🩺 Vet Guide to Hepatic Lipidosis (Fatty Liver Disease) in Cats – 2025 🐱🍽️

Hepatic lipidosis—often called fatty liver disease—is the most common cause of liver failure in cats. And while it sounds scary, this condition is highly treatable when caught early and managed properly with aggressive nutritional support. In this 2025 guide, Dr. Duncan Houston BVSc breaks down the cause, symptoms, diagnosis, and treatment of feline hepatic lipidosis to help you recognize the warning signs and act quickly. 🐾🧬

📉 What Is Hepatic Lipidosis?

Hepatic lipidosis occurs when a cat stops eating and begins to lose weight rapidly. In response, fat is mobilized from body stores to the liver, but a cat’s liver isn’t designed to handle large volumes of fat. The liver becomes overwhelmed, fills with fat, and begins to fail. 🧪

🚨 Most At-Risk Cats:

• 🐱 Previously overweight or obese cats
• 📉 Cats who lose >25% of their body weight quickly
• 🥣 Cats who stop eating for 2+ days

Owners are often pleased to see weight loss in an overweight cat—until it's too late. Unintentional weight loss is always a red flag. ⚠️

🔍 Symptoms of Hepatic Lipidosis

• 🥱 Lethargy and weakness
• 🤢 Vomiting, constipation, or diarrhea
• 😾 Poor or no appetite
• 🟡 Jaundice (yellow gums, eyes, or skin)
• 🔶 Bright orange or dark urine
• 🚫 Weight loss (especially fast or unexplained)

🧬 Diagnosing Fatty Liver Disease

Diagnosis involves a combination of tests and imaging:

• 🧪 Blood tests: Elevated ALP, bilirubin, and liver enzymes (ALT, AST)
• 🩻 Ultrasound: Fatty texture and liver swelling
• 🔬 Aspirate or biopsy: Confirms fat infiltration of the liver

Note: Biopsy may be too risky due to bleeding tendencies in these cats. Fine needle aspirate is often preferred. 🩺

📊 Common Underlying Conditions

More than 90% of lipidosis cases have a secondary cause that must also be addressed. These include:

• 🧠 Inflammatory Bowel Disease (28%)
• 🩺 Cholangiohepatitis or other liver disease (20%)
• 🧫 Cancer (14%)
• 🔥 Pancreatitis (11%)
• 🏠 Stressful changes (5%)

💡 Key Diagnostic Clues

📈 An increase in ALP and bilirubin combined with visible liver changes on ultrasound strongly suggest hepatic lipidosis.

💉 Treatment: Nutritional Support is Critical

Without feeding, cats with lipidosis will die. Survival approaches 90% when proper feeding is implemented. 🥣

Preferred Nutritional Composition:

• 🥩 35–45% of calories from protein
• 🍗 Low in carbohydrates
• 💊 May include diabetic or recovery diets

🍽️ Feeding Methods

1. Nasogastric (N-G) Tube

• 🌡️ Temporary; no anesthesia required
• ⚠️ Small, dislodges easily, used for 3–5 days only

2. Esophagostomy Tube

• 💉 Surgically placed under short anesthesia
• 🍽️ Larger diameter; supports thicker/slurried diets
• ⏱️ Stays in place for weeks to months if needed

3. Gastrostomy (PEG) Tube

• 🔧 Inserted into the stomach
• 💪 Ideal for long-term feeding; allows larger food volumes

⏱️ Refeeding Protocol

• 🍽️ Day 1: 33–50% of total calories
• 🍽️ Day 2: ~66% of total calories
• 🍽️ Day 3: Full caloric intake

Food must be warmed and delivered slowly to prevent vomiting. Always flush feeding tubes before and after use. ❄️

⚠️ Watch for Refeeding Syndrome

Rapid refeeding in a starved cat can cause dangerous shifts in:

• 🧂 Potassium – leads to weakness, drooping neck
• 🩸 Phosphate – leads to red blood cell destruction

Electrolyte levels are monitored closely, especially in the first 3–5 days. 🧪

💊 General Liver Support Therapies

• 🌿 Ursodiol – improves bile flow
• 🛡️ SAMe – liver antioxidant support
• 🚚 L-Carnitine – helps metabolize fats
• 💊 Taurine – binds bile acids; commonly deficient in anorexic cats
• 💉 Vitamin B-12 – given as injections or orally
• 🩹 Vitamin K – supports clotting, often impaired in lipidosis

💬 Prognosis and Follow-Up

If aggressive treatment is started early, 85–90% of cats will recover. However, some cats require:

• 📆 4–6 weeks of tube feeding
• 🩺 Daily medications and supplements
• 🧪 Regular lab monitoring

Jaundice should begin to improve within 7–10 days. If bilirubin drops by 50% in this time, the prognosis is excellent. 😺

📲 Ask A Vet for Guidance

Have a cat who stopped eating? Suspect lipidosis? Use the Ask A Vet app to speak with Dr. Duncan Houston or another licensed vet about diagnosis, feeding strategies, and liver support. 🐾💬

Visit AskAVet.com for expert care—right when your cat needs it most. 📱

💬 Final Thoughts

Hepatic lipidosis is an urgent but survivable condition. With early action, nutritional support, and close monitoring, your cat can make a full recovery. Don’t delay—every meal counts. 🐱❤️

Dr. Duncan Houston and Ask A Vet are here to help you through every step of your cat’s recovery. 🍽️🩺