What is Fatty Liver Disease?
The liver is responsible for a variety of functions necessary for life, which include body detoxification, producing digestive chemicals, and various metabolic functions. When fatty liver disease occurs, the liver is no longer able to carry out these functions, causing complications and death in cats.
Fatty liver disease, or hepatic lipidosis, is a serious condition in cats that is fatal if left untreated. The disease occurs when the cat stops eating due to a poor appetite. Its body is then forced to convert stored fat cells into energy. Because a cat's body relies on high levels of protein, the fat doesn't convert well, which causes the fat to build up in the cells of the liver and reduces its function.
Symptoms of Fatty Liver Disease in Cats
Symptoms begin slowly as the cat stops eating and then progress quickly as the liver begins to fail. These symptoms include:
- Anorexia, or refusal to eat, that can last for several weeks
- Decreased appetite
- Rapid weight loss
- Downward flexion of neck and head
- Muscle deterioration
- Jaundice (yellowing of the eyes and skin in the ears)
- Suddenly collapsing or fainting
Causes of Fatty Liver Disease in Cats
Though the cause of fatty liver disease is not always known, some diseases or conditions can increase a cat's risk of getting fatty liver disease. These causes include:
- Refusal to eat due to environmental changes, such as moving, a new family member, dietary changes, accidental confinement, or loss of a family member or family pet
- Pancreatitis (inflammation of the pancreas)
- Liver disease
- Kidney disease
- Being overweight or obese
- Other generalized diseases
Diagnosis of Fatty Liver Disease in Cats
The veterinarian will need to know the cat's complete health history, any recent stress that affected the cat, all of the symptoms, and when the symptoms first began. A thorough listing of all of the accompanying symptoms can help the veterinarian in diagnosing the primary condition that caused fatty liver disease to occur.
Laboratory tests, such as a urinalysis, biochemical profile and complete blood count will need to be done. These tests will be both indicative of fatty liver disease as well as the underlying condition. Blood tests may show red blood cells that are abnormally sized, varying white blood cell count levels, the loss of red blood cells, and an increase in the enzyme alkaline phosphatase. The biochemical profile will show further signs of the disease, including high liver enzyme levels and high bilirubin levels. A high blood sugar level is indicative of diabetes and low kidney functions levels will show if kidney disease is present.
An ultrasound may also be done of the cat's liver and surrounding organs. An enlarged liver and abnormalities in the spleen and kidneys are indicative of fatty liver disease. The veterinarian may also do a biopsy or a needle aspiration to confirm the diagnosis. In the biopsy, the veterinarian will make a small incision in the abdomen and remove some of the liver tissue. During a needle aspiration, a small needle will be inserted into the liver and cells from the liver will be removed. Both tests will be sent to an outside lab for testing.
Treatment of Fatty Liver Disease in Cats
If the cat is severely dehydrated, hospitalization for fluid therapy will need to occur. The cat will be given these fluids intravenously. The veterinarian will monitor the cat's labs to ensure that the fluid is being processed properly and isn't causing problems with kidney function.
Force Feeding or Feeding Tube
Treating fatty liver disease is dependent on the cat eating a healthy, normal diet. Cats who refuse to eat out of a dish will either need to be force fed or fed via a feeding tube. Food can be forced down the cat's esophagus with a syringe, taking care that aspiration doesn't occur. If the cat isn't responsive to being force fed, a feeding tube may need to be inserted. This tube is placed in the esophagus through a small incision in the cat's neck while it is under general anesthesia. A liquid diet can then be given to the cat through the feeding tube.
Anti-nausea medications may be prescribed to the cat in order to help them retain the food they eat. Vitamin supplements, such as vitamin K, B-complex vitamins, vitamin E and thiamine may also be prescribed to correct any nutritional losses in the cat.
Recovery of Fatty Liver Disease in Cats
With prompt treatment, 80 to 90 percent of cats fully recover from fatty liver disease. Treatments typically last three to six weeks. The veterinarian will need to monitor the cat during this time with follow-up appointments to ensure that recovery is occurring.
As soon as the cat is able to eat from a dish on its own again, the feeding tube can be removed and force feeding can be stopped. The cat will need to eat a carefully balanced diet to ensure that all of the necessary nutrients are eaten to prevent malnutrition from occurring.
Because obesity is a risk factor in the development of fatty liver disease, veterinarian instructions to help the cat lose weight should be followed in order to prevent a recurrence of the disease. It's important to remove or minimize any environmental stressors as they could cause a refusal to eat in the cat in the future, causing the disease to occur again.
Fatty Liver Disease Questions and Advice from Veterinary Professionals
My cat was diagnosed with FLD a week ago and she's being treated with 125mg of metadoxine every night (prescribed by her vet). Also we are force feeding her with a syringe 10ml of urgent care food every 4 hours, but she still refuses to eat on her own. Also, I've noticed that the skin around her ears started to turn yellowish and her stool is black. But what worries the most is that sometimes she sits still somewhere in alert position for a long time and she started peeing in our beds. We can't afford to hospitalize her again (she had surgery a month ago)and we will have a follow up with her vet in three weeks. Any advice on what can we do in the meantime?
I would switch her to home made liquidised boiled turkey diet from the beginning for easy digestion and continue forced her every 3 hrs or so to keep her hydrated and nourished. If needed, she should get intravenous IV to prevent feeling of nausea and getting enough fluids with nutrition. Also, I would detoxify her liver natural way using slippery elm sirup (google Dr Axe slippery elm sirup for recepee) and also using some other herbs that you can purchase in pharmacy called Liv 52 that is purely natural.
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What is considered extremely high levels of enzymes in monetary terms for a cat with FLD. What is considered the least worrisome and the most worrisome? In numbers please.
There are no set definitive numbers for liver enzyme levels indicating a disease, just whether they are slightly or significantly outside of physiological range and the symptoms being presented; the combination of these would be indicative of a condition. Most commonly, there is an underlying condition which lead to fatty liver disease which can also have an effect on the biochemistry results of a blood test. Generally (very generally) in a case of fatty liver disease you would expect an increase in circulating bilirubin, more than a two fold increase in aspartate aminotransferase (AST), alkaline phosphatase (ALP) and alanine aminotransferase (ALT) along with a normal or mildly increased gamma-glutamyl transferase (GGT) level I added a link to a biochemistry reference page for comparison. Regards Dr Callum Turner DVM
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