A case of fatty liver disease

Boo a 2 year old female, domestic short-haired cat presented to us because she was inappetant and lethargic. According to her owners Boo has always been a picky eater but since her owner moved recently she has been hiding, not eating and much quieter than usual. Boo’s owners has also noticed Boo had lost a considerable amount of weight and had a yellow tinge to the skin inside her ears.

Inappetant cats, especially obese ones, are predisposed to developing a condition called hepatic lipidosis or more generically “fatty liver”. Fatty liver is one of the most common causes of liver failure in cats. It is more typically seen in middle-aged to older overweight cats. Usually the disease process starts when the cat goes off of its food or has a decreased appetite over a period of time.

Many different things can cause a cat to go off of its food. It can be as simple as a recent stress (move, new pet, new baby); a cat that has run away; or a sign of an underlying disease process such as inflammatory bowel disease, liver disease, cancer or pancreatitis. As a way to access energy, the cat’s body will start breaking down fat stores which are sent to the liver for processing. The liver can become overwhelmed and unable to process the amount of fat being delivered to the liver. The build-up of fat in the liver interferes with the organ’s regular functions. If nutrition is not reinstituted quickly fatty liver can lead to liver failure.

Boo presented to River Road Animal Hospital very thin (ribs easily palpated), dehydrated, visibly lethargic with a yellow colour to her skin in and around her ears.. Bloodwork revealed a marked increase in liver enzymes and bilirubin, which is the culprit behind the yellow colour of jaundice.

Treatment for fatty liver involves supportive care, a lot of patience, and providing nutritional support to the cat as soon as possible. There are many levels of severity of fatty liver and it is another disease that has a better prognosis the sooner it’s diagnosed and treatment is initiated.

Boo was immediately started on intravenous fluids and supportive care to help her feel more comfortable. She was also started on appetite stimulants, hoping to get her eating on her own. Unfortunately, the following day she still was not eating on her own. As mentioned above the cornerstone of treatment is to try and get the animal to eat as soon as possible.

A feeding tube was placed into Boo’s esophagus under general anesthetic to deliver food into her stomach. A recovery diet was blended with water and feedings were started via the feeding tube. Boo was continued on anti-nausea medication to keep her comfortable during her feedings. Her daily feeding requirements were divided into 6 meals and given every 2 hours over 20 to 30 minutes to prevent vomiting. Her daily caloric intake was increased gradually over 4 days to reach her total maintenance requirement. Each time blood work was run her liver enzymes improved.

Fatty liver holds a poor prognosis without nutritional support. Once nutritional support is initiated it can require a lengthy course of treatment. It is imperative that the owners are committed and willing to provide feedings and care for their cat from weeks up to possibly a couple of months.

Boo’s owners were vital in her recovery. They took her home that first weekend looking after all of her feedings and medications. They even added a middle of the night feeding to her schedule. They returned Monday looking exhausted but with a much brighter Boo. Boo continued as an outpatient and decided a week later she didn’t want her tube anymore and it came out. Luckily at that time she started eating on her own.

According to the most recent update Boo has made a full recovery and is thoroughly enjoying her chicken treats.