Hepatic lipidosis in cats

 

Hepatic lipidosis is a disease that only cats get, and consequently, you might not have ever heard of it.

 

But if you love cats, and if you have cats in your life, you should know about hepatic lipidosis, because it is one of the most common liver diseases in cats.

 

It’s important to become educated about this disease: to learn how you might prevent hepatic lipidosis, and to recognize when your cat might be suffering from it. Prevention and early diagnosis are the two ways you can help keep this very serious disease from threatening your precious cat’s life.

 

If you are reading this post because your cat has already been diagnosed with hepatic lipidosis, I want you to know that I feel for what you and your cat are going through right now. I hope this post will help you understand more about a cat’s liver function, what is happening during this disease process, and what you can expect in terms of veterinary treatment. I know that when my own pets are sick, having information can help me feel more in control, ask better questions, and make better decisions.

 

What is a healthy cat’s liver supposed to do?

 

A cat’s liver is a very large organ, especially compared to his other internal organs. It’s kind of a multi-function tool kit that performs all kinds of services for a cat’s body.

 

The liver is critical to the digestion of food. It breaks down the food that a cat eats and processes it so that the body can use the nutrients to support life. Using digested food, the liver makes proteins, fats, and vitamins. It stores these nutrients, and then releases them as the body needs them.

 

The liver performs other functions, too. It manufactures bile, a fluid that is needed for absorbing fat and helping with digestion. The liver makes a variety of hormones, too, as well as substances that are important for blood clotting. And finally, the liver acts as a kind of filter for toxins, removing them, or breaking them down to make them safer.[1]

 

Many life-critical functions come down to the liver, which is why it is so devastating to a cat when the liver becomes diseased.

 

One more thing you need to know: a cat’s liver is broken into sections, called lobes, each of which contains thousands of lobules made up of cells called hepatocytes. You’ll see why knowing about hepatocytes are important in a minute.

 

What exactly is hepatic lipidosis?

 

Another name for hepatic lipidosis is “fatty liver syndrome.” Here’s why:

 

The disease usually begins when a cat doesn’t eat enough food for whatever reason. Maybe the cat has an illness that makes her feel nauseous. Maybe she doesn’t like her food anymore. Maybe she is stressed about something that is going on in your household, which causes her to lose her appetite. Or maybe a cat has gotten lost outdoors, or trapped in the garage or somewhere else, where she is unable to find food.

 

Whatever has caused a cat to stop eating, the not-eating (sometimes called anorexia) is super dangerous.

 

When a cat stops eating, the body does what a starving body is supposed to do. It takes whatever fat is in storage and sends it to the liver to be turned into energy.

 

The problem is that cats were never designed to store and use fat, the way we and other animals do. In fact, cats were really never supposed to have the opportunity to develop any stored fat at all.[2]

 

Cats evolved as predators of small birds and rodents, which are all meat, little fat, and few calories. Cats’ bodies are optimized for this lean, lean diet: their bodies are made to process frequent, tiny meals of pure protein.

 

Because a cat’s body wasn’t designed to handle a lot of fat, it’s not good at it. When a cat is starving, and fat stores get broken down, a cat’s liver becomes quickly overwhelmed. More fat is coming in than the liver can turn into energy and send back out. The hepatocytes – the liver cells – become swollen with fat. Thus, fatty liver syndrome.

 

 

 

Are overweight cats at special risk for hepatic lipidosis?

 

We know that the chances of a cat getting this disease are worse if a cat was overweight before the anorexia began.[3]

 

In fact, according to Dr. Sharon Center, of Cornell University College of Veterinary Medicine, who has seen hepatic lipidosis in cats of all ages, from three months to 25 years, the incidence of this terrible disease is much higher in obese cats.[4]

 

While being overweight might not be disastrous for a cat on a day-to-day basis, when something goes wrong, the extra weight a cat is carrying can become almost instantly life-threatening.

 

What are the symptoms of hepatic lipidosis?

 

If your cat is experiencing any of these symptoms, contact your veterinarian:

 

• Lack of energy
• Hiding
• Loss of appetite
• Weight loss
• Weakness
• Yellowing of the eyes, gums, and skin (look inside the ears, where there is less hair)
• Vomiting
• Diarrhea or small-than-normal poop
• Changes in your cat’s normal behavior[5]
• Drooling
• Dropped head and neck (called vetroflexion)

 

When you bring your cat to the vet, she may also look for gastroparesis – which is a slowing of food moving from the stomach to the small intestines, or for the inability of your cat’s stomach to empty normally.

 

She may also look for an intestinal ileus, which is a buildup or blockage of food in your cat’s intestines.[6]

 

Your vet may also feel for an enlarged liver.

 

What can cause hepatic lipidosis?

 

An awful lot of things can cause hepatic lipidosis. Anything that causes a cat to stop eating – whether it’s nausea or loss of appetite from an unrelated disease, or emotional stress – can quickly lead to disaster.

 

A 2002 study followed 157 cats with hepatic lipidosis and tried to determine the underlying cause of the disease. A large percentage (28%) had bowel disease, another 20% had another form of liver disease. Some had cancer, pancreatitis, diabetes, or a respiratory illness. And some (5%) had some kind of stress at home. There were other underlying causes, too.

 

Here’s the list of diseases or life circumstances that are associated with hepatic lipidosis:

 

• Inflammatory bowel disease
• Other liver disease
• Pancreatitis
• Stress[7]
• Cancer
• Hyperthyroidism
• Kidney disease[8]
• Diet change
• Nutritional deficiencies
• Diabetes[9]

 

If there is such a thing as a “typical” cat who comes down with hepatic lipidosis, it is a middle-aged overweight cat who has a poor appetite and who has recently lost weight.[10] This is why it is so important to continually manage your cat’s weight throughout his life, and to make sure that if you are helping a cat to lose weight, you do so under the guidance of a veterinarian.

 

There’s more information in this post, “How to help a cat lose weight.”

 

How is hepatic lipidosis diagnosed?

 

Unfortunately, hepatic lipidosis looks like a lot of other diseases. It shares symptoms with other types of liver disease, with kidney failure, feline leukemia viru (FeLV), feline infectious peritoniti (FIP), and even some cancers.[11]

 

Your emergency veterinarian has a number of tools he can use to determine whether your cat is experiencing hepatic lipidosis or something else.

 

Blood work – Your vet may evaluate your cat’s red and white blood cells, kidney and liver function, protein, electrolytes, and the ability of your cat’s blood to clot.[12]

 

A cat who is in the middle of hepatic lipidosis might show an increase in liver enzymes in the blood, including alkaline phosphatase (abbreviated ALP), and alanine aminotransferase (ALT), and aspartate aminotransferase (AST). ALT and AST, for example, are normally found inside the liver cells. If they are in the bloodstream, it’s usually a sign that liver cells have begun dying.

 

Note that a cat’s liver can sustain some damage without losing its ability to function properly.[13]

 

X-rays – An X-ray can show an enlarged liver, a sign that the liver is being overwhelmed by fat.

 

Ultrasound – An ultrasound is a non-invasive, painless diagnostic tool that can help rule out that the cause of your cat’s illness is a tumor. [14]

 

Fine-needle aspirate or liver biopsy – A tiny piece of your cat’s liver can be extracted, either as a surgical procedure, or with a needle, through your cat’s skin. The sample will be sent to a veterinary pathologist who will look under the microscope for fat cells amongst the liver cells.

 

And while a liver biopsy can very definitively confirm that your cat has hepatic lipidosis, sometimes a diagnosis will be made without it. If your cat is showing signs of hepatic lipidosis, and her blood work suggests that’s what she has, and if your cat is too sick to undergo a biopsy, your vet may proceed with treatment without the confirmation that a biopsy would provide.

 

In addition to diagnosing hepatic lipidosis, your vet may order additional tests to try to figure out why your cat has stopped eating. Is the pancreas or are the intestines inflamed? Is there a tumor somewhere, or is another organ failing?

 

Is hepatic lipidosis treatable?

 

Hepatic lipidosis is treatable, especially if caught early.

 

Left untreated, 90% of cats will die from hepatic lipidosis. Cats who are rushed to the vet early in the disease have a recovery rate of 80-90%.[15]

 

The “cure” for hepatic lipidosis is very simple…and also excruciatingly difficult.

 

A cat with hepatic lipidosis needs to eat to reverse her body’s impulse to continuing breaking down fat stores. The problem is that most cats with hepatic lipidosis will refuse to eat or drink.

But there is no choice. In order to save the cat’s life, he needs to be fed aggressively. There are a number of ways of doing this, each of which have their advantages and disadvantages. Your vet will choose the most appropriate method for your cat.

 

Force-feeding. Most cats cannot be successfully force fed. It is very stressful for the cat and they’re rarely cooperative. Force feeding can backfire, in that cats develop food aversions very easily. A force-fed cat may refuse to eat on her own even when the danger of hepatic lipidosis has passed.[16]

 

For the rare cat that can be safely force fed, cat food is typically rolled into a meatball and administered like a pill.

 

Nasogastric tube. The nasogastric tube is feeding tube that is passed through the nose and down the esophagus.

The good thing about the nasogastric tube is that placing one requires no anesthesia, which is perfect for cats who are not well enough to be sedated.[17]

 

The disadvantage of a nasogastric tube is that it can be dislodged by a determined cat, and most will need to wear an Elizabethan collar to prevent that.

 

The other disadvantage is that the tube is very narrow, meaning that only liquid diets can be used.

 

Esophagostomy, pharyngostomy, and stomach tubes. A tube is surgically implanted on the side of the neck, or side of the body, to send food directly into the esophagus or stomach. A bandage or collar will hold the tube in place.

 

While this procedure sounds very dramatic and invasive, it allows a cat to get the nutrition he needs to reverse hepatic lipidosis, without a lot of additional stress. It may also allow your cat to return home sooner.[18]

 

According to Blue Pearl, a cat with hepatic lipidosis is typically in the hospital for seven-10 days. During this time, veterinarians will reverse your cat’s dehydration, correct any electrolyte imbalances and vitamin K or vitamin B deficiencies, and begin reintroducing food.[19]

 

At the beginning, feedings will have to be small and extremely frequent, or given continuously, something that cannot be done at home. Slow feeding allows the cat to adjust and shift her metabolism away from using her own fat stores.[20]

 

How to care for your cat after his hospital stay for hepatic lipidosis

 

If your cat came home with a surgically implanted feeding tube, you will begin feeding her directly into her gastrointestinal tract.

 

Your vet will provide a special food mixture and instructions, but typically you will feed your cat through the tube three to five times per day.

 

Depending upon the diameter of the tube that was implanted, you will be instructed to mix the food with a certain amount of water, and then inject a certain quantity of food/water mixture directly into the tube.

 

You will likely be instructed to inject it slowly, only 1 cc of food mixture per second.

 

You will also likely be instructed to follow the feeding with 5-10 ccs of tap water through the tube, to flush any clinging food to prevent clogging.

 

You’ll then replace the cap on the tube.

 

If you have any extra food mixture left over, you can store this in the refrigerator. But remember to warm any chilled food to room temperature before feeding the next time.

 

To warm, you can run a closed food container under warm water, or place it in the microwave. Be sure to mix any food warmed in a microwave to prevent hot spots, and test the temperature on the back of your hand before feeding.

 

Note that a feeding tube doesn’t prevent a cat from eating food on her own. Your vet may recommend offering food by mouth once a week so you’ll know when your cat’s natural appetite returns. With your vet’s guidance, you can gradually decrease feeding-tube feedings as he begins to eat more by mouth.

 

Once a cat is eating well for three or four days, your vet can remove the tube. This is done without anesthesia, but must be done by a professional.

 

Recovery from hepatic lipidosis can take six or seven weeks, or to up to 12 weeks.

 

Will my cat get hepatic lipidosis again?

 

It’s rare for a cat to get this disease twice. Many cats who survive, go on to live completely normal lives.[21]

 

How can I prevent my cat from getting hepatic lipidosis?

 

(*Note, as an Amazon Associate, I earn from qualifying purchases)

 

The best thing that you can do for your cat to prevent this terrible disease is to monitor her weight regularly. It’s easy to let the ounces add up, unnoticed, but the scale doesn’t lie. It’s also easy to not notice if your cat is slowly losing weight.

 

A pet scale, like this one by Beurer, does the trick.

 

It’s also important to minimize your cat’s stress. Some of the things that cats find stressful often can not be avoided (such as a death in the family, or the addition of a new baby). But do what you can to provide your cat with a way to “get away from it all,” when household chaos seems to be mounting.

 

And finally, make dietary changes very gradually. Add only the smallest amount of new food to the old food at first. Add more new food only when you’re absolutely certain your cat has adjusted to the initial change. Rinse and repeat.

 

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Dawn LaFontaine

Dawn LaFontaine is a lifelong animal lover who always seems to have a little pet hair in her keyboard. Her blog, Kitty Contemplations, helps cat guardians better understand and care for the special beings they share their lives and homes with. Her cat-products business, Cat in the Box, sells beautiful, well-made, and award-winning products that she designed to meet the biological needs of cats.

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FOOTNOTES

 

[1] Hospitals, BluePearl Pet. “Hepatic Lipidosis in Cats - Bluepearl Pet Hospital.” BluePearl, 27 Sept. 2019, https://bluepearlvet.com/medical-articles-for-pet-owners/hepatic-lipidosis-in-cats/.

 

[2] “Hepatic Lipidosis.” Hepatic Lipidosis - Mar Vista Animal Medical Center, https://www.marvistavet.com/hepatic-lipidosis.pml.

 

[3] Barnette, Catherine, and Ernest Ward. “Liver Disease Fatty Liver Syndrome in Cats: VCA Animal Hospitals.” Liver Disease Fatty Liver Syndrome In Cats | VCA Animal Hospitals, https://vcahospitals.com/know-your-pet/liver-disease-fatty-liver-syndrome-in-cats.

 

[4] “Hepatic Lipidosis.” Cornell University College of Veterinary Medicine, 22 May 2018, https://www.vet.cornell.edu/departments-centers-and-institutes/cornell-feline-health-center/health-information/feline-health-topics/hepatic-lipidosis.

  

[5] Hospitals, BluePearl Pet. “Hepatic Lipidosis in Cats - Bluepearl Pet Hospital.”

 

[6] Center, Sharon A. “Feline Hepatic Lipidosis - Digestive System.” Merck Veterinary Manual, Merck Veterinary Manual, 24 Jan. 2022, https://www.merckvetmanual.com/digestive-system/hepatic-disease-in-small-animals/feline-hepatic-lipidosis.

 

[7] Hospitals, BluePearl Pet. “Hepatic Lipidosis in Cats - Bluepearl Pet Hospital.”

 

[8] “Hepatic Lipidosis.” Cornell University College of Veterinary Medicine.

 

[9] Hospitals, BluePearl Pet. “Hepatic Lipidosis in Cats - Bluepearl Pet Hospital.”

 

[10] ibid

 

[11] “Feline Hepatic Lipidosis.” Wikipedia, Wikimedia Foundation, 28 Dec. 2021, https://en.wikipedia.org/wiki/Feline_hepatic_lipidosis.

 

[12] Lee, Dr. Justine. “Fatty Liver Disease in Cats: Not Eating Can Quickly Kill.” Pet Health Network, https://www.pethealthnetwork.com/cat-health/cat-diseases-conditions-a-z/fatty-liver-disease-cats-not-eating-can-quickly-kill.

 

[13] “Hepatic Lipidosis.” Hepatic Lipidosis - Mar Vista Animal Medical Center,

 

[14] “Hepatic Lipidosis (Fatty Liver Disease).” Veterinary Specialty Center, 29 Oct. 2020, https://www.vetspecialty.com/hepatic-lipidosis-fatty-liver-disease/.

 

[15] Hospitals, BluePearl Pet. “Hepatic Lipidosis in Cats - Bluepearl Pet Hospital.”

 

[16] ibid

 

[17] ibid

 

[18] ibid

 

[19] Center, Sharon A. “Feline Hepatic Lipidosis - Digestive System.”

 

[20] Heinze, Cailin R. “Treatment of Hepatic Lipidosis in Cats.” Clinical Nutrition Service at Cummings School, 23 Nov. 2020, https://vetnutrition.tufts.edu/2020/11/hepatic-lipidosis-in-cats/.

 

[21] Hospitals, BluePearl Pet. “Hepatic Lipidosis in Cats - Bluepearl Pet Hospital.”