Feline Hepatic Lipidosis: Deep Welfare Guide
Pathophysiology
Feline hepatic lipidosis (HL, fatty liver syndrome) develops when a cat stops eating (from any cause) and mobilises body fat at a rate that overwhelms the liver's processing capacity. Fat accumulates within liver cells, causing liver dysfunction and failure. Obese cats are at highest risk; even 2-7 days of reduced food intake can trigger HL in susceptible individuals. It is the most common severe liver disease in cats. Without treatment, it is fatal; with aggressive nutritional support, survival rates of 60-80% are achievable.
Causes and Welfare Context
Any cause of anorexia can trigger HL: stress (new environment, new animals in household), illness, dietary change, pain, or behavioural problems. Paradoxically, well-intentioned owner actions — moving food bowls, changing diets, or placing the cat in a stressful situation — may precipitate HL in obese cats. Recognising the cascade risk is essential: any obese cat that has not eaten for 2-3 days should receive veterinary assessment and consideration of nutritional support before HL develops.
Clinical Signs and Diagnosis
Clinical signs include: progressive jaundice; weight loss and muscle wasting; vomiting; hepatomegaly (enlarged, fatty liver palpable on examination); drooling; and weakness. Diagnosis is based on clinical signs, blood tests (elevated bilirubin, elevated liver enzymes, particularly ALP), ultrasound (hyperechoic liver), and liver cytology or biopsy (confirmation of lipid accumulation in hepatocytes). Early diagnosis before severe liver failure gives the best welfare prognosis.
Nutritional Support
Nutritional support is the primary treatment: the liver cannot recover until the cat resumes eating. Hospitalised cats receive: nasogastric (NG) tube feeding (short-term, less invasive); oesophagostomy tube (OT, preferred for home management, well-tolerated by cats); or gastrostomy tube for severe cases. High-protein, high-calorie liquid diets are fed multiple times daily. Supplementation with L-carnitine, vitamin K, B vitamins, and S-adenosylmethionine (SAMe) supports liver function. Recovery takes weeks.
Prevention and Owner Education
Prevention focuses on: maintaining healthy body weight (avoiding obesity); recognising anorexia early and seeking veterinary help promptly; minimising stressors (particularly food changes, environmental stress, new animals); and understanding that any obese cat not eating for 2-3 days requires veterinary attention. Owner education during obesity management programmes should include specific advice about HL risk during any period of anorexia. Cats recovering from HL require ongoing monitoring of liver function and nutritional status.