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Liver disease in Dogs

The liver is a very important organ that helps maintain many body functions. The liver plays a major role in metabolizing byproducts of metabolism that would otherwise be toxic.  The liver has a great potential for regeneration (replacing injured tissue) and its function is rarely affected as long as no more than 2/3 of the organ is affected by disease.

Some of the major functions of the liver are: Elimination of toxins, production of proteins for growth and development, digestion (together with gall bladder), and maintaining normal sugar levels and blood clotting factors.

The most common liver disease in dogs is chronic active hepatitis (CAH). This disease can be caused by many different factors (drugs, bacterial and viral infections, genetic predisposition, auto-immune disorders, secondary to inflammation of the gall bladder or cancer). These diseases in turn cause an inflammatory process that, if left untreated would lead to death (necrosis) of the liver tissue.   Less commonly, liver cancer, pancreatic disease and gallbladder disease can contribute to elevated liver values on blood tests.

Some breeds have a higher predisposition to develop liver problems. Small breeds of dogs can have congenital liver disease wherein the blood circulation to the liver is bypassed.  Bedlington terriers, West Highland white terriers and Skye terriers are not able to eliminate copper from their body, so it accumulates in the liver causing irreversible damage to this organ. American and English Cockers spaniels have a tendency develop liver problems at a very young age. Unfortunately if these pets are not diagnosed on time the progressive liver disease can lead to death.

Clinical signs

Clinical sign can range from mild; decrease appetite, lethargy, vomiting and diarrhea to a more severe signs like inappropriate mentation (strange behavior), seizures and coma. Other commonly seen signs are increased thirst and urination, jaundice (yellow tinge to pet’s gums, skin, whites of eyes and ears) and enlarge belly (maybe fluid filled).

Diagnosis

Liver disease is usually suspected by clinical signs and physical exam, but confirmed by blood testing and ultrasound. These tests include liver enzymes (included in most blood chemistries), ammonia levels (toxins), electrolytes, complete blood cell counts and sometime bile acids to assess the function of the liver. Ultrasound is often used to check size and appearance of the liver. The ultimate diagnosis is done with a liver biopsy obtained with the ultrasound or sometimes with surgery. The biopsy results will assist in determining the disease process and will help design an appropriate treatment plan.   At our hospital, our board certified surgeons will perform a liver biopsy using a laparoscope which allows for a keyhole incision. 

Treatment

The treatment of chronic active hepatitis is complex and needs to determined by the severity of the disease. If the pet is in crisis, hospitalization, intravenous fluids and supportive care are a MUST. In cases where infection is suspected or has been detected antibiotics should be added to the treatment. In cases where severe inflammation is suspected anti-inflammatory agents or even immune-suppressive drugs might be prescribed in order to decrease the inflammation and prevent further damage to the liver.  Liver cancer may respond to chemotherapy depending on the cell type which is determined by biopsy. Some types of liver disease where the gallbladder is full of thick bile, called a gallbladder mucocele, can be completely cured by surgical removal of the gallbladder.

 In most cases, long term treatment will include low protein diets, strong anti-oxidants such as S-Adenosylmethionine (also known as Zentonil®, Denosyl® and SAMe®) and Vitamin E (200- 400 IU), antibiotic such as Amoxicillin and/or Metronidazole, antacids such as Pepcid ®, and Lactulose to help decrease toxins in the blood. Other products such as multi-vitamins, Milk thistle (Herbal supplement known to benefit liver function) and Omega-3 fatty acids may be added to support liver function.   A special prescription diet may also be prescribed for your pet.

It is recommended that liver enzymes, protein, sugar, ammonia and electrolyte levels be followed closely. This means that your pet may need regular lab work.  Abdominal ultrasound can also help assess progression of disease so it is recommended that pet suffering from CAH have regular ultrasound re-checks.

Always consult with your doctor before adding any medication or supplement if you know your pet suffers from chronic hepatitis.

Picture of the liver obtained from the ALLRefer.com web site.

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