Pet Education

A Big Fat Lecture: Hepatic Lipidosis (Fatty Liver)

Hepatic Lipidosis-01

Hepatic lipidosis, also known as fatty liver syndrome, is a disease process characterized by excessive accumulation of fat within liver cells.

By Stella Chu, VMD
Emergency + Critical Care


What is hepatic lipidosis?

Hepatic lipidosis is a commonly acquired and potentially fatal liver disease seen in cats. It usually occurs following a prolonged period of anorexia (not eating). Most affected cats are overweight or obese, although cats in ideal body condition can also be affected. Occasionally, there is a secondary disease process that caused the loss of appetite in the first place. “Primary” or “idiopathic” hepatic lipidosis is when an underlying disease process cannot be identified.

Common secondary disease processes that can predispose cats to hepatic lipidosis are:

  • Pancreatitis (inflammation of the pancreas)
  • Cholangiohepatitis (infection of the liver)
  • Diabetes Mellitus
  • Cancer
  • Stress – i.e. boarding, family going away, introduction of new pets
  • Diet change

Unfortunately, once this disease process develops, cats can become very ill. Without aggressive medical attention, the condition can lead to death.

It is understood that continual anorexia can lead to break down of fat throughout the body. Normally, the fat will be transported to the liver, which should process the fat and transport it back to the rest of the body. However, in affected cats, this process is impaired and the fat cells become accumulated in the liver. The liver cells become swollen with fat and become damaged, which can lead to loss of liver function.

What symptoms can you see at home?

The most common symptoms associated with hepatic lipidosis are:

  • Loss of appetite
  • Lack of energy
  • Vomiting
  • Icterus (yellow tinged to skin, inside of ears, eyes)

Occasionally, neurological signs may be seen, such as abnormal mentation, circling, head pressing, and seizures. This is due to a condition called hepatic encephalopathy. This happens when the liver fails to detoxify toxins in the bloodstream. The toxins can circulate to the brain leading to brain dysfunction. This condition requires immediate medical attention.

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What tests will your veterinarian perform?

Your veterinarian will take a thorough medical history and perform a complete physical examination, which can raise suspicion for hepatic lipidosis.

Complete bloodwork, such as complete blood count and biochemistry profile may help further suspicion for hepatic lipidosis. In addition, it may indicate the underlying primary disease process that had triggered hepatic lipidosis.
Abdominal x-rays can be effective in evaluating the size of the liver, as patients with hepatic lipidosis tend to have an enlarged liver. Abdominal ultrasound allows veterinarians to evaluate the architecture of the liver, as the typical appearance of a fatty liver is usually evident on ultrasound. Again, these tests may also allow veterinarians to identify the primary disease process.

Ultimately, the diagnosis of hepatic lipidosis is made base on a cytological evaluation of the liver by demonstrating fat cells within liver cells under a microscope. This can be done with a needle under ultrasound-guidance, laparoscopic, or surgical biopsy. However, this step may not be performed base on patient’s clinical status and the stage of the liver disease.

How can we treat hepatic lipidosis?

The mainstay of treatment for cats with hepatic lipidosis is nutritional support. The goal is to stop any further fat breakdown and accumulation of fat within the liver. Unfortunately, once the clinical signs associated with hepatic lipidosis begin, it can become extremely difficult to entice cats to eat by mouth consistent enough to reverse the process of hepatic lipidosis.

The use of tube feeding has improved the mortality rate of this disease process based on recent literature. It is the only way to ensure patients receive their full daily caloric intake. It will also make administration of medication easier at home. There are different feeding tube options:

  • From nose into the esophagus or stomach (temporary)
  • Surgical placement directly into esophagus (long term)
  • Surgical placement directly into stomach (long term)

Your veterinarian should provide the exact type and amount of food to give through the feeding tube based on the patient’s body weight and clinical status. Some patients may require a lower protein content if they are showing signs of hepatic encephalopathy. Most cats will require tube feedings for at least 1-3 months until they begin to eat consistently on their own.

It is also important to identify and treat the underlying primary disease process that triggered hepatic lipidosis. Depending on the disease process and stage of liver disease, your veterinarian may treat with aggressive fluid therapy, gastrointestinal protectants, antibiotics, and other necessary supportive care.

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What does this mean to you in the long run?

Hepatic lipidosis can require long term treatment, aggressive supportive care, and diligent monitoring both in hospital and at home. Frequent trips to your veterinarian are required for repeat physical examination, recheck feeding tube site, bloodwork, and monitor response to treatment.

You will also be responsible for frequent tube feedings, medication administration, and close monitoring at home. Some cats may require weeks to months for recovery.

Along with aggressive medical intervention to reverse the process of hepatic lipidosis and resolution of the underlying disease process, cats can have a good chance for recovery.


Animal Specialty Group

VMD, Emergency + Critical Care

Dr. Stella Chu received her B.S. in Animal Science from Rutgers University and went on to University of Pennsylvania to attain her VMD. While the majority of her time is spent helping the animals in Emergency & Critical Care, Dr. Chu is also interested in veterinary hematology, immune-mediated diseases, and nephrology.