Fatty Liver Disease in Cats

“My cat has very strange looking orange urine and is very depressed.  What should I do?” Mrs. Gonzalez asked on the phone.  My receptionist told her that she should bring Sunny down to the veterinary clinic as soon as possible.  Sunny was normally a very large buff colored cat, and when Mrs. Gonzalez placed the cat on the examination table, I was surprised to see how sunken and saggy he looked.  Sunny had dropped from his typical 18 pounds to 14 pounds without the aid of a diet.  His owner reported that his appetite had been down for a week, and he hadn’t eaten a thing in 3 days.

On physical examination, Sunny was jaundiced, meaning having a yellow tinge to his skin and mucous membranes (such as his gums).  He did not have a fever, but he was dehydrated and lethargic.  He hardly moved as I examined him.  At this point I was not sure what had started Sunny’s illness, but I was extremely concerned that he had developed a condition called hepatic lipidosis, also known as “fatty liver” disease.

Hepatic lipidosis usually occurs in overweight cats that do not eat for a couple of days.  Loss of appetite can be due to simple things likes a viral infection, but the result is impaired liver function and an increasingly sick cat.  When a cat does not eat, he begins to break down body fat for energy.  In overweight cats, the amount of fat that is broken down and metabolized by the liver overwhelms the normal liver cells and fills them up, rendering them unable to work.

Sunny was hospitalized and started on intravenous fluids.  His blood was sent to a lab for analysis, and to get some quick results, we performed a urinalysis in house.  The urinalysis showed that his kidneys were working ok, but there was a high level of bilirubin, the pigment responsible for his jaundice and orange colored urine.

We immediately began trying to get him to eat.  He refused but my technician was able to force feed him with a strained canned cat food and a syringe.  Sunny, a normally voracious eater, was not interested in food and about 20 minutes after he was fed, he vomited up what he had been given.  He was started on some injectable anti-vomiting medication.  He was also started on injectable antibiotics, since we were unsure whether he was going to be able to hold anything down orally.  When hand fed small amounts of food frequently, Sunny did not vomit, but he still did not want to eat on his own.

The next morning we received the blood test results and found that Sunny’s blood cell count was normal, but he had liver enzyme elevations and high levels of bilirubin in his blood.  Liver enzyme elevations on a test are an indicator of liver inflammation, but they are not specific to a cause.  Mrs. Gonzalez wanted to do whatever it would take to help her cat. I next took some abdominal x-rays, but aside from an enlarged liver, we could not see anything else out of the ordinary. I continued with more diagnostics.

Sunny was given a sedative and an ultrasound of his abdominal cavity was performed.  I did not see any one specific area of problem, so a couple of needle biopsies of his liver were taken and submitted to the lab.  While he was sedated, I placed a feeding tube into Sunny’s esophagus.  Esophagostomy tubes provide a route to more easily treat cats with larger volumes of food and also give owners an easier way to medicate.  Although we had been able to successfully feed Sunny with a syringe, his high nutritional requirements for recovery made force feeding enough this way very difficult.

Sunny’s liver biopsy confirmed my tentative diagnosis of hepatic lipidosis, and no other liver disease was found.  We still did not know what had initiated his anorexia, but so far he was responding to treatment.  Sunny was sent home with his feeding tube in place.  His owner continued his feedings, antibiotics, and anti-vomiting medications. She also gave him some important supplements including taurine and carnitine.  It took her a couple of days to get comfortable with his care, but she became a real pro.  Despite all of this care, Sunny was still not eating a week later.  This did not surprise me because it can take weeks for a lipidotic cat to resume eating.  Many owners are unable to provide the ongoing care and patience needed to pull a cat through an episode of hepatic lipidosis.  Mrs. Gonzalez did not give up.

After three weeks, Sunny began to eat on his own.  His owner was thrilled and was able to reduce the amount of feeding she was doing through his tube.  When his appetite returned to normal and his physical condition was stable, the tube was removed and Sunny did well.  Sunny was put on a measured portion diet so that he would not become so obese again and to try to prevent another episode of hepatic lipidosis.

The lesson to learn in the case of Sunny is that it is not normal for a cat to stop eating.  If anorexia persists for more than a day, get your cat into your veterinarian’s office.  The doctor will need to decide which course of treatment and diagnostics are needed.  Not every anorexic cat needs a feeding tube to get well, but for many it is the difference between success and failure.

Written by Dr. Wexler-Mitchell of The Cat Care Clinic in Orange, CA
Copyright © 2011 The Cat Care Clinic

About Dr. Elaine Wexler-Mitchell

Dr. Elaine Wexler-Mitchell is the owner of The Cat Care Clinic in Orange, CA
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