Hepatic Lipidosis

Highly Curable With Aggressive Nutritional Treatment

When guests arrived for several days, Dusty Rainbolts one-and-a-half-year-old cat Sunny wanted nothing to do with them, so he made himself scarce. Four days later, Rainbolt found him in a closet, much thinner than when she had last seen him. I didnt know he had stopped eating because he only eats dry food and our cats can free feed. Consequently, it took a while for me to figure things out.

By that time, however, the cat was critically ill after having gone several days without eating. The veterinarian diagnosed him with hepatic lipidosis, a common feline liver disease in which excess fat deposits accumulate in the liver; the condition is sometimes called fatty liver syndrome.

About 90 percent of cats with lipidosis have an underlying disease causing the anorexia (not eating); by treating the condition, you can save the cats life, says Sharon Center, DVM, professor of internal medicine at the Cornell University College of Veterinary Medicine. These underlying conditions include diabetes mellitus, hyperthyroidism, cardiomyopathy, kidney disease, chronic cystitis (inflamed bladder), chronic upper respiratory disease, cancer, pancreatitis, and other disorders.

Until just a few years ago, hepatic lipidosis in cats was usually fatal. These days, with aggressive nutritional treatment, which involves force-feeding, more than 80 percent of stricken cats survive.

Sudden, dramatic weight loss
Although no particular breed, gender, or age is linked to hepatic lipidosis, about 90 percent of cats that develop it are obese, and many are indoor, middle-aged, or older cats. When obese cats — and some thin cats – stop eating for as little as three or four days, they may develop lipidosis and become critically ill. For others, it may take a week or two of not eating, while other cats, despite prolonged anorexia, will never develop hepatic lipidosis.

Stress seems to be a common trigger for the anorexia, which often is not noticed until the cat suddenly loses weight; a cat will commonly lose up to 50 percent of its usual weight before being diagnosed. Without food, the cat uses its stored body fat for energy. Because cats are carnivores and are primed to burn both protein and fat, they will continue to metabolize protein whether they eat or not. Without adequate caloric intake, cats start mobilizing their own body stores (protein and fat) to acquire energy, explains Center. The result is they start tearing apart their own bodies, mobilizing fat to the liver for energy.

Normally, the liver absorbs fat from the blood to convert it for use by the bodys cells. But when the liver accumulates more fat than it can handle, the fat clogs up the organ and impairs its function. In the cat with hepatic lipidosis, this can lead to jaundice (yellow discoloration), neurological disorders, bleeding disorders, important electrolyte disturbances (such as imbalances in sodium and potassium, both of which help cells maintain voltages and generate electrical impulses), vitamin depletions, and eventually, liver failure and death.

To diagnose lipidosis, veterinarians use blood tests to detect any underlying disease that is causing anorexia and to check liver status. If necessary, liver cells can be examined to see if they are abnormally expanded with fat. Although a liver biopsy would help make a definitive diagnosis, we do not run whole-liver biopsies, because these obese cats are initially at risk for complications from anesthesia and have bleeding tendencies, Center says. Rather, we use an ultrasound examination of the liver and collect a very small liver sample using a small needle attached to a syringe.

The very first goal of treatment, Center stresses, is to rehydrate the cat, normalize the electrolytes, and provide food energy by force-feeding a liquefied diet either with a syringe into the cats mouth or via a tube placed through the nostril into the esophagus if the cat will not swallow or voluntarily take food.

We try to be as non-invasive as possible and be aware that cats very easily develop food aversions, which provoke nausea, says Center. Once the electrolytes and hydration status are normal, we become more aggressive, often putting in an esophagostomy (to deliver food to the esophagus from a neck opening) or a gastrostomy tube (to deliver food to the stomach from an opening in the abdominal wall) through which we feed small amounts of a high-protein, high-caloric diet multiple times a day, says Center. She initially supplements these diets with vitamins B1, B12, and E. Her research has found that cats with hepatic lipidosis do much better when they also receive supplements of potassium and carnitine, a conditionally essential nutrient (the nutritional requirements change with the metabolic status and body condition of the cat) that helps process fats in the liver. Medications to help control vomiting, diarrhea, and other problems resulting from the primary disease may also be prescribed.

As with many diseases, the earlier the cat is treated, the better the prognosis. Many cats recover fully in three to six weeks, but some cats require force-feeding for several months before they will eat normally. The cat may go home, however, as soon as it is stable and the human caretakers are comfortable with using the feeding tube. They can determine when their pets appetite starts to return by offering the chance for voluntary eating each day. Once the cat is eating well for several days, the veterinarian will determine if it is time to remove the tube. Recurrences are rare.

The best way to prevent lipidosis is to prevent or reduce obesity and to pay attention to your cat when she seems to have a decline in appetite. During stressful periods, cat lovers should be particularly watchful, especially if their cat is obese, to be certain the cat eats normally. A veterinarian should check a cat that stops eating for even just a day or two.

Today, Rainbolts kitty is a little on the chunky side, thanks to his human caregivers dedication and attention. Sunny was first force-fed orally and given subcutaneous fluids until he began to eat on his own. When my veterinarian faxed me the results of the final blood test, her words were, I believe we have witnessed a miracle, Rainbolt says. It may have been a miracle, she adds, but we had to work very hard to make it happen.