[nagdu] AS promised, info about chronic hepatitis in dogs

[Vanessa Lowery]

This is long, so sit back, relax wiht your favorite beverage in  hand,
crank up the volume on your screen reader, and be informed.  The
following information will be especially imformative for those on list
who have labarador retrievers as guides, and also for any one who has a
dog wiht a smaller than normal liver.  Also, I wnat to let folks know
that I have not had the definitive testing done (a liver biopsy), but
everything that is described fits Griffin in terms of his age, his
breed, and the size of his liver.  And he has had a liver ultrasound
done.

Chronic Hepatitis in Dogs
 
Richard E. Goldstein, DVM, DACVIM (Small Animal Internal Medicine) 

What is a chronic hepatitis?
Chronic hepatitis is a syndrome in dogs that can result from many
different disease processes. It means that the liver has undergone or is
undergoing inflammation and/or necrosis. Inflammation is an invasion of
different types of white cells that are active components of the immune
system. The cells come from the blood stream into the liver and help
fight infection. Necrosis refers to the death of large numbers of liver
cells. 

The invasion of white cells and cell death can both be a result of
previous damage to the liver by infectious agents, such as viruses or
bacteria. Previous damage could also be due to poisons ingested by the
dog, cancerous processes, or a primary attack of the immune system
against the liver cells (referred to as auto-immune disease). Liver
cancer can also result in similar liver damage, but once cancer is
identified the term chronic hepatitis is not used. 

The term chronic means that the damaging process has been going on for
some time, at least a number of weeks. This is in contrast to an
acutehepatitis that has most likely been present for just a few days.
Unfortunately the chance for complete recovery (cure) is less in chronic
hepatitis than in acute hepatitis. 

Chronic hepatitis can occur in any breed of dog, male or female, and at
any age. Most dogs with chronic hepatitis are middle-aged to older.
There are certain breeds that are predisposed to this condition, meaning
that although the exact mechanism may be unknown, genetics likely plays
a role in disease development. Bedlington terriers, and less commonly
West Highland white terriers and Skye terriers, may develop chronic
hepatitis as a result of the accumulation of copper in the cells of
their liver. Affected Bedlington terriers may not be able to excrete
copper from the liver to the intestine via the bile because of a known
genetic defect. High concentrations of copper are damaging to liver
cells, resulting in severe chronic hepatitis. 

Doberman Pinschers and Cocker Spaniels (American and English) are also
commonly diagnosed with chronic hepatitis. Affected spaniels are usually
young, and are usually diagnosed when they are 1 to 4 years old.
Unfortunately Cocker Spaniels tend to be severely affected and most die
within a short time of diagnosis despite therapy, although some (with a
bit of luck and very aggressive treatment) may live much longer.
Recently, some Labrador retrievers have also been identified with
chronic hepatitis.

What are the symptoms of chronic hepatitis?
The symptoms associated with this condition vary greatly. Symptoms can
be quite vague and may include:

●Mild to marked decrease in appetite
●Lethargy
●Vomiting
●Diarrhea
●Increased drinking and urination
●Swollen belly filled with fluid
●Yellow or jaundiced tinge to skin, ears and gums
 

A small number of affected dogs exhibit strange behavioral or
neurological symptoms. These can include severe lethargy, depression,
aggression, blindness, standing in corners or pressing their heads into
walls or corners and sometimes even loss of consciousness, seizures and
coma. These neurological signs are a result of the effects on the brain
of toxins that accumulate in the body when the liver is not functioning
adequately, and are part of a syndrome called hepatic encephalopathy.
When these symptoms occur, they can wax and wane (the symptoms come and
go with the pet appearing healthy at some times and showing these
problems at other times). 

What tests are needed?
Liver disease is usually suspected based on a dog's symptoms, or
problems detected during the physical examination performed by the
veterinarian. 

Some tests used to help diagnose chronic hepatitis include:

●Blood work
●Imaging techniques (i.e. x-rays or abdominal ultrasound), used to
assess the size and appearance of the liver, as dogs with chronic
hepatitis tend to have relatively small livers
●Liver biopsy is the only definitive way to diagnose chronic
hepatitis
 

A liver biopsy involves removing a small piece of tissue for
evaluation. The evaluation could include microscopic evaluation by a
pathologist, culture of the liver tissue for bacteria or measurement of
substances in the liver like copper. There are various ways your
veterinarian may recommend obtaining this biopsy, including
ultrasound-guided needle biopsy, minimally invasive surgery
(laparoscopy) and full exploratory abdominal surgery. These various
techniques for obtaining the liver biopsy have benefits and drawbacks:

●A smaller sample can be obtained by inserting a special needle
through the skin with ultrasound guidance. Although this technique may
be the easiest for your dog, sometimes the size of the sample is
inadequate for obtaining a correct diagnosis.
●A larger quality sample may be obtained by using laparoscopy. This
is a technique where long instruments and a camera are inserted through
the body wall under general anesthesia and a tissue sample is removed
from the liver.
●Although the most aggressive, full exploratory surgery obtains the
best samples for analysis because larger biopsies may be obtained from
multiple locations (or the more severely affected areas), and bleeding
can be more easily controlled.
 

Information obtained by performing a biopsy is necessary in determining
the type and severity of liver disease that the patient has, as well as
allowing an accurate assessment of the patient's condition and the
determination of appropriate treatment. The potential benefits, risks,
and precautionary measures that should be taken prior to the biopsy
procedure vary from case to case and should be discussed with your
veterinarian. The most suitable technique for obtaining a sample of the
liver from your dog should also be discussed with your veterinarian. 

What treatment is needed?
The treatment of chronic hepatitis is complex, and recommendations are
based on the severity and type of disease process in the liver as well
as the clinical signs exhibited by your dog. Hospitalization, fluid
therapy and supportive care may be necessary in severe conditions to
help stabilize the patient for further diagnostics and treatment. Some
medications commonly used in this disorder include:

●Special diets
●Antibiotics
●Vitamins
●Minerals (i.e. zinc)
●Immunosuppressive agents
●Anti-inflammatory agents
●Antioxidants
●Medications to prevent gastrointestinal ulceration
●Diuretics to increase urination and promote fluid loss if there is
fluid in the belly.
 

Additional medications are also used in specific instances, such as
when excess copper accumulation is present or if there are signs of
hepatic encephalopathy. 

What is the prognosis?
Unfortunately, despite appropriate treatment, this condition is not
often curable. Many dogs, though, can be kept relatively free of
clinical signs and have a good quality of life for months and even years
with therapy. Your veterinarian will need to recheck your dog's
condition and blood work frequently as circumstances may change,
requiring the therapeutic regimen to be adjusted as needed. 

Updated 11/23/2009: Anthony Carr, DVM, DACVIM (Small Animal Internal
Medicine)



Vanessa Lowery, LGSW
Adult and Community Services Division
Adult Services Screening Unit
410-853-3550
VLowery at dhr.state.md.us


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