Feline Hepatic Disease – Hepatic Lipidosis (Fatty Liver Syndrome)

Cats are unique compared to dogs… with one key difference being something most owners wouldn’t think of right away. For cats, a strict limit on their food intake can be life threatening: cats can develop a serious condition called hepatic lipidosis if they stop eating. If not picked up early, hepatic lipidosis can be fatal, as it severely damages the liver if left untreated. However, if detected early, most cats will fully recover with treatment, though ongoing supportive feeding may be needed for several weeks until the cat is able to eat by themselves.   

What is hepatic lipidosis?  

Hepatic lipidosis is also commonly known as fatty liver disease. It occurs when a cat stops eating or has a reduced appetite for a period of time, so they are only eating very little food each day. There are many reasons why cats become inappetent (have a lack of appetite) but it most commonly occurs due to an underlying illness, such as diabetes, kidney disease or heart disease, or due to stress. However, rapid weight loss that may result from dieting an overweight cat, introducing a new diet that a cat refuses to eat, or a cat becoming trapped and unable to access food can also result in hepatic lipidosis developing.  

When cats become inappetent, they are not taking in sufficient calories from their food to meet their daily needs, so they go into negative energy balance. In an attempt to produce the energy they need, cats will rapidly break down their own body fat stores and send it to the liver to be converted into an energy source. However, in cats, the liver only has a limited capacity for converting fat into energy, so this mobilised fat quickly accumulates in the liver, where it damages liver cells and blocks the bile duct, preventing the liver from being able to function normally.  

Why is the liver important?  

The liver is responsible for a wide range of roles that are essential for helping to keep the body healthy, from storing sugar to helping keep blood sugar levels stable, detoxifying the blood to remove waste products and anything harmful from the body, to producing vital proteins needed for clotting. If the liver’s ability to perform these roles is compromised, it can have severe consequences for the rest of the body and may even be life-threatening.  

Functions of the liver include: 

• Breaking down nutrients from food to provide energy  

• Producing bile that is used in digestion  

• Regulating blood sugar  

• Absorbing and storing water-soluble vitamins  

• Removing toxins from the blood, including waste products and some medications  

• Producing proteins, including some involved in clotting  

Is hepatic lipidosis an emergency?  

Even though hepatic lipidosis can usually be successfully treated if detected early, it should still be considered as an emergency, as the disease can be fatal if left without treatment. However, signs of inappetence will usually develop before hepatic lipidosis occurs, so if urgent veterinary care is sought within 1 to 2 days of your cat stopping eating and the underlying cause of the inappetence is treated, it can prevent hepatic lipidosis and avoid your cat becoming severely unwell.  

How to recognise signs of hepatic lipidosis 

There is a range of signs that cats may show if your cat develops hepatic lipidosis, and these may vary depending on the stage of the disease. One of the most important signs to recognise is that your cat is not eating or has a reduced appetite, as other signs of illness may be difficult to detect in the early stages of the disease.  

There are several signs of illness that cats with hepatic lipidosis may show, including:  

• Inappetence or eating very little  

• Quiet and lethargic in themselves 

• Vomiting  

• Diarrhoea  

• Weight loss 

• Jaundice – yellowing of the skin, eyes, gums and mucous membranes 

• Dehydration 

Many cats with hepatic lipidosis will also have an underlying illness, so they may show additional signs of being unwell. If you notice your cat is showing any signs of illness, especially if it is combined with a reduced appetite or not eating, you should get your cat checked by your vet as soon as possible.  

Treatment  

Cats affected by hepatic lipidosis may require intensive nutritional support and fluid therapy to address any dehydration and electrolyte imbalances. For the best chance of recovery, a feeding tube is frequently used to ensure your cat is getting the nutrition they need to stop them breaking down their own fat stores. The feeding tube may need to be placed under general anaesthetic and may need to remain for several weeks, until your cat is eating well and taking in sufficient amounts of food by themselves. However, feeding tubes are usually straightforward to manage, which means that you will often be able to continue your cat’s treatment from home.   

In addition to supportive treatment, any underlying disease will need to be diagnosed and treated as part of your cat’s recovery. This underlying disease can affect your cat’s prognosis and chance of recovery if it is life-limiting.  

Can hepatic lipidosis be prevented?  

It is not always possible to prevent hepatic lipidosis, especially if it develops due to an underlying illness. However, you can help reduce your cat’s risk by making sure they are eating normally and getting your cat checked by your vet if they stop eating or their appetite decreases.  

Keeping your cat at an ideal weight can also reduce the chance of hepatic lipidosis developing as cats that are overweight or obese are more likely to develop this condition, especially if they suddenly lose weight. This also means that you need to be careful not to cause hepatic lipidosis if you put your cat on a diet, if you reduce the amount of food you are feeding, or if you change your cat’s diet and they will not eat it.  

Cats that are stressed may also stop eating, so creating a calm environment with sufficient opportunities to feed, drink and use the litter tray, alongside plenty of enrichment can help reduce your cat’s stress. Stress can contribute to many different health conditions in cats, including skin disease and urinary disease, so if you feel that your cat is showing signs of stress or they are at risk of becoming stressed due to previous health conditions, speak to your vet for individual advice.   

Hepatic lipidosis is a serious condition that can affect our cats and can be fatal if not treated early. However, closely monitoring your cat’s appetite and quickly recognising if they stop eating can help prevent hepatic lipidosis from developing and increase your cat’s chance of making a full recovery.