🚨 THIS IS A MEDICAL EMERGENCY
Seek immediate veterinary attention. Do not wait or attempt home treatment. Every minute counts.
Feline Hepatic Lipidosis (Fatty Liver Disease)
The most common liver disease in cats. Occurs when an anorexic cat mobilizes excessive fat stores, overwhelming the liver. A potentially fatal consequence of a cat not eating. Aggressive nutritional support is lifesaving.
Last updated: 2026-05-08
Severity
severe
When to Act
🚨 Immediate Emergency Care
Symptoms & Signs
Complete anorexia
Cat has stopped eating entirely — often the primary history. Any cat not eating for 48+ hours is at risk.
Jaundice
Yellow discoloration of the gums, skin, and whites of the eyes — a hallmark of hepatic lipidosis.
Weight loss
Rapid weight loss over days to weeks, often preceded by obesity.
Vomiting
May be intermittent or frequent.
Lethargy and weakness
Cat is profoundly lethargic and may be too weak to stand.
Hepatomegaly
Enlarged liver, palpable on examination.
Behavioral Changes to Watch For
Pets can't tell us what's wrong. These behavioral changes are often the first clues that something is wrong.
🐾 Not eating after a stressful event
Cat stops eating after a stress trigger (move, new pet, diet change attempted too quickly).
What You May Notice:
Your cat stopped eating when you went on vacation or moved furniture — and hasn't eaten since. This is the most dangerous chain of events in feline medicine.
Causes & Risk Factors
Causes
- •Prolonged anorexia (not eating) — the primary trigger
- •Overweight/obese cats are at greatest risk — fat mobilization overwhelms the liver
- •The underlying cause of anorexia can be anything: stress, illness, pain, diet change
- •Cats are unique in their inability to efficiently process large fat loads — making them uniquely susceptible
Risk Factors
- ⚠Obesity — single biggest risk factor
- ⚠Any disease causing anorexia (pancreatitis, IBD, kidney disease, dental disease, cancer)
- ⚠Stressful events (move, new baby, new pet, owner vacation)
- ⚠Sudden diet change attempted too quickly
How It's Diagnosed
- 1Clinical history — obese cat that stopped eating days to weeks ago
- 2Physical exam — jaundice, weight loss, hepatomegaly
- 3Blood work: elevated ALP and GGT (cholestatic enzymes), elevated bilirubin, variable ALT
- 4Abdominal ultrasound — diffusely hyperechoic (bright) liver
- 5Liver biopsy or fine needle aspirate — confirms hepatocellular lipid accumulation
Treatment Options
Aggressive Enteral Nutrition via Feeding Tube
This is THE treatment. Without nutritional support, the disease is 100% fatal.
Steps
- 1.Esophagostomy tube (E-tube) placement — the standard of care
- 2.Nasoesophageal tube — temporary, for initial stabilization
- 3.Calculate resting energy requirement (RER) and feed a recovery diet
- 4.Start at 25-50% RER and increase to 100% over 3-5 days
- 5.Feed small, frequent meals — 4-6 times daily
- 6.Continue tube feeding until the cat is eating 100% of RER voluntarily — takes 4-8 weeks typically
Expected Outcome
80-90% survival with appropriate aggressive nutritional support.
Precautions
- !Refeeding syndrome — start feeding gradually and monitor electrolytes (phosphorus, potassium, magnesium)
- !E-tube is well-tolerated by cats and allows home care
- !Force-feeding by mouth is stressful, inadequate, and risks aspiration
Supportive Medications
Adjuncts to nutritional therapy.
Steps
- 1.Antiemetics (maropitant, ondansetron) — control vomiting
- 2.Appetite stimulants (mirtazapine) — encourage voluntary eating
- 3.S-adenosylmethionine (SAMe, Denamarin) — liver support
- 4.Vitamin K1 — if clotting abnormalities present
- 5.L-carnitine — may improve hepatic fat metabolism
Expected Outcome
Supportive care while nutritional therapy reverses the disease.
Precautions
- !Medications are adjuncts ONLY — nutrition is the definitive treatment
Common Medications Used
| Medication | Usage | Important Notes |
|---|---|---|
| SAMe (Denamarin) | Liver-supportive antioxidant supplement | Given on an empty stomach. Widely used for feline liver disease. |
| Mirtazapine | Appetite stimulant | Transdermal gel applied to inner ear. Supports voluntary eating during recovery. |
Prevention
- ✓Never let a cat go more than 48 hours without eating — seek veterinary care
- ✓Maintain ideal body weight — obesity is the #1 risk factor
- ✓Gradual diet transitions over 7-14 days
- ✓Prompt treatment of any underlying disease causing anorexia
- ✓Monitor food intake during stressful events
When to See a Veterinarian
- 🚨Cat hasn't eaten in 48 hours — DO NOT WAIT
- 🚨Yellow gums or skin (jaundice) — EMERGENCY
- 🚨Rapid weight loss in an overweight cat
- 🚨Cat stopped eating during a stressful event
Frequently Asked Questions
Can I just force-feed my cat at home with a syringe?
Prognosis
Good to excellent with aggressive nutritional support — 80-90% survival. Fatal without treatment. Recovery takes 4-8 weeks of tube feeding. Most cats return to normal liver function once they resume eating. Weight loss and dietary management are essential for prevention of recurrence.
References
- [1] ACVIM — Feline Hepatic Lipidosis Consensus
- [2] JVIM — Nutritional Management of Liver Disease
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moderate