Hepatic Lipidosis

What is hepatic lipidosis (HL)?

Hepatic lipidosis (HL) is a liver problem that can affect cats of any age, breed or sex. It is also called fatty liver disease or fatty liver syndrome. HL occurs when a cat suffers a decrease in appetite or stops eating completely. The decrease in caloric intake triggers mobilization of fat stores from other parts of the body in order to maintain metabolic requirements. The fat is processed by the liver and in some instances it overwhelms the liver’s metabolic capacity to metabolize it. Fat then begins to accumulate in the liver and starts to impair liver function.

There are certain risk factors that can predispose a cat to developing HL and certain “triggers” that may alert you to the potential for a problem. Cats that are overweight are at a higher risk for developing this disease. Changes in diet, environment and development of another illness may also predispose a pet to a decrease in appetite and development of HL. It is possible not to EVER find a reason for the development of HL in which case it is termed idiopathic hepatic lipidosis (IHL). In order to reach a diagnosis of IHL however, other problems need to be ruled out.

Recent information suggests that some cats may have intestinal disease (Inflammatory Bowel Disease) as a predisposing factor. If that is the case long term therapy may be required. 

What are the signs of hepatic lipidosis?

Some of the first signs that people will notice is a loss of appetite, depression, sporadic vomiting. Some owners may even notice a yellow tinge to the tips of the ears or the whites of the eyes as a first sign. If the problem is severe or not addressed, patients can progress to stupor, salivation, bleeding problems and death. The earlier the disease is caught, the better the chance of successful treatment.  

How do we diagnose hepatic lipidosis?

One of the first things that your veterinarian will do is a physical exam to look for any obvious problems. Sometimes the patient has an enlarged liver as a result of the fat accumulation. The next step will be some routine blood tests to assess organ function. There are certain changes and patterns in the liver values that suggest the presence of HL. Other organ systems will also be evaluated for any signs of a problem. If your veterinarian feels that the liver is indeed the source of the problem, they may run some tests to assess your cats clotting ability. The liver is responsible for making the proteins that make blood clot normally as well as facilitating the activation of these proteins. If liver function is compromised, then the blood cannot clot normally and there is a risk of excessive bleeding.

Because an underlying disease such as an infection or cancer may be the reason for the development of HL, abdominal radiographs and an ultrasound are recommended. This allows visualization of the liver to look for masses or other changes that may alert us to a different problem.

At this point your veterinarian may recommend things such as an aspirate of the liver or a liver biopsy. Both of these procedures will help obtain a diagnosis of HL but both have pros and cons. An aspirate may be preferred because it is less invasive, does not require anesthesia and there is less risk of bleeding. The drawback however, is that a diagnosis may be missed as it is a very small sample of cells and not actual tissue like a biopsy. A liver biopsy may be more diagnostic but does require anesthesia and there is a higher risk of complications. Your veterinarian will help you decide which is the best option for the particular situation.

How do you treat hepatic lipidosis?

The cornerstone of therapy for HL is nutritional support. This allows the body to reverse the metabolic derangements that have occurred and halts progression of the problem. There are a number of ways that nutritional support may be provided. In very mild cases, you r veterinarian may choose to try an appetite stimulant and feeding with a syringe until the appetite improves. This rarely works and in most instances, more aggressive support is required. One option is the placement of a feeding tube in the stomach. This procedure entails placing the cat under general anesthesia for placement of a tube directly in the stomach that protrudes from the left side of the body. This tube can then be used to feed the pet while in the hospital as well as at home until the cat regains its appetite. Some veterinarians may also use a feeding tube placed in the nose which reaches down into the stomach called a nasogastric tube. A tube placed in the esophagus may also be used – an esophagostomy tube. The type of feeding tube used often depends on the circumstances and your veterinarian’s preference. Because placement of these tubes typically require anesthesia another option is to feed through an IV (intravenous) catheter. This is called total parenteral nutrition or TPN. TPN may allow the patient time to become a little less debilitated and a stronger candidate for anesthesia. TPN also allows us to supply the amino acids, fats and electrolytes needed without having to use the intestinal system which is ideal for those patients that are vomiting.

Other ancillary treatments for this disease involve antibiotics, acid reducers (i.e. Pepcid), specific vitamins, and treatment of any underlying conditions.

What should I feed my cat when he/she goes home?

If your cat goes home with a stomach tube, your veterinarian will give you recommendations on what and how to feed. It will be important to stay in contact with your veterinarian as frequent exams will be necessary to assess the tube, recheck lab data and monitor weight.  Once your cat begins to eat on their own, the tube feeding can be gradually reduced and the tube ultimately removed.

With proper diagnosis, early intervention and treatment, cats with IHL have a very good chance at recovery and will go on to lead normal lives.


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