SA Heptic Disease

Hepatic disease clinical signs

• acute - days to weeks vs diarrhoa <3wks

• chronic - weeks to months

• inappetance/anorexia

• vomiting ± diarrhoea → 2ndary GI disease

• jaundice

• depression/lethargy

• PU/PD

• neurological encephalopathy

• bleeding tendancies (coagulopathy)

• GI ulcertion (gastrin not broken down)

Acute hepatopathies DOGS

Infections + parasites

• Leptospira (many serovars so vaccs not always effective)

• Adenovirus (CAV-1) → canine infectious hepatitis, part of core vaccs

• Bacterial endotoxaemia/septocaemia

• Parasitic - liver flukes → increase hepatic neoplasia risk

Toxic/Drug-induced

• Phenobarbitone (anticonvulsant) - rare

• Carprofen (NSAID) - Labrador retrievers or rimadyl (idiopathic toxicity)

• potentiated sulphonamides (given with another drug S&T)

• fungi - contaminated good

• aflatoxin

• mycotoxins - blue-green algae

Neoplasia

• diffuse tumour infiltrate - lymphoma (quick, aggressive)

• [hemangiosarcoma does not damage parenchymal cells]

Genetic

• acute hepatic necrosis → copper storage disease (young Bedlingtons)

  • excessive storage

Chronic hepatopathies DOGS

• appear acutely unwell when albumin decreases/starts to bleed/encephalopathy

Inflammatory 

• idiopathic chronic hepatitis (steroid treated)

• chronic progession of acute hepatopathy

• eosinophilic and granulomatous (macrophageal) hepatitis

• lobular dissecting hepatitis → standard poodles + GSD

• Doberman hepatopathy (immune-mediated or copper toxicosis - which one trigger unknown)

Cirrhosis

• end-stage chronic hepatitis - few viable cells, low ALT

• micronodular or macronodular stage

Neoplastic

• Primary → lymphoma

• Secondary → hemangiosarcoma

Drug-related

• glucocorticoid hepatopathy → excessive glycogen storage

Developmental/Congenital

• congenital portocaval shunts

• portal vein hypoplasia including microvascular dysplasia

• copper storage disease

  • Bedlingtons, west highland whites, Dobermans (± immune mediated)

Acute hepatopathies CATS

Inflammatory

• acute suppurative/neutrophilic cholangitis (bile duct inflam)

  • caused by increased SI bacterial load → increases permeability

Neoplastic

• diffuse tumour infiltrate - sudden lymphadenopathy (lymphoma) - aggressive

Hepatic Lipidosis

Infectious

• bacterial endotoxiaemia/septicaemia

• toxoplasma (semidormant liver cysts - bradyzoites)

• FIP (without jaundice)

Toxic/Drug-induced

• diazepam (valium, high GABA, reduced vagal tone)

• phenobarbitone - high GABA (inhibitory neurotransmitter)

• potentiated sulphonamides

  • tend not to be used in cats 

Cats eating house plants

Chronic hepatopathies CATS

Inflammatory

• Lymphocytic cholangitis

  • may involve pancreas and gut → triaditis

• Chronic neutrophilia cholangitis → may be triaditis

Amyloidosis

• Devon Rex cats

Neoplasia

• primary and secondary

• lymphoma and biliary carcinoma

Infectious

• FIP

• Toxoplasmosis

Congenital

• Vascular disorders - portosystemic shunts

Diagnostic aides - hepatobiliary disease - imaging

Radiology → stones and liver size

Ultrasound - skilled

• cannot determine type → multiple lesions could be bacterial or neoplasia

• Hepatic parenchymal pathology: cannot rule out pathology → 40-50% dogs & cats with inflammatory liver look  normal

• Extra-hepatic pathology → mucoceles and gallbladder changes (cholecystitis)

• CT - used for metastases 

Liver Biopsy - hepatobiliary disease diagnosis

• determines parenchymal disease

• Ultrasound guided

• Laparoscopy

• Exploratory surgery

Types

• Fine needle aspirate → hepatic lipidosis or lymphoma (liver & gallbladder)

• Tru-cut - biopsy (ultrasound guided or laporoscopy)

• Wedge - pathologists want

  • see morphology + location of inflammation

Treatment of hepatic disease

• supportive: fluid therapy → acid base or electrolyte derangements

• antibiotics → neutrophilic cholangitis

• Dietary management

  • low fat

  • dietary fibre

  • high digestibilty (80-85%)

• Anti-oxidants - not much evidence

  • Dena-marin (S-adenosyl L-methionine [SAMe])

  • liver support supplements, not drug - not treating underlying pathology

• Urso-deoxy-cholic acid - increases bile excretion

  • treats significant cholestasis

  • non-toxic bile acid

  • replaces and dilutes toxic bile acids

• Anti-inflammatories - corticosteroids → feline lymphocytic cholangitis

• Specific treatments

  • copper chelators

    • copper toxicity → bedlingtons

  • anti-fibrotics → treat cirrhosis (usually unsuccessful)

• Treatment of complications → encephalopathy (lactulose) + gastroduodenal ulceration