Signs and Symptoms of Canine Liver Disease

January 6, 2009 by Lisa  
Filed under All Info, Symptoms

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We cannot stress enough that the symptoms of liver disease are VERY subtle and your dog may be acting normal other than a few small differences in behavior.  DO NOT WAIT TO CONSULT YOUR VETERINARIAN.  Often times, by the time the symptoms below are present, the disease is quite advanced.  Early detection is the KEY for treatment and survival.

Pets with liver disorders can show a variety of physical symptoms. Very few of the symptoms are specific for liver disease, but can be signs of multiple diseases and conditions. Symptoms of liver disease are variable and subtle in the early stages of the problem.  All, some, or only one of these signs may be present:

Loss of appetite – Anorexia (Most Common) – THIS IS VERY IMPORTANT AND ANY EATING CHANGES SHOULD BE REPORTED TO YOUR VETERINARIAN!!!

Intermittent recurrent abdominal or gastrointestinal upsets; vomiting, diarrhea, constipation

Progressive depression or lethargy; does not want to play anymore or refuses to go for walks.

Swollen belly with a “fluid filled” look. This is also known as ascites and is actually fluid accumulation in the belly due to circulation alterations in the abdomen.

Pale gray feces. Bile pigments are what give feces it’s characteristic brown color and if the liver is not processing bile properly, the feces will not get their color.

Orange urine. The improper processing of bile results in the excretion of bilirubin in the urine in high amounts, thus orange urine.

Jaundice, also known as icterus. Any pale or white skin or visible tissue takes on a yellow hue. Again the biliary pigments are accumulating in the body because the liver is not processing them.

Bleeding problems. Many of the proteins required for proper blood clotting are created in the liver. Remove these proteins and blood clotting decreases.

Hepatic encephalopathy, or severe neurological signs; behavioral changes, seizures, aimless pacing or circling, head pressing.

Pain associated with the abdomen. This is due to the stretching of the liver capsule. May be noted when the dog is lifted around the belly or when the veterinarian probes the abdomen. The veterinarian may also notice a swollen liver while palpating with some of the more acute liver diseases

Chronic weight loss or wasting. The liver processes all the building blocks. If it fails to process, the body fails to maintain itself.

Increased water consumption and urination. Most likely due to dramatic shifts in serum and kidney salt balances.

In a recent study it was found that dogs with liver disease can also have high blood pressure. This is called hypertension, and should be monitored to see if therapy is needed

If you notice any of the above symptoms, make sure you consult your veterinarian as soon as possible. Because the liver is able to function effectively even at 70-80% capacity, the disease may be in its advanced stages by the time the condition manifests itself.

Testing and Diagnosis of Canine Liver Disease

January 4, 2009 by Lisa  
Filed under All Info, Testing and Diagnosis

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A thorough approach is needed for a correct diagnosis of any liver problem. An organ like the liver that
is so intimately involved with other important organs will exhibit symptoms that mimic disease in these other organs. Also, what initially might appear as a diseased liver is in reality a disease elsewhere in the
body that is involved with the liver secondarily. This is why it is crucial to follow a thorough and methodical approach called the diagnostic process.

Examination

Specifically noting signs which may indicate liver disease. Periodic ascites, intolerance of a high protein diet, icterus, chronic weight loss, abnormally colored feces or urine, bleeding disorders, chronic illness, and all that has been mentioned above. Sometimes urinary crystals formed from the improperly metabolized proteins and amino acids may indicate liver disease.

Liver disease can occur in pets of any age. If it occurs in young animals we tend to think more of toxicity, a liver shunt or a viral disease like adenovirus in dogs. In older pets we tend to think more of inflammation and cancer as the cause of the liver problem.

Several canine breeds are prone to getting liver disease:

Bedlington terriers, Skye terriers, Doberman pinschers, and West Highland White terriers get a
problem with excessive copper accumulation that results from failure of normal biliary excretion of copper. Cocker spaniels have an increased incidence of chronic hepatitis

History

Early signs of liver disease are subtle, and might exhibit as some of the symptoms described above. It is important to remember that some pets do not show any symptoms early in the course of the disease. This is another reason for yearly exams, along with blood and urine samples in dogs and cats 8 years of age or more. Even though many cancers do not show up in a blood sample, we can sometimes get indirect evidence there is a problem, leading to additional diagnostic tests that might find cancer.

The recent use of pesticides, insecticides, and drugs might give us a clue. Some Labradors are sensitive to the use of the arthritis medicine Rimadyl. These dogs should have a blood panel analyzed prior to initiating Rimadyl therapy. Every 6 months this panel should be repeated.

A history of poorly controlled diabetes mellitus might also clue us in to liver problems. Pets with
liver shunts might have stunted growth and become depressed right after eating.

Physical Exam

Routine physical exam findings might include:

Distended abdomen due to enlargement of the liver (hepatomegaly) might be found. This can be palpated in some situations, especially in the smaller animals. an enlarged liver from a disease other than liver disease can cause hepatomegaly. This includes heart disease and Cushing’s Disease.

Enlarged lymph nodes due to secondary bacterial infections or spread of a primary or metastatic
liver tumor.

Bruising (hematoma) might be observed under the skin, or when a blood sample is obtained. This is
due to the liver’s affects on the clotting mechanism

Fever- a rectal temperature of greater than 103 degrees F could accompany liver disease when inflammation or infection is present

Skin infections and wounds that do not heal, or recur after antibiotics are stopped

Yellowish discoloration (icterus or jaundice) of the ears, gums, or hairless areas of the skin

Anemia might be observed by checking the mucous membranes for a normal pink color

Extensive Blood Work and Diagnostic Testing

A complete blood count to check for anemia and blood cell abnormalities. A CBC (complete blood
count) and BCP (biochemistry panel) should be run on every pet 8 years of age or more, especially if they have any of the symptoms of liver disease. The CBC might show a decrease in the number of red blood cells (RBC’s). This decrease in RBC’s is called anemia. The white blood cell count (WBC) might be elevated (leukocytosis), normal, or decreased (leukopenia), mostly depending on the cause of the liver problem and how long it has been present. A change in the WBC’s does not necessarily indicate there is a liver problem.

A complete chemistry screen, including ALT, ALP, AST, bilirubin, glucose, urea, electrolyte levels,
albumin, globulin and bile acid levels. The bile acid levels should be checked on an empty stomach and two hours after feeding. All these values, with the exception of the bile acids, usually are included on
a standard Small Animal Data Base Screen.

Important Liver Enzymes

Traditionally the medical practitioner has measured the relative concentration of several enzymes which may indicate alterations in liver health. The following enzymes typically change values in the face of liver failure

Alanine Aminotransferase: ALT – Liver specific. Cell damage will cause elevations of ALT due to leakage. The elevation of the enzyme correlates with the number of cells damaged. Falling levels of ALT may indicate recovery or may indicate a failing number of functional liver cells. Rapid increases in ALT may indicate an acute process, while slow increases may indicate bile duct obstruction.

Normal Test Range: 10-100 U/L*

Aspartate Aminotransferase: AST - an enzyme seen in the liver, heart, kidney, skeletal muscle and brain. The half life of the AST in the blood stream is much shorter than that of ALT, therefore the values of AST tend to drop more rapidly once liver function is resumed. AST elevations and ALT elevations should parallel each other in liver disease

Normal Test Range: 5-55 U/L*

Alkaline Phosphatase: ALKP/ALP – This enzyme is present in many tissues, therefore it not very specific in liver disease, but it appears very early in the progress of liver disease, therefore it is considered quite sensitive. ALP tends to be slightly more specific in the cat, but not quite as sensitive. A similar enzyme or isoenzyme is secreted as a result of high levels of cortisone, therefore an effort must be made to separate Cortisole induced ALP or CALP and normal ALP. Liver ALP is released from the liver when many anticonvulsant drugs are administered to the dog. This must be taken into account when evaluating ALP levels. ALP levels typically are greatly elevated in the young, growing animal and therefore a veterinarian should not mistake any elevations as disease in a young animal.

Normal Test Range: 23-212 U/L*

Gamma Glutamyltransferase: GGT – This enzyme is has its highest concentration in the kidneys and pancreas, but it is also found in the liver and other organs. The major proportion of GGT in the serum seems to come from the liver. Elevations of GGT in disease seem to stem from new synthesis rather than leakage, therefore the changes seen due to disease are not spectacular. Large elevations of GGT are more commonly associated with pancreatitis and bile duct obstruction.

Bile Acids

These series of organic acids circulate almost entirely in the localized blood flow between the intestines
and the liver (a.k.a. the Portal system). The flow is typically from the liver, into the bile duct system, then excretion into the intestines to aid digestion after a meal, to be re- absorbed into the portal system and recycled by the liver. Very little of the bile acids escape from the portal circulation system into the rest of the body. Leakage is considered abnormal and is a sure sign of a liver abnormality. This is one of the most sensitive tests available to diagnose liver disease. While the liver does actually manufacture this product, it has tremendous reserve capacity and can easily meet the bodies demand for bile acids despite severe disease. As a result of this reserve, the bile acid levels do not typically drop due to liver disease.

Normal Test Range: Pre = Less than 7.0 umol/L, Post = Less than 15.0umol/L*

A complete urine analysis

Check urobilinogen levels, bilirubin levels, glucose levels, protein levels. Again all this is usually on a standard urinalysis panel.

Radiograph the abdomen

X rays can show increased liver size, decreased liver size liver abscesses, abnormal mineralization , and circulatory abnormalities (using special dyes).

Ultrasound the liver

Perfect technique for visualizing the circulation of the liver, the bile duct system, the density of the liver tissue, the size of the liver. Ultrasound is highly beneficial in the diagnosis of liver disease. We recommend ultrasounding a liver when the liver enzymes tests are elevated over time, or the bile acids test is abnormal. The internal structure (called parenchyma) can be analyzed, and post-hepatic liver disease can be differentiated from hepatic liver disease. This can be very important because disease in the liver can often be diagnosed with a biopsy during the ultrasound. Post-hepatic liver disease cannot easily be diagnosed in this matter. Instead it is diagnosed and treated with an exploratory surgery (called a laparotomy).

Biopsy of the liver

While this is a surgical technique, it is the ultimate for diagnosis, since it allows us to directly examine and test liver tissue, give an absolute diagnosis and hopefully a final treatment regime. Biopsies can be taken by full laparotomy, where the surgeon actually looks at the liver and removes a small piece, or they can be done by a biopsy needle guided by ultrasound through the body wall. The liver will regenerate any piece that has been removed, therefore liver biopsy is usually a low risk procedure in capable hands.

*The ranges for the test results listed above are dependent on the lab, the testing done and are relative. Some specialist allow for a much larger range before they diagnose “true” Liver Disease. After receiving your test results, please consult with an internal specialist and have them explain the results to you.

Preventative Maintenance

January 2, 2009 by Lisa  
Filed under All Info, Yearly Prevention

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1. LISTEN TO YOUR INSTINCTS. You know your dog better than any vet or specialist. If there is something “not quite right”, encourage blood tests to see what is going on. The symptoms of canine liver disease are so subtle and can be mistaken for so many other things, ask for a liver panel test to rule it out.

2. Educate yourself about the signs/symptoms of canine liver disease so that you are able to recognize them if any are present in your dog.

3. Feed your dog a high-quality balanced diet with easily digestible protein (beef and fish are harder for dogs to digest), no animal by-products, fillers or allergens.

4. Know your dog’s normal body temperature and take it regularly and if/when they show behavior changes. Temperatures above 103F may be linked to internal infection and may be affecting the liver.

5. Know your dog’s eating and bathroom habits. If there are even slight changes that extend over a period of a week or so, seek out the advice of your veterinarian.

6. Do not allow dogs to roam freely where they can encounter animals or insects, standing water or poisonous plants.

7. Routinely vaccinate dogs for infectious canine hepatitis and leptospirosis.

8. Take your dog in for a yearly exam that should include blood, stool and urine samples in dogs 8 years of age or more. (Veterinarians will do these tests on dogs under the age of 8 as well.)

9. If tests are abnormal or presenting high range numbers, seek out the advice of an Small Animal Internal Medicine Specialist – your vet should be able to refer you to someone in your area.

10. Practice good dental hygiene for your dog. Brushing your dog’s teeth helps rid the gums and mouth of harmful bacteria that, if left unchecked, can spread to the heart, liver and other vital organs.

11. Avoid medications such as Cortisone, Rimadyl and Phenobarbital if at all possible. Also try to minimize exposure to flea and tick products, heartworm medication, anti-fungals, etc.

* If Rimadyl cannot be avoided:

A blood panel should be taken and analyzed prior to initiating Rimadyl therapy.
Every 6 months this panel should be repeated.

* If Phenobarbital cannot be avoided:

Have a chemistry panel with the liver enzymes ALT, GGT and alkaline phosphate
done every 3 to 4 months.

If all three liver enzymes are severely elevated (more than just a few points
above normal) then you should do a urine bile acid test or a pre- and post-meal
bile acid test to see what kind of damage has been actually done to the liver so you
can change the diet to the liver cleansing diet and/or reduce the Phenobarbital.

Monitor Phenobarbital levels every 6 months, more frequently if you do not have
seizure control or if there are any signs of toxicity like ataxia, wobbliness, and hind end
weakness (not after a seizure).