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

In order to treat this condition, placement of a feeding tube (percutaneous gastrostomy tube) into the stomach is the most satisfactory method to manage feedings.

Recurrence of hepatic lipidosis is rare, and those cats that survive go on to live normal lives.

What is Hepatic Lipidosis?

• Hepatic lipidosis is a common cause of potentially reversible liver failure in cats. The disease is 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 (loss of appetite), weight loss, weakness, jaundice (yellowing of the skin, eyes and gums), vomiting, diarrhea, and behavioral changes.
• Hepatic lipidosis is just one of many liver diseases which can cause the clinical signs listed above. Despite years of careful scientific research, the exact cause of this disease is still unknown. Factors which may be associated with the onset of hepatic lipidosis include stress, obesity, anorexia, cancer, change in diet, nutritional deficiencies, diabetes, and hyperthyroidism.
• Cats are unique in their tendency to develop this disorder. Excessive amounts of fat are broken down from the cat’s peripheral fat storage during periods of fasting or decreased food intake. This fat is then transported to the liver. The liver should then process this fat and export it to the rest of the body in a new form. 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 by swelling of the liver cells with excessive fat. Impairment of liver function or, in severe cases, overt liver failure results.

Diagnosis

• The suspicion that a cat is suffering from liver disease is confirmed by physical examination, a through history including diet and medications, comprehensive blood work, and abdominal ultrasound.
• The definitive diagnosis of hepatic lipidosis requires visualization of fat globules in the liver cells; this 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 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, yet the only way to reverse the process of fat accumulation within the liver is through aggressive feeding. This supplies your cat with his or her full caloric requirements. Force feeding your cat is an option, though most cats are not very cooperative, and 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 feeding tube (percutaneous gastrostomy tube) into the stomach is the most satisfactory method to manage feedings. The percutaneous gastrostomy tube is placed using an endoscope and requires a short duration of anesthesia. This allows us and you to ensure that your cat is receiving its full caloric requirement with a minimum of stress and fuss. A specially formulated recovery diet is fed through the feeding tube for the entire time it takes for your cat to recover from the hepatic lipidosis. If necessary the feeding tube can safely remain in place for several months. This method of management allows your pet to return home where you can perform the feedings.
• The expected hospitalization for a cat presenting with severe hepatic lipidosis is 7-10 days. During this period of time we will correct the dehydration, monitor for any electrolyte abnormalities that may occur, and begin reintroduction of food to your cat. As these cats have not eaten for some time, 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 about 80% of its calculated caloric requirements we will set up a time for your cat to go home. Discharge time takes approximately 30-60 minutes. During that time we will go through any medications your cat may require, demonstrate how gastrostomy tube feedings are done, and answer any other questions you may have.
• You will be expected to bring your cat in to see your veterinary technician for regular rechecks, generally every 2 weeks. As liver function recovers, appetite will gradually improve. Expected recovery time is typically 6-12 weeks, with an average time of 8 weeks. When your cat is totally self-feeding for 2 weeks without any weight loss, the feeding tube can be removed.

Prognosis

• Recurrence of hepatic lipidosis is rare, and those cats that survive go on to live normal lives.