Feline hepatic lipidosis: high ALP with normal GGT
8-year-old obese domestic shorthair cat that stopped eating 10 days ago after moving house. She has lost 20% of her body weight. Icteric mucous membranes.
| Parameter | Result | Reference |
|---|---|---|
| ALT | 220 U/L | 20–100 |
| Alkaline phosphatase (ALP) | 480 U/L | 10–80 |
| GGT | 3 U/L | 0–5 |
| Total bilirubin | 4.5 mg/dL | 0.0–0.4 |
| Potassium | 3.1 mmol/L | 3.5–5.5 |
What is the most likely diagnosis?
chevron_right Show answer and explanation
A. Feline hepatic lipidosis
Correct. An obese cat with prolonged anorexia after stress, jaundice and very high ALP with normal or mildly raised GGT is the typical profile. Confirm with ultrasound and fine-needle aspirate cytology, and start tube feeding as soon as possible.
B. Neutrophilic cholangitis
In cholangitis and other biliary diseases GGT usually rises as much as or more than ALP. A normal GGT with very high ALP points more towards lipidosis, although cholangitis can coexist as an underlying cause.
C. Extrahepatic biliary obstruction
Biliary obstruction causes marked rises in both ALP and GGT, usually with dilated bile ducts on ultrasound. A normal GGT makes this diagnosis unlikely.
D. Hyperthyroidism
Hyperthyroidism raises ALT and ALP, but typically causes polyphagia rather than anorexia, and does not cause jaundice. It does not fit this picture.
lightbulb Key takeaway
In cats ALP has a very short half-life and low hepatic activity: any increase is significant. Very high ALP with normal GGT in an anorexic cat suggests lipidosis; monitor and correct hypokalaemia, which worsens the prognosis.
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Updated: October 31, 2026 · Educational content for veterinary professionals. It does not replace current clinical guidelines or the judgement of the attending veterinarian.