Feline Hepatic Lipidosis

Definition

What is hepatic lipidosis? It’s a condition that affects the liver of cats especially the overweight ones. Typically, it occurs if they stop eating for a while and their metabolism begins to burn fat as an energy source. Fat has to be transformed in the liver to be useable as an energy source. When the demand is too great, the liver becomes engorged and stops working partially or completely. Since the liver isn’t working properly, metabolic waste accumulates in the bloodstream and cats feel sick. It then creates a vicious cycle where they eat even less, lose weight, maybe vomit, become lethargic and dehydrated. Occasionally, these waste products cause neurological signs and profuse salivation. Biliary pigments will accumulate in the bloodstream and cause jaundice. The skin, the oral mucosa, inner ears and the sclera take on a yellow hue. Often, coagulation problems and hemorrhages are seen. If the condition remains untreated, death can occur.

Sometimes, the disease can occur without any obvious reason but more often it occurs following prolonged anorexia. Sometimes, introduction of a new diet, the owners going away or another stressful event can trigger anorexia. Other general causes include a primary liver problem (infections, inflammation, tumors), pancreatitis, viral diseases etc..

How is it diagnosed

Clinical signs combined with a physical exam will reveal the presence of jaundice. Tests will need to be performed to obtain a diagnosis. An initial data base would include: complete blood count, biochemistry, total T4 (thyroid) for cats over 6 years, feline leukemia and feline aids virus screening and a urine analysis. Additional tests such as an abdominal ultrasound and liver biopsies are often necessary to get a definitive diagnosis.

Fortunately, the liver is a very forgiving organ and can regenerate if an underlying cause can be identified. Goals of treatment will aim at eliminating this cause if possible, stopping fat mobilization, correcting dehydration and electrolyte imbalance in order to help liver healing.

Treatment

Getting calories into this cat will be essential. The cat will need to be fed a caloric dense diet in sufficient amount to meet its nutritional requirements. Since they don’t want to eat they have to either be syringe fed or fed via a tube that has been placed in their esophagus or their stomach. Syringe feeding can be quite a challenge because the amounts of food are significant and sick cats often will just spit it out and this could lead to food aversions. It is much easier to place a tube under general anesthetic and feed them this way until they are healthy and can eat on their own. This way, we can give adequate amounts of food as well as oral medication without the cat having to taste it. Re-feeding will have to be done progressively by giving many small meals a day in increasing amounts. On the 1st day, we will be giving 25% of the daily caloric needs, on the 2nd day 50%, 3rd day 75% and 4th day 100%. There needs to be at least a 2 hour period after a feeding to enable the stomach to empty completely. Sometimes tubes can become clogged. To prevent this, we recommend that the diet be put in a blender or through a strainer. You can also feed veterinary diets that are made for this specific purpose. You also have to flush the tube before and after feeding with 5 cc of lukewarm water. If the tube were to become clogged in spite of this, you could fill the tube with cola and let it sit for a while. If still blocked, contact the veterinary clinic for assistance. After a week’s time, we could start offering different types of cat foods, wet and dry, avoiding the one that the cat was previously on when it became sick. An appetite stimulant could be prescribed.

If placing a tube is not an option, syringe feeding can be attempted. Avoid straitening the neck because food could go in the airway. The frequency and amounts to be administered will be the same as if fed via a tube.

How to proceed with feedings:
- In a bowl, put the strained diet. Add a small amount of hot water to obtain adequate texture in order to be able to aspirate in the syringe. Mix thoroughly to obtain an even texture.
- Aspirate food into the syringe. Very likely, air will go in as well. You will need to evacuate this by tapping the syringe upside down so air will go up. Press the plunger so air comes out.
- To feed the cat, place the syringe at the corner of the mouth and gently insist to get the mouth to open. Direct the syringe towards the back of the mouth and inject small amounts at a time. Avoid putting it on the tip of the tongue because the cat will most likely spit it out instead of swallowing it.
- If the cat vomits during the feeding, stop and start a little later. If he vomits every time, contact a veterinarian.
Other possible treatments:
-To correct dehydration and electrolyte imbalance, intra-venous fluids will be needed.
-Antibiotics depending on the case.
-Medication to control vomiting.
-Vitamin K1 by sub-cutaneous injections to prevent bleeding due to a deficiency in
clotting factors.
-Antioxydants
-Medication to help with liver congestion
-Tender, loving care will hasten recovery

Prognosis
Survival is 80-85% if lipidosis is primary and treatment is aggressive and involves placement of a feeding tube. With syringe feeding, survival rates drop to 10 or 15%. If an underlying cause is found, prognosis depends on diagnosis.