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Hepatic Lipidosis

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Hepatic lipidosis is a common cause of potentially reversible liver failure in cats due to the excess accumulation of fat in the liver. 

What is Hepatic Lipidosis?

Hepatic lipidosis is a common cause of potentially reversible liver failure in cats due to the excess accumulation of fat in the liver. The liver is responsible for a variety of important functions, including the metabolism of carbohydrates and fats; the synthesis of proteins and vitamins; the storage of vitamins and iron; the production of substances necessary for blood clotting; and the removal or breakdown of toxins.

Because the liver is involved in many crucial biologic functions, a cat with liver disease may show a wide variety of symptoms. These may include lethargy, anorexia, weight loss, weakness, jaundice, vomiting, diarrhea, and behavioral changes.

Hepatic lipidosis is just one of many liver diseases that can cause the clinical signs listed above and can be either the primary problem or secondary to another disease process. Possible primary disease processes include inflammatory bowel disease, another liver disease, cancer, pancreatitis or social interaction problems (i.e., introduction of a new pet or other stresses at home). Factors which may be associated with the onset of hepatic lipidosis include stress, obesity, anorexia, a change in diet, nutritional deficiencies, diabetes, and hyperthyroidism. The typical cat with hepatic lipidosis is middle-aged, overweight, has a poor appetite, and has recently lost a significant amount of body weight.

Cats are unique in their tendency to develop this disorder. Excessive amounts of fat are broken down from their peripheral fat storage during periods of fasting or decreased food intake. This fat is then transported to the liver, which should then process it and export it to the rest of the body in a new form. However, in cats that develop hepatic lipidosis, this process is impaired and the rate of fat export from the liver is much slower than the rate of fat intake, resulting in fat accumulation within the liver cells. Damage to the liver is caused as the liver cells swell with excessive fat. At minimum, the impairment of liver function occurs and, in cats with severe hepatic lipidosis, overt liver failure results.

Whenever your pet is showing signs of a health issue, your first step is to contact your primary care veterinarian. If it is indicated that your pet may suffer from hepatic lipidosis or other serious condition, a veterinary specialist is available at an ExpertVet certified or affiliated hospital.

 

Diagnosis

The suspicion that a cat is suffering from liver disease is confirmed by a physical examination; a thorough history including diet and medications; comprehensive blood work; and an abdominal ultrasound. The definitive diagnosis of hepatic lipidosis requires visualization of fat globules in the liver cells, which can only be accomplished through needle aspiration or biopsy of the liver.

 

Treatment

Regardless of the cause, the basic treatment for hepatic lipidosis is the same. Many cats with the disease will be dehydrated and completely anorexic when brought to the hospital. Intravenous fluids are used to correct the dehydration. Most cats with hepatic lipidosis refuse to eat, however the only way to reverse the process of fat accumulation within the liver is through aggressive feeding. This supplies your cat with their full caloric requirements. While force feeding your cat is an option, most cats are not very cooperative and therefore meeting their caloric requirements is difficult at best. Cats also seem to develop food aversions quite easily, and the unpleasant experience of force feeding may further delay your cat’s return to self feeding.

Placement of a nasogastric feeding tube may be the first step to start the healing process. If needed for longer term therapy, an E or G tube into the stomach or neck, respectively, is an effective method to manage feedings. The percutaneous gastrostomy tube is placed using an endoscope and requires a short duration of anesthesia. An esophagostomy tube also requires a short amount of anesthesia and is placed into your cat’s esophagus through a small hole in the neck. Some cats require supportive care, including vitamin K, to help them clot their blood for a period of time before they are stable enough to undergo these procedures. 

Both options allow your veterinarian and you to ensure your cat is receiving its full caloric requirement with a minimum of stress and fuss. A specially formulated recovery diet can be fed through the feeding tube for the entire time it takes for your cat to recover from hepatic lipidosis. If necessary, the feeding tube can safely remain in place for several weeks to several months. A feeding tube allows your pet to return home, where you can perform the feedings and provide medications in a less stressful way.

The expected hospitalization for a cat presenting with severe hepatic lipidosis can be up to seven to 10 days. During the period of time their dehydration is corrected, electrolytes are monitored for abnormalities and the reintroduction of food to your cat will begin. As these cats have not eaten for some time, the reintroduction of food must be done slowly so as to not overwhelm their system. Once your cat is stable, off intravenous fluid therapy, and receiving most of its calculated caloric requirements, it will be time to transfer continued care to you at home. Your veterinarian will review medications and demonstrate how tube feedings are done, and answer any other questions you may have.

 

Prognosis

You will be expected to bring your cat in to see your veterinarian for regular check-up visits, which might be more frequent in the beginning, but will decrease in frequency as your cat recovers. As some feeding tubes require bandaging that will need to be changed every couple days, many owners learn to do these bandage changes at home, along with learning how to monitor for infections. As your cat’s liver function recovers, their appetite will gradually improve. Expected recovery time is typically six to 12 weeks, with an average time of eight weeks. Once your cat has been totally self feeding for two weeks without any weight loss, the feeding tube can be removed. Recurrence of primary hepatic lipidosis is rare, and many cats that survive it go on to live normal lives. Some cats have other contributing diseases that require specific long-term treatment.

 

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