What classifies canine chronic hepatitis?
Hepatic inflammation for greater than 4-6 months
Which histological features characterize canine chronic hepatitis?
Hepatocellular apoptosis/necrosis associated with an inflammatory infiltrate (often mixed, but predominantly lymphoplasmacytic) that typically progresses to fibrosis and cirrhosis
When is the typical age of onset of canine chronic hepatitis?
4-7 years of age
What causes canine chronic hepatitis (four)?
- Idiopathic
- Infectious (ex. leptospirosis)
- Toxins (drugs)
- Copper storage disease
also has immune mediated (in 60% of cases) and lobular dissecting hepatitis (rare, young dogs)
What are the clinical signs of canine chronic hepatitis?
- Abdominal effusion
- Icterus
- Poor body condition
How can canine chronic hepatitis be diagnosed on bloodwork?
- Elevated ALT in at risk breeds (cholestatic parameters will be less dramatic)
- Hypoalbuminemia (most common)
- Hyperbilirubinemia
BUN and cholesterol also decreased in late disease (w/ true liver failure)
How can canine chronic hepatitis be treated?
- Treat underlying cause first (ex. leptospirosis, copper storage disease, ascites)
- Corticosteroids (try prednisone then consider cyclosporine)
- Try hepatoprotectants
in notes: immunomodulatory therapy (prenisone 1-2mg/kg), hepatoprotective drugs, supportive care (nutrition, nausea), copper chelation
What is the prognosis of canine chronic hepatitis?
Good if diagnosed early and given appropriate therapy. Poor to guarded if diagnosed later and has fibrosis or cirrhosis
generally 21.1-36.4 month median survival time
What causes copper storage disease?
- Genetics
- Secondary to other liver disease
How can copper storage disease be diagnosed?
Copper accumulation (histopathology)
When is treatment for copper storage disease indicated (three)?
- Elevated copper on quantification (can vary lobe to lobe)
- Copper deposition is focused in zone 3 (perivenular)
- Hepatic necrosis is intermixed with copper-positive granules
What are the steps to treating copper storage disease?
- Chelation therapy (30 mins prior to eating)
- Diet modification
- Zinc supplementation
- Corticosteroids/immunosuppressants (cyclosporine or prednisone)
- Hepatosupportive medications
What are some diet treatment options for copper storage disease?
Diets with a low copper content and higher zinc content (commercial liver diets, RC labrador, or home cooked diets). Be careful restricting too much protein!
What is chelation therapy?
Chelation (D-penicillamine) is a compound that forms a water soluble complex with copper and is excreted in the urine (be careful as it also chelates zinc)
What should not be given with chelation therapy?
Zinc (chelation therapy will chelate zinc)
True or False: Chelation can be used to treat acute cases of copper storage disease
False, as chelation does not drop levels acutely
What can cause acute liver injury?
- Infectious (leptospirosis, adenovirus)
- Toxins (xylitol)
- Drugs (NSAIDs, antibiotics)
True or False: Liver biopsies are helpful in diagnosing acute liver injury
False. Biopsies often just reveal non-specific necrosis and apoptosis
How can acute liver injury be treated?
- Treat underlying cause if identified (ex. infection)
- Antiemetics
- Fluid therapy (monitor electrolytes and BG)
- Give hepatoprotectants and cholerectics
What causes gallbladder mucoceles (four)?
- Concurrent endocrine disease (Cushing’s, hypothyroidism)
- Exogenous steroid administration
- Hyperlipidemia
- Mucosal hyperplasia (not as common in cats due to not having many mucosal glands in gallbladder)
What are the clinical signs of a gallbladder mucocele?
- Anorexia
- Lethargy
- Intermittent abdominal pain
- Icterus
- Shock and/or bile peritonitis (if gallbladder is ruptured)
How can gallbladder mucoceles be diagnosed on serum chemistry?
- ALP elevation (most common)
- GGT and bilirubin frequently elevated
- Hypercholesterolemia may be see with EHBOs
How can gallbladder mucoceles be diagnosed on a CBC?
CBCs will usually be normal although may show an inflammatory leukogram
How can gallbladder mucoceles be diagnosed on ultrasound (both immature and mature)?
Immature:
- Hyperechoic sludge suspended or dependent
- Liquid bile in varying amounts
Mature:
- Sediment often centrally located and immobile
- Stark contrasting layers (kiwi gallbladder)
-
Neuro 141
-
Neuro 2 & 330
-
Ortho 179
-
Ortho 231
-
Ortho 331
-
Ortho 422
-
Head and Neck56
-
Cardiology60
-
GI 142
-
GI 249
-
GI 334
-
Dentistry 127
-
Dentistry 245
-
Dentistry 344
-
Abdominal Surgery 1 + 255
-
Abdominal Surgery 336
-
Abdominal Surgery 465
-
Liver 152
-
Liver 225
-
Pancreas33
-
Oncology 1 & 283
-
Immune 170
-
Resp 1 & 2100
-
Resp 341
-
Repro surgery92
-
Infectious75
-
Diabetes Mellitus75
-
Thyroid Disorders62
-
Adrenal Gland Disorders17
