Fatty liver disease, also known as Feline Hepatic Lipidosis (FHL) or Fatty Liver Syndrome, is one of the most common liver diseases found in cats. Dogs can also develop the condition, but it is rare. This condition tends to be secondary to some other primary condition, and it can evolve quickly into a serious situation. This blog will focus on the symptoms, causes, treatment and prognosis of Fatty Liver Disease in cats.
What is Fatty Liver Disease?
Fatty liver disease is a buildup of fat in and around the liver that can happen when a cat stops eating for a period of days. Triglycerides, a type of fat molecule, can build up in the hepatocytes, the cells that make up the liver. This process can happen very quickly and cause severe, even fatal, liver damage within a matter of days. The buildup of triglycerides is mainly due to a period of anorexia, where the cat is eating very little or stops eating altogether. Since the cat is no longer receiving energy from food, the body begins to break down stored fats to make up for the energy deficit. These fats get processed by the liver, which can get overwhelmed by a mass release of fats into the bloodstream at a greater level than it can tolerate. If the liver cannot keep up with fat processing, the fat will build up in the liver cells causing hepatic lipidosis or fatty liver disease.
What causes fatty liver disease?
Overweight and obese cats are at a higher risk of fatty liver disease because they carry excess fat that can quickly fill liver cells. The goal in diagnosing this disease is to determine why the cat stopped eating in the first place. Often another underlying health condition such as diabetes, cancer, hyperthyroidism, pancreatitis, kidney disease, or another liver disorder may cause a cat to stop eating. In these cases, the condition that caused the anorexia must be treated along with fatty liver disease. In addition to other health conditions, physically healthy cats may stop eating due to stressful changes in their environment such as a sudden change in diet, moving to a new home, introduction of a new family member, loss of a pet in the family, or a generally stress-filled home.
What are the symptoms of fatty liver disease?
If you notice any of these symptoms, it is important to contact your veterinarian.
- Eating less or not eating at all (anorexia), along with dramatic weight loss >25% of body weight
- Depressed mood
- Lethargy and dullness
- Weakness, unable to exercise and jump
- Dehydration
- Vomiting, constipation, or diarrhea
- Drooling
- Head pushed to the ground (neck ventroflexion)
- Yellowing of the skin, gums, and eyes (jaundice) – in particular, jaundice is an indicator that the liver is failing, and the cat requires immediate attention. Over 70% of fatty liver disease cases exhibit jaundice.
How is Fatty liver disease diagnosed?
Your veterinarian may need to run several of the following tests to confirm a diagnosis.
- A physical exam will show signs of jaundice, and palpation of the liver will uncover abnormal size or abdominal discomfort.
- Blood testing including a CBC (complete blood count) and chemistry panel provides insights into the liver’s function. A high triglyceride number would be a red flag. These tests also help identify signs of infection or inflammation in the liver. Blood work can confirm dehydration and an imbalance in electrolytes.
- Ultrasound is used to examine the shape and size of the liver.
- A liver biopsy can provide a definitive diagnosis. The veterinarian uses a procedure called a Fine Needle Aspirate (FNA) to extract a very small sample of liver tissue for analysis.
- It is important to concurrently treat any primary disorder that has led your cat to stop eating. Other tests may be conducted to confirm a diagnosis for a primary condition.
How is fatty liver disease treated?
Treatment involves general liver support and nutritional support. Feeding tubes are often placed to deliver nutrients. While on a feeding tube, the cat should be offered some regular food at least once a day. Once the cat begins eating on its own, the amount of food delivered through the feeding tube can be slowly decreased and eventually the tube can be removed. Slowly reintroducing food is important, as sudden ingestion of food after a period of fasting can create life-threatening imbalances of electrolytes in the blood.
- Fluids: A cat with acute fatty liver disease will likely need IV fluids to rehydrate the body. The IV may contain potassium and phosphate supplementation to rebalance electrolytes.
- Vitamins and minerals: Vitamin B12 deficiency is common in cats with fatty liver disease. Vitamin K1 supplementation is essential in blood clotting and is critical as an immediate intervention in cats with suspected fatty liver disease. Magnesium deficiency is also common in anorexic cats and may be added to the treatment protocol.
- Antioxidants such as SAMe, dandelion root, and vitamin E help to slow down liver damage.
- N-acetyl-cysteine (NAC) helps boost glutathione production in the body and remove toxins from the liver.
- L-carnitine and S-adenosyl-L-methionine (SAMe) are essential nutrients that help the body break down fatty acids and turn them into energy to power cells.
- Taurine is recommended for anorexic cats and should be given until they are eating normally again.
- Appetite stimulants can help encourage your cat to eat food on their own.
- Ursodeoxycholic acid (Ursodiol) is a bile acid used to treat the symptoms of several different types of liver disease including fatty liver disease.
TCVM in Fatty Liver Disease
In Traditional Chinese Veterinary Medicine (TCVM), the cause of fatty liver disease is an accumulation of lipids in the liver, known as Phlegm. Blood Stagnation is also common with the condition. The Spleen (digestive function) in TCVM comprises the spleen, pancreas and duodenum and oversees the overall the digestive process. When Phlegm clogs the liver and Blood isn’t moving well (Stagnation), the ability of the Spleen to transport and transform fat and bile acids is compromised. Emotional factors such as frustration (stress) can lead to a Stagnation of Liver Qi (energy) and the liver fails to support the role of the digestive process. As a result, Blood is stagnant, and Phlegm can accumulate in the liver. Another possibility is that poor diet, chronic disease, or a prolonged hot, cold, or damp environment can lead to Spleen Qi (energy) deficiency.
The goal of treatment is to get the Blood moving, build Qi, and resolve the Phlegm. Foods such as rumen (the stomach of a ruminant - goat, sheep, deer, cow), mackerel, and beef are good choices to build Qi. Lemon and honey in small amounts will help resolve Stagnation without being too warming. Surprisingly, kidney beans are a food some cats enjoy to drain Damp and nourish Blood. Foods to avoid include mutton, venison, eggs, and dairy. There are a variety of Chinese herbs that clear Heat and resolve Stagnation, tonify Blood, and strengthen the Spleen. Consult with a holistic practitioner well-versed in TCVM. Acupuncture and Tui-na are other modalities that can be used in the treatment of Fatty Liver disease.
Recognizing the risk factors and symptoms of fatty liver disease early and intervening with prompt, appropriate treatment can ensure the cat makes a full recovery. Cats may stop eating for many reasons; it is important to consult a veterinarian if your cat suddenly stops eating or shows any of the other signs of fatty liver disease. The priority is to get the patient to eat, and this can be problematic because in general, cats can be picky eaters. Have your veterinarian prescribe an appetite stimulant if necessary.
Gently cooked foods are better than raw with this condition. Avoid overly cold or hot foods, if possible. With prompt treatment, cats usually recover from fatty liver disease within 14-21 days. Recurrence after recovery is rare. Management of the underlying cause is essential. Keep your cat at normal weight for their size and place him/her on a weight loss program if needed. Have a system in place to recognize if your cat has stopped eating. Treat any underlying physical conditions and disorders. Provide an environment that is as low-stress as possible. A happy cat is a healthy cat!
