Hepatic Lipidosis (‘fatty liver disease’)

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What is it?

The liver has several vital functions for life:

  • Making proteins
  • Producing bile used in digestion
  • Producing blood clotting factors
  • Removing toxins from the body
  • Processing fats
  • Cats have a vital need for proteins made by the liver, so when the liver is not functioning properly, malnutrition quickly develops. Hepatic lipidosis is a condition resulting from an excess of fat within the liver. It is commonly triggered when a cat stops eating. During a period of starvation, the body moves fat from its reserves to the liver. A cat’s liver has a limited ability to cope with large amounts of fat, so this sudden rush of fat reduces liver function. Hepatic lipidosis, or ‘fatty liver’ occurs when more than 50% of the liver cells become full of fat. Hepatic lipidosis is often a condition of middle aged, obese cats, but it can occur in any cat.

    Why is it important?

    Hepatic lipidosis may occur secondary to other illness such as cancer of the liver, liver damage due to paracetamol poisoning, pancreatitis, hyperthyroidism, inflammatory bowel disease, inflammation of the liver, and diabetes. 50-98% of cases are secondary to other diseases. The rest are idiopathic (cause unknown).

    Reduced liver function can have serious, life threatening consequences. Hepatic lipidosis often requires intensive treatment in a veterinary practice or even a hospital facility.

    What is the risk?

    If untreated, hepatic lipidosis can develop into a condition called hepatic encephalopathy (HE) where toxins accumulate and cause inflammation around the brain, leading to seizures. Coma and death may then occur.

    What happens to the cat?

    The cat will not want to eat, often for 2-7 days. They will usually have some vomiting. Sometimes diarrhoea or constipation occurs. The cat may be jaundiced (yellowing of gums, skin, and the tissues surrounding the eyes) due to accumulation of bile pigments in the blood. The cat may become very sick and be showing signs of hepatic encephalopathy such as seizures, or pressing the head into corners or walls.

    How does the vet know what is going on?

    When the animal is examined in the clinic, they may have been off their food for several days. They may be jaundiced. Your vet will usually recommend blood and urine tests, ultrasound of the liver, and a liver biopsy, which will all help towards a diagnosis.

  • Blood tests for liver function and to check blood electrolytes (salts). If the blood potassium level is low, this has been associated with a poorer prognosis. Blood tests will also indicate underlying disease such as pancreatitis.
  • Urine tests - bilirubin (bile pigments) and lipids (fat molecules) in the urine indicate liver disease.
  • Ultrasound will often show an enlarged liver with a brighter appearance than normal due to the excess fat within the liver. The other organs can be examined to check for underlying causes of hepatic lipidosis, mentioned above.
  • A liver biopsy is a very useful test. This can be done surgically or with ultrasound guidance. The liver is responsible for producing blood clotting factors. If the liver is not functioning properly, blood clotting can be delayed and the animal is at increased risk of bleeding. For this reason, the ability of the blood to clot is assessed with a blood sample before taking a biopsy of the liver.

  • What can be done?

    There are a range of treatment and management options, and in most cases several will need to be used together.

  • If blood clotting is delayed, the cat will require treatment with vitamin K before biopsying the liver. If still abnormal, the cat may require a blood transfusion.
  • Fluid therapy - these cats are usually dehydrated because of not eating and vomiting. Fluid therapy allows the correction of electrolyte levels in the blood.
  • Force/syringe feeding is sometimes used, but may not be appropriate as there is a high risk of aspiration on to the lungs.
  • Most cats require being fed 4-6 times daily via a feeding tube during their recovery as it will take several weeks for their appetite and intake to meet their energy requirements. Feeding tubes can be passed through the nose into the oesophagus, or they can be surgically placed straight into the oesophagus or straight into the stomach. A high protein support diet can be used for tube feeding. If the cat has signs of hepatic encephalopathy, the protein level may need to be restricted. A liver or kidney support diet is appropriate for this.
  • Blood samples are taken daily for 3-5 days for electrolytes (salts) and red blood cell numbers in order to monitor for ‘refeeding syndrome’ - disturbances in blood electrolyte levels, anaemia and hepatic encephalopathy caused by feeding.
  • Antibiotics and lactulose will help to reduce the seizures from hepatic encephalopathy, by reducing the levels of toxins building up in the gut.
  • Vitamin B12 supplements by injection are sometimes helpful.
  • Anti-oxidants such as silybin or SAMe may help support the liver function.

  • How can I protect my pet?

    It is very important to feed your cat an appropriate diet which avoids them becoming obese. If your cat is vomiting, or stops eating for 24 hours or more, get them checked out by your vet as soon as possible, as early diagnosis and treatment are associated with better outcomes.

    More than 60% of hepatic lipidosis cases will recover with intensive treatment.

    Idiopathic (cause unknown) cases usually have a good prognosis with treatment. The prognosis for secondary hepatic lipidosis depends on the underlying disease. Recovery can take weeks to months. There are significant costs associated with hospitalisation and intensive treatment, and sadly it is sometimes an appropriate decision to euthanase cats who are seriously ill with this condition.