If you’re thinking your cat needs to lose weight, great! Excess weight is not good for anyone. But, with your cat, it’s wise to enlist the help of your veterinarian to help you develop a weight- loss feeding plan because of the risk of the cat developing hepatic lipidosis (HL), also called “fatty liver syndrome.” A cat who stops eating can become very sick very quickly, literally within a few days.
This liver disease happens most commonly in overweight cats who stop eating for whatever reason. With no incoming calories, affected cats mobilize their fat stores so rapidly that fat begins to accumulate in liver cells, resulting in liver failure. HL is notoriously difficult to treat, so awareness and prevention are key to your cat’s health.
“At the Cornell University Hospital for Animals, we see approximately one case per month,” says Dr. Alyssa Chandler. “Because this condition is common, I suspect many cases are managed in practice by our terrific referring veterinary community.”
While HL can happen all by itself for no apparent reason (idiopathic), it is usually a consequence of prolonged anorexia due to an underlying condition. In a Cornell University study looking at causes of HL in 157 cats, inflammatory bowel disease (IBD) came out on top, followed by cholangiohepatitis (inflammation of the liver and gall bladder), cancer, pancreatitis, stress-related anorexia, respiratory disease, and diabetes.
“Any cat with prolonged anorexia can develop hepatic lipidosis,” says Dr. Chandler, including healthy-weighted cats. “However, we tend to be more concerned about HL in overweight cats that become anorexic.”
The heavier the cat is to begin with and the more prolonged the anorexia, the more likely and severe the hepatic lipidosis will be.
Signs of HL
The first sign of impending HL is loss of appetite. Rapid weight loss is next, followed by any combination of lethargy, weakness, dehydration, vomiting, diarrhea or constipation, and jaundice (yellow coloration of mucous membranes).
Diagnosis
Diagnosing HL in cats isn’t usually difficult. An enlarged liver will be noted upon examination, and bloodwork will usually show classic changes in the concentration of liver enzymes in the blood.
The difficult part is usually diagnosing the underlying cause of the anorexia that resulted in HL.
Ultrasound and fine-needle aspirate of the liver can be pursued but are usually not necessary, unless needed to find the cause of the HL.
Liver biopsy is not recommended in the early stages of HL, as there is a high likelihood of hemorrhage due to the fact that a compromised liver produces less vitamin K, which is necessary for normal blood clotting to occur.
Treating HL
While we’re discussing treatment specifically for HL, remember that the underlying disorder must be diagnosed and treated for a successful outcome.
The most important aspect of treatment for HL is to stop the negative caloric balance (i.e., caloric deficit) that is causing the rapid mobilization of fat stores. It is not enough for your cat to eat a little or lick the gravy from the food. They must ingest enough calories to create a positive calorie balance in their bodies.
The problem is that these cats usually do not want to eat. Force feeding a cat is not recommended. It will likely create such a food aversion that they may never want to eat again, not to mention the potential for damage to your relationship with your kitty.
The Feeding Tube
So, how do we get food into them? If tempting with yummy food and appetite stimulants do not work, a temporary feeding tube must often be placed. There is no halfway approach to successful treatment of HL, and both the cat’s owner and the veterinary team must be all-in for successful treatment of HL.
“We recommend esophageal feeding tubes. They are well tolerated by cats and easy for owners to manage at home,” says Dr. Chandler. “HL cats stay in the hospital for several days on average, possibly longer depending on severity of disease. When they go home, the owners will typically need to manage the feeding tube for weeks to months, depending on the patient’s progress.”
The cat receives everything they need via the feeding tube. That means all nutrition, hydration, and any oral treatments or supplements. Your veterinarian will calculate your cat’s caloric requirement and help you create a consistency appropriate for tube feeding and maintaining hydration. Be sure to warm the food a little, administer it through the tube slowly, and feed four to six small meals a day to avoid stomach upset and vomiting.
Beyond the feeding tube, other treatments for HL might include fluid therapy; supplementing vitamins K, E, and B; antiemetics as needed for vomiting; SAMe (a compound that improves liver cellular function); l-carnitine (helps with fatty acid oxidation and glucose metabolism); and of course, whatever treatment is indicated for the underlying disorder that caused HL.
Your cat may decide to eat and drink on their own even with the tube in place. Once they seem to be feeling better, you can start offering small meals to see what happens. The general rule of thumb is that the cat should be eating well on their own for a couple of weeks while tube feeding is gradually decreased and the tube is eventually removed. The esophagus and the skin wound where the tube was placed will usually heal on their own.
Prognosis
The liver can fully heal from the fatty insult of HL if the cat is managed and supported properly. “The prognosis for these cats ultimately depends on the underlying disease process that precipitated the anorexia and HL, and our ability to diagnose and manage that,” says Dr. Chandler.
While your cat can recover, it’s often a long and intensive road to get there, so you are much better off preventing it. This means if you have a cat who suddenly stops eating, don’t let it go for more than 48 hours before seeking veterinary intervention.
Dr. Alyssa Chandler is an assistant clinical professor in the section of Small Animal Internal Medicine at Cornell University’s College of Veterinary Medicine.
