Astra, the 6-year-old Cocker Spaniel exhibited several vague clinical signs like not eating every few days and occasional vomiting. Blood tests showed significantly elevated liver enzymes. Many conditions can cause an increase in these values, but one enzyme caught my attention: ALT. ALT stands for alanine transaminase and is usually part of routine screening blood chemistries. Whenever a dog has a high ALT and no other liver enzyme elevations, it indicates chronic hepatitis could be the cause. Because Astra’s other liver tests were normal, it suggested this could be early in the disease course.

Symptoms of chronic hepatitis in dogs

The clinical signs associated with chronic hepatitis vary widely as a result of the multiple functions of the liver. The most common symptoms include:

• A mild-to-marked decrease in appetite, often irregular and intermittent
• Lethargy or being less active
• Vomiting
• Diarrhea
• Increased thirst and urination
• Distended abdomen that may be filled with fluid (ascites)
• Pale yellow (jaundiced) tinge to the skin, eyes, ears and gums

In more severe cases, dogs may act strangely or exhibit neurological signs, such as: unresponsiveness, depression, aggression, blindness or staring into space, standing in corners, pressing their heads into walls or corners, and, rarely, loss of consciousness or seizures.

Chronic hepatitis may be detected on routine blood health panels and can be diagnosed before your dog develops illness. Once clinical signs of liver disease develop, the condition is often in a very advanced or late stage.

Tests for dogs to check for chronic hepatitis

In scenarios when a patient has fuzzy symptoms (ones that could come from a variety of issues) and elevated ALT like in Astra’s case, moving quickly is the patient’s best chance of surviving many forms of hepatitis. But, we needed more information to determine if Astra had chronic hepatitis and why. To do that, I needed to have a look at her liver.

While radiographs are useful in many cases, they’re not good at detecting subtle or minor abnormalities, particularly in organs such as the liver. I suspected this could be early chronic hepatitis, and I needed to confirm it quickly to begin treatment. To do that, I needed to use ultrasound.

Fortunately, a radiologist specialist visited our clinic once a week and would be available the following day. I needed to add Astra to her already busy schedule.

The radiologist performed the hepatic ultrasound and agreed that chronic hepatitis was likely. Based on her findings, I recommended Astra have a liver biopsy. Before that, we ran some blood clotting and additional liver-function tests to ensure Astra could undergo the relatively straightforward laparoscopic biopsy. This procedure is done under brief anesthesia through a small, keyhole-like incision in the skin.

How does a dog get chronic hepatitis

While I expected the diagnosis of chronic hepatitis to be confirmed, it’s never easy to accept. The biopsy showed increased liver copper, indicating Astra had a copper storage disorder. This is often a genetic disorder, but we don’t fully understand it yet. There are many causes of chronic hepatitis, but all require an early diagnosis to achieve successful outcomes. Some potential causes of chronic active hepatitis include:

• certain medications (carprofen, phenobarbital, trimethoprim/sulfa, etc.)
• infections (canine adenovirus type 1, leptospirosis)
• genetics
• autoimmune disorders
• excess dietary copper
• certain liver toxins

Most cases of chronic hepatitis are of unknown etiology, and we still don’t fully understand the condition. Even when we identify chronic hepatitis early, many dogs still succumb to this terrible disease.

Treatment for dogs with chronic hepatitis

In Astra’s case, the first step was to remove the excess copper harming her liver through a medical process called chelation. I started her on d-penicillamine (D-Pen) and a low-copper therapeutic diet. The main side effect of this drug is nausea and vomiting, and it needs to be taken on an empty stomach to facilitate absorption and bioavailability. In dogs that experience upset stomach or decreased appetite, anti-nausea meds or a short course of steroids may help. I also advised offering distilled water if copper plumbing contributed to Astra’s condition.

After six months of treatment, Astra’s ALT liver enzyme returned to normal. I suggested we repeat the liver biopsy, but her owner declined. We chose to continue monitoring Astra’s liver tests every three months.

About a year later, Astra returned with the same symptoms as before. This time I noticed her eyes were yellowish as soon as I entered the exam room. Blood tests confirmed all her liver enzymes were increased, and she’d lost considerable weight. Sadly, it was time to let her go.

Chronic hepatitis is a disease that isn’t talked about enough in dogs. Even if your dog’s symptoms don’t seem specific for a disease, they’re real. It’s essential for you to be their advocate during the exam and insist on finding an answer. For Astra, her human family was able to spend another 18 months with her before she passed away, and those memories are incredibly precious to them.