If your dog has been struggling with liver issues, you are doing the right thing by learning as much as possible about it. If they’ve had liver biopsies, they may have even been diagnosed with chronic hepatitis. The good news is that the liver is a robust organ with an amazing ability to regenerate; after all, it acts as a filter for all the nutrients and toxins coming into the body.
Despite that, the liver has its limits, and your dog will need ongoing treatment and monitoring. We hope this article helps your pup get the fantastic care that they deserve.
What Is Chronic Hepatitis?
Chronic hepatitis is an ongoing inflammation of the liver. While all cases of chronic hepatitis involve inflammation, not all liver inflammation can be classified as chronic hepatitis. This is because chronic hepatitis is only caused by a primary liver disease, while secondary liver inflammation can be caused by diseases elsewhere in the body.
The inflammation in chronic hepatitis causes the liver cells to die; then, they are replaced with regenerated cells or scar tissue. Cirrhosis refers to end-stage liver disease where there is so much scar tissue and very few functional liver cells left.
Some breeds, like Doberman Pinschers, Dalmatians, Cocker Spaniels, English Springer Spaniels, and West Highland White Terriers, are prone to chronic hepatitis. On average, dogs with chronic hepatitis will start showing signs around 7 years old. The disease can only be diagnosed by a liver biopsy. The results of your dog’s initial tests will guide your vet in making the decision to take liver biopsies.
If your dog has had some liver issues, you might be familiar with the “ALT” and “ALP” values seen on their blood tests. ALT stands for alanine aminotransferase, and ALP stands for alkaline phosphatase. ALT is an enzyme found in liver cells; when it is elevated on a blood panel, it can indicate liver cell damage; 90% of dogs with chronic hepatitis have ALT elevations.
ALP is found in the bile ducts within the liver and can also be elevated with chronic hepatitis. The problem with these enzymes is that they don’t tell us why the liver is unhappy, and they aren’t a diagnosis but rather a sign of a problem. In cirrhosis, the lack of many liver cells may mean ALT and ALP are within normal limits.
What Are the Signs of Chronic Hepatitis?
If your dog has chronic hepatitis, aside from the changes in their bloodwork, you might not notice any signs immediately. With time, you or your vet could notice some general signs of illness, including:
- Poor appetite
- Lethargy
- Increased thirst and urination
- Vomiting
- Diarrhea
- Abdominal pain
If your pet’s condition becomes more serious, you could notice more specific yet very concerning signs of liver disease, such as:
- Gastrointestinal ulcers: Sores in the stomach and the first part of the small intestine can lead to intestinal bleeding and signs like fresh blood in vomit or dark tarry feces.
- Jaundice: This is the yellow pigmentation in the gums and skin that is seen when bilirubin accumulates in your dog’s system due to severe liver disease.
- Ascites: Fluid accumulation in the belly causes a bloated appearance. It can be uncomfortable and cause breathing problems.
- Hepatic encephalopathy: Neurological signs like wobbly gait, head pressing, circling, and confusion are thought to occur due to the effects of blood toxins on the brain.
- Coagulopathy: Blood clotting problems can occur as the liver makes some clotting factors. Abnormal or prolonged bleeding, including internal bleeding, can be very serious.
What Are the Causes of Chronic Hepatitis?
Most of the time, chronic hepatitis is “idiopathic,” meaning no inciting cause is found. This is probably because the initial injury has passed by the time of diagnosis, and only the resultant inflammation remains. However, there are a few conditions that can lead to the development of chronic hepatitis.
Immune System
Chronic hepatitis can be caused by an abnormally functioning immune system that leads to damage to the liver. Female dogs who have a family history of chronic hepatitis and respond well to immunosuppressive medications may have this type of disease.
Toxins and Drugs
Some medications and toxins can cause liver damage, which can be followed by chronic inflammation. Medications like phenobarbital, primidone, carprofen, oxibendazole, and amiodarone could be involved. Cycasin, found in cycad plants, and aflatoxin, produced by certain species of mold, are toxins that could be implicated in chronic hepatitis.
Copper
Excess copper in the liver can cause chronic hepatitis. Bedlington Terriers, Dalmatians, Labrador Retrievers, Skye Terriers, Doberman Pinschers, and West Highland White Terriers are predisposed to this.
While excessive copper consumption can be a problem in any dog, and some commercial foods may contain excess copper, certain genetics in these breeds reduce the excretion of copper in bile. Genetic tests are available for copper storage diseases like Wilson disease.
Infectious
Specific pathogens can infect the liver and lead to chronic hepatitis. Leptospira spp bacteria is a notable cause of leptospirosis. Other bacteria and protozoa like Neospora spp and Toxoplasma spp can cause liver injury.
Even some worm larvae migrating from the intestines can cause liver damage. Interestingly, there is not much evidence for viral causes of chronic hepatitis in dogs.
How Do I Care for a Dog With Chronic Hepatitis?
Caring for your dog with chronic hepatitis starts with a veterinary visit. Your vet can take a thorough history, examine your dog, and perform any necessary testing as a starting point to determine if chronic hepatitis is likely and which treatments your pup would benefit from.
- Full blood work, including hematology and biochemistry
- Bile acid tests
- Ultrasound
- Blood clotting tests
- Tests for infectious disease
- Bacterial cultures
- Liver biopsy
The first thing your vet will want to do is address the underlying cause. For example, if your dog has leptospirosis, treating them with antibiotics may lead to remission of the chronic hepatitis. Your vet may also recommend canceling any medication that could harm the liver. For dogs with high levels of copper in the liver, a copper-restricted diet and medication to remove copper from the system can be used. Immunosuppressive medication is used for suspected immune-mediated causes of chronic hepatitis, and anti-inflammatories can also be helpful with toxins and copper accumulation.
Ursodeoxycholic acid is a medication used to support the liver as it helps move potentially toxic bile acids out of the liver. It is used in many cases of chronic hepatitis, along with more specific treatments. Supportive care for your pup depends on their signs. For example, if they are suffering from gastric ulcers, gastroprotectants can be prescribed. Anti-nausea can decrease vomiting and improve appetite.
With your vet’s approval, you can buy supplements to help your dog with liver problems. Nutramax’s Denamarin for Liver Health Tablets for Medium Dogs contains S-adenosylmethionine (SAMe), which is the biologically active form of the amino acid methionine, which has antioxidant and detoxifying effects.
They also provide silybin-phosphatidylcholine complex (SPC), which is the bioavailable form of Silybin, found in milk thistle. Silybin is an antioxidant and anti-inflammatory substance that supports some metabolic pathways in the liver. Vitamin E is also a great supplement for dogs with liver problems, reducing inflammation and scar tissue formation and providing antioxidant effects.
After treatment is started, your pup will need follow-up tests and potential adjustments to medication and treatment protocols. Chronic hepatitis can go into remission, but we never expect it to be cured, which is why you should expect management of the disease to be life-long.
Frequently Asked Questions (FAQ)
Are There Any Dietary Restrictions for Dogs With Chronic Hepatitis?
If chronic hepatitis is caused by the accumulation of copper in the liver, a low-copper diet is recommended. Royal Canin Hepatic and Hills L/d contain low levels of copper. These formulas can also be recommended if your dog has severe signs of liver compromise, like hepatic encephalopathy.
However, they are low in protein, which is not recommended for every patient with chronic hepatitis. You should speak to a veterinarian about the ideal diet for your dog. A board-certified veterinary nutritionist can create a meal plan for dogs with unique dietary requirements.
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What Are Some Other Causes of ALT and ALP Elevation?
ALT can be elevated with steroid use, Cushing’s disease, toxins, liver infections, liver cancers, other liver and gallbladder problems, diabetes, and skeletal muscle injury. ALP can be normally elevated in young, growing dogs as it is released from active cells in the bone. It can also be elevated with bone cancer, Cushing’s disease, toxins, steroid use, gallbladder diseases, pancreatitis, and other liver diseases like nodular hyperplasia and cancer.
How Long Can a Dog With Chronic Hepatitis Live?
In the best cases, chronic hepatitis can go into remission, and some dogs live more than 5 years after the diagnosis. However, dogs with severe signs of liver compromise and cirrhosis may live only another week or so.
Since the prognosis is so variable, it can be very hard to say how long an individual dog will live, although middle-of-the-road survival time is around 18–36 months.
Conclusion
Early diagnosis and treatment are beneficial for dogs with chronic hepatitis. Although some known causes exist, many cases will be classified as idiopathic as no cause can be found.
Copper accumulation in the liver is worth investigating, especially if you have a breed predisposed to it. It can cause chronic hepatitis and is treatable and preventable. Follow your vet’s instructions regarding treatment and follow-up tests, as this condition is never cured, only managed. We wish you the best of luck on this journey with your dog.
Featured Image Credit: SeventyFour, Shutterstock
