Fatty Liver Disease (Hepatic Lipidosis) in Cats
Written by Small Door's medical experts
A decreased appetite, even for just 2 to 7 days in cats, can lead to a rapid metabolization of extra fat cells. When this happens, an influx of fat cells enters your cat’s liver and may cause a blockage, resulting in a condition known as hepatic lipidosis (also referred to as fatty liver disease). This can be a life-threatening disease, but if caught early and treated appropriately, your cat can make a full and successful recovery.
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Hepatic lipidosis refers to a large buildup of fat cells in your cat’s liver. It typically occurs when your cat has not eaten anything, or eaten very little, for at least three to four days. In this situation, your cat’s body tries to find an alternative way to provide them with energy, and resorts to breaking down their peripheral fat storage. As the fat cells (triglycerides) break down, they flood and obstruct the liver, making it difficult for it to perform its normal filtration functions.
As the Merck Veterinary Manual states, hepatic lipidosis is the number one most common liver disease that occurs in cats.
If your cat is showing any of the following symptoms, contact your veterinarian immediately:
Jaundice (yellowing of the skin, gums, or eyes)
Hepatic lipidosis in cats is triggered by inappetence (loss or lack of appetite) or a decreased appetite. This can be triggered by any condition that causes a cat to stop eating, such as dental pain or discomfort, or systemic disease.
Common conditions that cause or increase the risk of hepatic lipidosis in cats
As the Cornell Feline Health Center states, studies have shown that approximately 90% of cases of hepatic lipidosis in cats are caused by an underlying health condition. Some of the common conditions that can cause or increase the risk of your cat developing hepatic lipidosis include:
Inflammatory bowel disease (IBD)
Stress (such as the introduction of a new pet into the home or boarding)
Respiratory diseases (such as feline asthma)
Viral infections (such as feline leukemia)
Other types of liver disease (such as cholangiohepatitis)
How to tell if your cat is overweight
Extra weight can put your cat at risk of hepatic lipidosis. In cats, body weight is measured using the body condition score (BCS). This is a scale that assesses your cat’s weight using nine points, with one being severely underweight and nine being severely obese. Ideal body weight is scored between four to five, depending on your cat’s natural body structure. Your veterinarian will assess your cat’s BSC score at each physical exam, and they will be able to provide you with an ideal BSC that is specifically tailored to your cat and their health needs.
If there is a concern about the presence of liver disease, your veterinarian may recommend performing one or more of these tests:
Blood chemistry: A blood chemistry test will check the function of your cat’s organs. Your veterinarian will specifically be looking for abnormalities within your cat’s liver enzymes, such as alanine aminotransferase (ALT) and alkaline phosphatase (ALP), aspartate transaminase (AST), and gamma-glutamyl transferase (GGT), as well as other enzymes that can also indicate a liver issue such as albumin, bilirubin, blood urea nitrogen (BUN), creatinine, glucose, and cholesterol.
CBC: A complete blood count (CBC) will measure your cat’s red and white blood cells and platelets.
Packed cell volume/total protein: The packed cell volume (PCV) will measure the percentage of RBCs within the total volume of blood. Total protein (TP) involves analysis of a cat’s blood plasma to assess the degree of dehydration.
Coagulation profile: Prothrombin time (PT) and activated partial thromboplastin time (APTT) will show your cat’s ability to form blood clots and detect bleeding, which are risks associated with liver dysfunction.
Urinalysis: A urinalysis will check your cat’s urine for signs of any underlying infection or disease process, such as urinary crystals, protein, bacteria, and elevated levels of bilirubin. High levels of bilirubin can be suggestive of red blood cell or muscle cell damage.
Radiographs: Abdominal radiographs may be taken to help visualize your cat’s internal organs. This allows your veterinarian to assess the size of your cat’s liver to see whether it may be abnormally small or large. They will also check for any other abnormalities or masses present that could be related to an underlying cause of disease.
Ultrasonography: Ultrasonography offers a different perspective from radiographs, allowing your veterinarian to assess the structure of internal organs, as well as visualize components not visible on X-rays (such as the layers of the intestines, lymph nodes, and vessels within the liver).
Liver biopsy: A liver biopsy is when a small collection of tissue and cells are obtained from the liver, which are then studied under a microscope, also known as a histopathology. A biopsy can help your veterinarian to identify the presence of any cellular abnormalities and diseases, such as cancer. Biopsy samples may also be cultured to check for bacterial infection.
The biopsy itself can be performed through different methods, such as:
Wedge biopsy: Performed under anesthesia, a small wedge is taken from the liver during either an abdominal exploratory or laparoscopic surgery.
Ultrasound-guided needle biopsy: Performed with or without sedation/anesthesia, your veterinarian will use an ultrasound probe to locate the liver and then aspirate (take) a small portion of cells using a syringe and needle. This method does not involve any surgical incisions.
Treatment of hepatic lipidosis in cats includes supportive care that may likely require hospitalization. If left untreated, hepatic lipidosis can be fatal. It is important for your cat to be monitored for any deficiencies of electrolytes, vitamins, or minerals. Often, hepatic lipidosis treatment consists of hospitalization and intensive care, which may include:
Intravenous (IV) or subcutaneous (SQ) fluids
Liver supportive medications and supplements (Ursodiol, SAMe, L-Carnitine)
High protein/low carbohydrate diet
Anti-nausea medications (antiemetics)
Management or supportive care of any underlying conditions (i.e., administering insulin if the cat is diabetic)
Nutritional support via a nasogastric tube, esophagostomy tube, or stomach tube
Vitamin K and vitamin B12 supplementation
Is there a cure for fatty liver disease in cats?
As the Veterinary Information Network (VIN) states, the survival rate of cats who receive nutritional support is approximately 90%. Studies have shown that recurrences of hepatic lipidosis in cats who recover is extremely rare.
Is fatty liver disease in cats contagious for humans or other pets?
Fatty liver disease in cats is not contagious to humans or other pets.
What is the cost of treating hepatic lipidosis in cats?
The cost of treating hepatic lipidosis in cats can vary depending on the severity of symptoms and what treatment is needed. It may cost about $150 for a basic examination and medications to upward of hundreds to thousands of dollars more if further testing and supportive care is needed.
Cats can successfully recover from hepatic lipidosis if signs and symptoms are caught early, and appropriate treatment is administered. Nutritional support is a key factor for recovery, as is treating any underlying conditions that may be contributing to the onset of fatty liver disease.
Fatty liver can develop quickly in cats as soon as two weeks after experiencing an appetite reduction of 50% to 75%, so it’s important to monitor your cat’s daily eating habits.
Keeping your cat up to date with their routine wellness exams and lab work can also help you and your veterinarian to monitor for, or identify an onset of, any underlying conditions that may lead to fatty liver disease.
It is also important to never place your cat on a weight loss diet without consulting your veterinarian, as losing weight too quickly can lead to hepatic lipidosis.
Is there a vaccine for hepatic lipidosis in cats?
There is not a vaccine for hepatic lipidosis in cats. There are vaccines for possible underlying causes of viral infections, such as feline leukemia. While vaccines may not prevent infection, they can minimize the severity of symptoms.
While hepatic lipidosis can be a fatal disease in cats, being aware of possible signs and symptoms and knowing when to seek medical attention can help save your cat’s life. Keeping your cat at a healthy weight (as recommended by your veterinarian) and managing any diseases they may develop throughout their life can help prevent hepatic lipidosis from occurring. If your cat stops eating normally for more than two to three days, contact your veterinarian right away.