Canine Liver Disease (TV4102, Lecture 28 Notes)

List clinical signs of canine liver failure

- Early presentation with lethargy, inappetence, vomiting, weight loss and PU/PD

- Hepatomegaly (vacuolar, lymphoma or congestion) or small liver (chronic hepatitis or shunt)

- Failure with jaundice, ascites, HE, melaena, bruising, pale mucous membranes and hypoglycaemia in acute necrosis

Discuss diagnosis of canine liver disease

Provide diagnostic framework for canine liver disease

List causes for fulminant canine hepatitis

Discuss chronic hepatitis

- WSAVA = hepatocellular apoptosis/necrosis, lymphoplasmacytic inflammation, regeneration and fibrosis

- Effect middle-aged dogs

- History of high ALT with no clinical signs

- Asymptomatic enzyme elevation → chronic GI signs → jaundice, ascites and HE once the reserve gone → portal hypertension and acquired shunts end-stage

Discuss copper-associated hepatitis

Discuss immune/idiopathic chronic hepatitis

- Present with interface hepatitis, lymphoplasmacytic infiltrate, no significant copper, negative culture and dog getting worse on support alone

- Adminster prednisolone, taper over months to lowest alternate-day dose that holds the ALT and the dog

- Steroid-sparing, consider azathioprine and monitor CBC or ALT at 2-4 weeks and cyclosporine or mycophenolate

Discuss steriod/vascular hepatopathy

- Endogenous or exogenous glucocorticoids

- Elevated ALP ± GGT and mild ALT

- Dog systemically Cushingoid

- Big, hyperechoic, mottled liver on ultrasound

- Vacuolated hepatocytes with FNA

- Treat endocrine disease (not liver)

Discuss nodular hyperplasia

- Old-dog nodules

- FNA/biopsy to separate from neoplasia

- If benign, no treatment required

Discuss reactive hepatopathy

- Secondary to IBD, dental disease, pancreatitis or systemic inflammation

- Mild-moderate enzyme leakage

- Address extrahepatic disease and recheck enzymes before a liver work-up

List infectious causes of hepatic disease

Discuss gallbladder mucocoele

- Cushingoid and hypothyroid dogs over-represented (treat endocrine disease)

- Kiwi-fruit/stellate appearance on ultrasound

- May cause necrosis and bile peritonitis

- Perform cholecystectomy and culture (adminster antibiotics accordingly)

Discuss EHBDO

- Pancreatitis, stone, mass or mucocoele at the duct

- Present with acholic faeces, rising bilirubin and dilated CBD

- Provide Vitamin K before any procedure with surgery or stenting after medical stabilisation

- Once patent UDCA and SAMe

Discuss neoplasia of hepatic disease

Hepatocellular carcinoma - often massive, one lobe, older large-breed, surgical resection can be curative.

Lymphoma/MCT - FNA is high-yield for round-cell disease.

HE/ascites/bleed - administer lactulose, metro, levetiracetam, spironolactone ± furosemide, omeprazole and plasma + vitamin K before biopsy.