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

Tracy Carcione carcione at access.net
Tue Jul 10 14:28:44 UTC 2012


Hi Vanessa.
Thanks for the CH description.  My Benny has a small liver.  Wonder if it
runs in TSE's lab lines, or if it just happens.
Ben was having a problem a couple years ago with excessive urination, so
the vet did an ultrasound and saw his little liver.  She put Ben on
antibiotics for a couple weeks, and the urination problem seems to have
been fixed.  But now I know to keep CH in mind, as Benny gets older.  It
might be hard to notice lethargy; he's a low-energy guy to begin with.
Sounds like you have a good vet.  That's great, and hard to find.
Tracy


> 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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