lethargy
- hypersalivation
- weight loss
Other feline hepatic lipidosis symptoms may be noted that would be related to concurrent, underlying disease. For example, if your cat has unregulated diabetes that is contributing to hepatic lipidosis, you may also notice excessive thirst and urination. Pancreatitis for instance can contribute to abdominal pain and discomfort and result in the development of hepatic lipidosis.
Diagnosing hepatic lipidosis (fatty liver syndrome) in cats
To properly diagnose a cat with hepatic lipidosis, your veterinarian will perform a detailed physical exam and take a thorough history. Many affected cats will have a 5-7 day history of not eating. Hepatic lipidosis causes weight loss (up to 50% of body weight) that is relatively recent and rapid in cats. Diagnostic tests that your veterinarian may perform include:
Routine blood work - This will evaluate the red and white blood cells, and different liver enzyme levels such as ALT, ALP, AST, and GGT. Bilirubin levels are also evaluated and increased bilirubin pigment in the blood contributes to jaundice (yellow skin). As many cats with hepatic lipidosis are hypokalemic (low potassium levels), electrolytes should be evaluated as well. Kidney parameters are also checked which helps interpret dehydration and renal function.
Liver function tests - The most common liver function test available to veterinarians is bile acids. A bile acid assay is performed by measuring bile acids (blood sample) in the fasted pet, feeding, and then measuring bile acids again in 2 hours. This test is not necessary if your cat is jaundiced (yellow skin) or if the bilirubin counts are elevated on blood work, as the bile acid test would be abnormal.
Coagulation profile - Many cats with hepatic lipidosis are deficient in their blood clotting mechanisms. Whether your veterinarian feels it necessary to test your cat's coagulation depends on the symptoms, diagnostic, and treatment procedures. For example, a coagulation profile should be performed before performing a liver biopsy.
Abdominal ultrasound - The appearance of the liver on ultrasound can be very suggestive of fatty liver disease. Other abnormalities may be present depending on the presence of concurrent diseases (e.g. pancreatitis, inflammatory bowel disease).
Liver biopsy - A hepatic lipidosis diagnosis is confirmed by a liver biopsy. This is performed under sedation with a small, hollow needle that takes a tiny piece of the liver tissue. Expectations for this procedure include no hepatic discomfort and quick recovery without complications.
Treatment of hepatic lipidosis (fatty liver syndrome) in cats
Treatment should begin immediately in a cat diagnosed with hepatic lipidosis or hepatic lipidosis in cats. Your veterinarian will administer intravenous fluids will correct dehydration and reduce the workload on your kitty’s kidneys. The intravenous fluids will help replenish lost electrolytes, especially potassium.
Nutritional assistance is one of the most crucial elements of the treatment plan for fatty liver disease. As there is a risk of food aversion, forced feeding is not recommended. Most anorexic patients require the insertion of a feeding tube. Naso-esophageal tube feeding may be used initially, but because the small tube size only allows for liquid meals, it is not generally recommended. Because esophageal tubes are typically safe, easy to place, allow for canned food administration, and have fewer issues than other types, they are the best alternative (e.g. stomach tube). The feeding tube will be required until your cat starts eating on its own and the length of time varies from cat to cat. On average, the feeding tube is in place for 5-7 days. If the owner is comfortable feeding food via the feeding tube, most cats can be discharged from the hospital with the tube in place.
Frequently asked questions about fatty liver disease in cats
What is the survival rate for cats with fatty liver disease?
The prognosis for cats with hepatic lipidosis is determined by the presence of underlying diseases and whether they can be treated effectively. Most cats (>80%) with hepatic lipidosis make a full recovery with the appropriate treatments.
What is refeeding syndrome?
Refeeding syndrome is a life-threatening complication that can occur when food is reintroduced to the body and occurs 24-48 hours after feeding. Refeeding syndrome can be prevented by slowly introducing food and gradually increasing the amounts of calories day by day. If your cat has hepatic lipidosis, it is likely they will need nutritional supplementation before discharge from the hospital. Your veterinarian should review refeeding syndrome with you and provide education about what care should be provided at home.
How long does hepatic lipidosis last and how do cats recover?
The length of hepatic lipidosis is approximately 1-3 weeks. The hepatic lipidosis disease process may take longer because it involves damage to the hepatic cells that can affect hepatic functions for weeks to months post-hepatic lipidosis. The hepatic cells will slowly regenerate and function normally again.
How to prevent fatty liver disease in cats?
There is no definitive prevention available for hepatic lipidosis. Managing and controlling concurrent diseases such as pancreatitis and IBD (inflammatory bowel disease) is important as these conditions can lead to hepatic lipidosis in cats. If you have an obese cat and they stop eating, please call your veterinarian if your cat continues to be anorexic for longer than 2-3 days, it is at risk of developing fatty liver disease.
Hepatic lipidosis in cats (fatty liver syndrome) is a condition where fat accumulates in the liver and causes severe damage. Treatment of hepatic lipidosis, or fatty liver disease, should begin immediately when diagnosed by a veterinarian with intravenous fluids to correct dehydration and reduce kidney workload, nutritional assistance with anorexic patients requiring insertion of a feeding tube for liquid meals supplemented with food reintroduction slowly increased day-by-day if needed per vet instructions on refeeding syndrome prevention. The prognosis for hepatic lipidosis is determined by whether there are underlying diseases that can be treated effectively; most cats (>80%) make a full recovery even without treatment but hepatic cells will take weeks months to regenerate post hepatic lipidosis.