Hepatic Lipidosis (Fatty Liver Syndrome) in Cats

Laurie Anne Walden, DVM

Public domain photo by Alexandre Burner on Flickr

Hepatic lipidosis, or fatty liver syndrome, is a life-threatening condition in cats that stop eating for any reason. It’s most common in overweight or obese cats but can affect cats of any weight. Cats that don’t eat for more than a couple of days need to see a veterinarian without further delay.
 
Causes
When cats don’t eat, their bodies start to break down stored body fat to use for energy. Eventually the level of metabolized fat in the blood is higher than the body can use, and the excess fat is stored in the liver cells. The liver cells become swollen with fat and can no longer function normally, resulting in liver failure. The swollen liver cells also squash the bile ducts within the liver, obstructing the flow of bile (which is needed for normal digestion).
 
Overweight and obese cats are at higher risk than average-weight cats because they have more body fat to metabolize. The tendency to store metabolized fat in liver cells is a quirk of feline liver function, so hepatic lipidosis is much more common in cats than in dogs.
 
Anything that makes a cat stop eating can cause hepatic lipidosis. The cause is usually an underlying disease like a digestive system disorder, diabetes, kidney disease, cancer, or hyperthyroidism. Healthy cats can develop hepatic lipidosis if they don’t eat for some reason, like changing to a new food they don’t like, experiencing a stressor like a new pet or a house move, boarding, getting accidentally locked in a garage, getting lost outdoors, and so forth.
 
Signs
Cats with hepatic lipidosis usually have signs of liver disease like these:

• Refusal to eat
• Weight loss
• Loss of energy
• Yellow tint to the whites of the eyes
• Behavior changes like hiding and not engaging in usual activities
• Possibly vomiting and diarrhea

 
Cats might also have signs related to the underlying disease that caused them to stop eating.
 
Diagnosis
Baseline diagnostic tests (bloodwork and urinalysis) are run to evaluate liver function, assess the cat’s overall condition, and look for an underlying disease. Cats with signs of liver disease usually also have imaging studies like ultrasound of the abdomen. The diagnosis of hepatic lipidosis can be confirmed with liver biopsy, although not all cats need this step.
 
Treatment
Cats with hepatic lipidosis are typically hospitalized for at least a few days. Treatment includes intravenous fluids, correction of electrolyte imbalances and anemia (which can happen with liver disease), treatment for nausea and vomiting, nutritional support, and if possible, treatment of the underlying disease.
 
Nutritional support is crucial for cats with hepatic lipidosis so their bodies will stop metabolizing fat for energy. Because most cats with this condition don’t eat on their own, they are fed through a tube at first. Feeding tubes are placed through the nose (cats tolerate this better than you would think) or surgically placed through the skin. Some cats need to continue tube feeding for weeks. These cats receive surgically placed feeding tubes designed for long-term use, and their owners must continue the tube feedings at home.
 
Prognosis
Most cats that receive prompt intensive care (including early tube feeding) recover from hepatic lipidosis. The long-term prognosis depends on whether the underlying disease is treatable.
 
Prevention
Keeping a cat at a lean body condition reduces the risk of hepatic lipidosis. For cats that stop eating, early intervention to get nutrition into the cat—feeding something the cat will eat, using an appetite stimulant medication, or starting tube feedings—can help prevent hepatic lipidosis. Cats should never be force fed, though. Placing food directly into a cat’s mouth by hand or through a syringe can cause a cat to avoid that food in the future and be even less likely to eat on its own.
 
Image source: https://www.flickr.com/photos/139162177@N05/46079745404/

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