Last updated Jun 20, 2026
Pete Wedderburn / Cats.com
Fatty Liver Disease, also known as feline hepatic lipidosis (FHL) or fatty liver syndrome, is one of the most common liver diseases seen in cats.
It’s a complex type of feline liver failure that is still not fully understood. It can happen as a primary condition (i.e. as the only problem, on its own).
More commonly, it tends to be secondary to some other primary condition (e.g. diabetes mellitus, pancreatitis, inflammatory bowel disease, kidney disease, hyperthyroidism, some other type of liver disease).
The condition is typically seen in middle-aged, obese, or overweight cats that have stopped eating for a couple of days or more. Lipids (fats) accumulate inside the affected cat’s liver cells, and the consequent disease process then aggravates the original issue which caused the cat to stop eating in the first place.
Quick Overview: Fatty Liver Disease in Cats
Other Names: Feline hepatic lipidosis (FHL), fatty liver syndrome
Common Symptoms: Anorexia (absent appetite), weight loss, jaundice/icterus (yellowing of eyes, gums, and skin), vomiting, diarrhea, constipation, head pushed to the ground (neck ventroflexion)
Diagnosis: History of absent appetite for at least 24-48 hours or longer, bloodwork, x-rays, ultrasound, fine needle aspirate for cytology or biopsy of liver tissue.
Requires Ongoing Medication: No
Vaccine Available: No
Treatment Options: Focus is on getting a cat to eat again. Appetite stimulants and supportive care may help but in many cases, a feeding tube is required. Because hepatic lipidosis can have several underlying causes, the underlying cause must also be addressed for hepatic lipidosis to fully resolve.
Home Remedies: Prevention by ensuring proper access to food and having a system in place to recognize if your cat has stopped eating.
Causes of Fatty Liver Disease in Cats
When an overweight or obese cat doesn’t eat for an extended period of time, excess body fat spreads to the liver and causes secondary problems in the cat’s metabolism, leading to the signs of Fatty Liver Disease. Pete Wedderburn / Cats.com
The main precipitating issue is the fact that the cat is carrying extra body weight in the first place. Then, when the cat stops eating for any reason, this extra fat in the cat’s body is mobilized, and the liver is flooded with excessive fats that accumulate inside liver cells. This then causes secondary problems in the cat’s metabolism, leading to the signs of fatty liver disease.
There are many possible causes of this initial loss of appetite, ranging from a primary disease (such as those listed above) to a significant change in the cat’s lifestyle (e.g. sudden change of diet, or social change in the household such as a new pet, etc).
The problem is that the lack of food being absorbed into the bloodstream forces the body to tap into the body’s fat stores for its needs, and in a cat that is carrying too much body fat, this leads to the mass release of fats into the bloodstream at a greater level than the liver can tolerate.
Symptoms of Fatty Liver Disease in Cats
The initial problem is that the cat stops eating, for one of the reasons listed above. This may be a seemingly simple reason (e.g. diet changes) or it may be more serious (e.g. diabetes mellitus).
However, after a few days of being inappetent, the signs of fatty liver disease itself begin to show.
There may be obvious, rapid weight loss with muscle wasting, the cat may become dull and unwilling to move around, and more serious signs include vomiting, diarrhea (or sometimes constipation), jaundice (yellowing of the gums), drooling (hypersalivation), and ventroflexion of the neck (pushing the head down to the ground, as if starting to do a tumbleturn or somersault).
Diagnosis of Fatty Liver Disease
This condition will be suspected by your veterinarian if the history and signs listed above are identified.
Physical Examination
On physical examination, the liver may be felt to be enlarged, and over 70% of cases exhibit jaundice (icterus, or yellow gums).
Blood Tests
Blood tests for liver function will show marked elevations of liver enzymes (such as ALT, GGT, ALKP, and AST), as well as high levels of bilirubin (hence the jaundice). Ultrasound will show a diffusely enlarged liver with a diffusely brighter appearance, and if computerised tomography (a CT scan) is carried out, characteristic changes in the appearance of the liver are seen.
Fine Needle Aspirate (FNA)
To confirm the diagnosis, as well as blood work, your veterinarian may recommend a fine needle aspirate (FNA) which uses a very small sample of liver tissue cells obtained by passing a very fine needle through the skin into the liver.
Characteristic changes are often seen in over 80% of the liver cells. A liver biopsy could be used to make a definitive diagnosis, but this is not generally necessary.
How Do You Treat Fatty Liver Disease in Cats?
Fatty liver disease is a serious condition that often requires veterinary care and sometimes hospitalization. Treatment focuses on restoring adequate nutrition, as recovery depends on getting the cat eating again despite their reduced appetite. Pete Wedderburn / Cats.com
Fatty liver disease is an incredibly serious condition. In many cases, a cat may require hospitalized care, at least initially.
The primary aim is to get the cat eating again: the issue is caused by metabolic changes that happen when a cat is not absorbing any food via their digestive system.
Since fatty liver disease causes cats to lose their appetite, it is not always so easy to get them to take in the food that they need to get them onto the road to recovery.
Force-feeding has sometimes been carried out (restraining the cat, and either placing food into their mouths, and clamping their jaws shut, or using a syringe with liquid food). This approach is not recommended, as it causes stress and fear, and may lead cats to dislike food, even more, leading to an even longer period of inappetence, not to mention a risk of choking.
Appettite stimulants like mirtazapine and capromorellin may be used depending on the underlying cause of anorexia, but they are not always successful on their own.
A feeding tube (a flexible, rubbery type of tube) is needed for most cats, and this needs to be put in place under anesthesia, which is part of what may require an initial hospital stay. Three types are available.
- A naso-esophageal tube is placed through a nostril, to the back of the nose and then into the esophagus. These tubes are narrow, so they require the use of liquid food for feeding.
- An esophagostomy tube or pharyngostomy tube is inserted through an incision in the side of the cat’s neck: these are wider bore, to allow the use of normal food that’s been liquidified to be given via a large syringe.
- A gastrotomy tube may be placed directly into the cat’s stomach through the abdominal wall: these are not used so commonly, as they tend to be more complicated.
The aim is to feed the cat a daily allowance of around 50 kcal/kg of their ideal weight, using a balanced, digestible, “recovery” type of diet.
This should be given in frequent small meals (e.g. six times daily), starting with lower quantities and gradually building up as the animal’s body readjusts to the food intake.
The length of time a feeding tube must remain in place can vary. This may be only a few days to a couple of weeks, as long as it takes for the cat to start eating on their own. The cat in the photo above was at a point where the feeding tube could almost be removed, as she had started to show interest in eating on her own, but still required some feeding through the tube. Her tube was in place for about 2-3 weeks.
Other supportive treatment is usually needed, including:
- Intravenous fluid therapy (“ a drip”)
- Vitamin K and vitamin B12 supplementation
- Liver-supportive medication such as L-carnitine and S-adenosyl-L-methionine (SAMe)
- Where indicated, medication to stop vomiting
It also important, of course, to concurrently treat any primary disorder that has led to the period of inappetence which was the precursor to fatty liver disease.
Blood clotting problems can develop in this disease, so veterinary care may include monitoring red blood cell parameters on blood tests.
Close veterinary monitoring is important during recovery, as refeeding syndrome can occur within the first 1–2 days after eating resumes. This serious complication involves dangerous electrolyte imbalances triggered by reintroducing food after starvation. Pete Wedderburn / Cats.com
Careful monitoring by the veterinary team is important: in particular, “refeeding syndrome” is a common complication that can develop within the first two days of food ingestion recommencing. This is a life-threatening metabolic crisis caused by disturbances to the electrolyte levels in the blood that can be prompted by the sudden ingestion of food after a period of fasting.
The gradual reintroduction of food, in small quantities only, and slowly increasing, aims to prevent the onset of this issue.
As well as treating fatty liver disease specifically, it’s also important that any underlying condition, as mentioned above, is also treated effectively.
The cost to treat fatty liver disease depends on the severity of the fatty liver condition, severity of the underlying cause, and the degree of veterinary intervention needed versus home care as the cat recovers. The total cost can therefore vary widely, e.g. from $6 to $6000 or more.
As an example, a cat who stops eating because of a new change in food that they rejected has a simple underlying issue to resolve. Focus of treatment needs only to be on regaining appetite without much else in the way of medical complications. On the flip side, a cat who stops eating because of complications of diabetes mellitus will require hospital care to correct the problems caused by diabetes as well as addressing the hepatic lipidosis.
It’s difficult to predict the outcome for cats with fatty liver disease, as there are so many variables. Not only does fatty liver disease need to be treated, but the underlying primary problem often also needs to be addressed. For this reason, survival rates vary from 20% to 80%. Again, for more detail, discuss your cat’s individual condition with your veterinarian.
The primary aim of all cat carers should be to prevent fatty liver disease by ensuring that their cats do not become overweight or obese.
And all owners of overweight or obese cats should be aware of the fact that extra body weight is a key risk factor for this condition. They should be aware of the clinical signs of this condition, and they should be ready to take urgent action if their cat stops eating for more than a day.
—
My cat developed mouth ulcers and was anorexic and malnourished for a month; she was fed through a syringe. I didn’t know that a feeding tube could be placed. Although her transaminases were normal (one was elevated due to an infection that troubled her simultaneously with the ulcers), after a month an ultrasound found mild hepatopathy/fatty degeneration. Usually, when a cat is anorexic for so many days, after how many days should a feeding tube be placed? Does malnutrition affect a cat’s recovery when, for example, she has a cold?
—
Let me know if you want me to help with anything else!
In cats, going without food for even 2–3 days can put them at risk for hepatic lipidosis (fatty liver), so vets often recommend placing a feeding tube if anorexia is expected to last more than a few days. Malnutrition definitely impacts recovery, as a weakened body has fewer resources to fight off infections like colds or other illnesses. Early nutritional support is one of the most important factors in helping a sick cat heal and regain strength.