I am attempting to look for an underlying cause of liver disease in our 10 year old Scottish Terrior. Two years ago, she became very sick at her stomach after having her teeth cleaned. Coincidentally, this was also the time perimeter of the dog food scare. (The food she was eating was not on any of the lists publicized.) I have been assured by more than one source that if she had experienced an episode from the dental cleaning, the liver would not have continued to deteriorate over this course of time. The blood work found that her liver enzymes were grossly abnormal. Radiography was performed and we were advised to have an ultrasound. The ultrasound found that her gall bladder was enlarged and we were referred to UT Vet Hospital in Knoxville for possible emergency surgery and further diagnosis. UT did not see the urgency with the gall bladder and she was hospitalized and monitered for a couple of days. She was released feeling well.
A couple of months later, her liver enzymes continued to be abnormal. We returned to UT for additional testing . They performed a needle biopsy and found a few abnormal cells in her liver, but nothing (they felt) to go further.
She was placed on Ursidial, Benazapril, Denamarin, and Fish Oil. Her bloodwork continued to be monitored at least once each 3 months and the results varied. The liver enzymes continued to be elevated, but increasingly additional protein was found in her urine. Her diet was changed to a high quality low protein diet. She continues to feel well. However, she had increased water consumption. Currently, her urine is very diluted. Sometimes, large proteins show in the urine and other times smaller proteins show up causing us to believe there is some globular nephritis happening.
This has continued over the last 2 years. Every test that we know of has been run including multiple Cushings tests with no results and continued blood and urine tests. A few weeks ago, she did test positive for atypical Cushings. The vet school at UT is not convinced that the atypical test conclusion is accurate.
Our vet referred us back to UT requesting an ultrasound be performed. It was non-conclusive. They recommended a laparascopic biopsy with additional bile, copper, etc tests. We received the results today and they have no idea what the underlying problem could be. Her liver is fragile and the biopsies broke apart with very little bleeding when extracted. Cancer biopsies have shown to be negative. The copper test was not back but the slides showed no crystals. There is some evidence of regeneration. They feel she may be a first and I feel that there has to be another “baby” out there that has had an evasive diagnosis.
I would very much like any suggestions, ideas, etc that anyone may have had that has experienced a difficult diagnosis. Any suggestions to continuing to preserve the liver and promoting regeneration will be grateful.
I would gratefully appreciate you forwarding this email to anyone has any sources that may be familiar with this type of case or know of anyone with professional interest in liver disease. I feel certain that there are internists that specialize in liver care and disease but I have no way of knowing who they are.
Thanks and love,
My name is Diane and my liver compromised pup is Kasper. He is a white german shepherd/lab/ mix. He is a very sweet dog who just turned 2 on Nov. 11th.
We’ve had incredible problems with Kasper from the outset. He had mange early on which we treated with dips (very harmful for liver shunted dogs, but we didn’t know). Then, at around 4 months of age, Kasper started having bad diarrhea,vomiting and extreme lethargy. We took him to the vet, they conducted a bunch of tests, found nothing, and put him on antiobiotics & anti-nausea meds. He did not get better and seemed worse after a couple of days. We went back and after several more x-rays, the vet wanted to do exploratory surgery b/c he thought it might be an obstruction. We did it (at the cost of $3000, plus the pre-op testing, which cost $500) and found no obstruction. The official diagnosis was pancreatitis. It took Kasper FOREVER to recover from the anaesthesia. One month later, he got another dip. The dip nearly put him over the edge. He was lethargic, totally “out of it”, and even showed signs of aggression.
He seemed to get better at around 6 months, but still seemed rather “low spirited”. I decided to get him a playmate to raise his spirits and Shawnee (a husky/wolf mix) was purchased. Shawnee
is perfectly healthy, although very slow to trust, skittish and very wary. She escaped out of my yard after we’d had her for only 2 weeks (she was 6 months old at the time), and after 2 days of utter misery & despair, we got her back only because Kasper came out and caught her on our street. The two of them are now fric & frac — like husband & wife.
So, at 10 months of age, Kasper started to get way worse…the lethargy, crooked walking, drunken state got really bad one night & I took him in to the emergency vet. They suspected liver shunts right away because of the chronic nature of his symptoms. They conducted a bile acid test the next morning and his numbers were very high (both pre & post feeding). His ammonia levels were also through the roof. We did an ultrasound shortly thereafter and found out about the numerous shunts (both intra and extrahepatic) that poor Kasper possesses. His condition is totally inoperable & the vets gave him 6 months to live (or less). So far, we have beat that prognosis!
He was put on L/D diet, plus Lactulose, plus metranidizole , plus milk thistle. I joined a liver shunt group, and added other supplements/changed his food. He is now on Royal Canin Hepatic LS14 which he gets fed 4 times a day (spread-out meals are much better for these guys). He’s also on hepatosupport (milk thistle plus B Vitamins), VSL#3 ( human probiotic for IBS which has significantly lowered his ALT), Vitamin E, Zinc, VetriDMG and Apple Pectin. He’s still on metranidizole (given 3 hours apart from the VSL#3), lactulose, and also Ursodiol.
He is doing okay — he still experiences some H.E. in the form of lethargy/vacant starting, but not to the extremes that he suffered before his diagnosis.
We (my husband & two small kids) got Kasper when he was only 7 weeks old (New Year’s Eve) as a playmate for my Wolf/White Shepherd mix, Nikki (who was 11 at the time and who lost her playmate Mandy (10) one year before). Nikki died that same night that we got Kasper of a ruptured spleen (cancerous). It’s like poor Kasper was jinxed. We got him, then our baby Nik died (my husband & I had her since she was 3 months old; we got her before either of the kids — she was our FIRST child!). It took my husband forever to even get close to Kasper since he missed Nikki so much. I just pray that we have MUCH more time with Kasper than we were told. We’ve already beat the original diagnosis and are hoping for some more good years with Kasper.
The course of treatment required in a case of canine liver disease will depend upon the cause of the condition. For example, if trauma was the trigger, hospitalization while the dog recovers from the impact of the trauma may be all that is required. On the other hand, antibiotics may be needed if a bacterial infection is at the root of the disease. Furthermore, when liver disease is caused by another medical condition such as cancer or anemia, these additional medical circumstances will need to be taken into account.
In addition to certain medications, dietary adjustments and supplements can be very useful when attempting to treat canine liver disease. Dietary changes can include adjusting the amounts of proteins, vitamins, carbohydrates, fats, and minerals that a dog ingests. This will then ensure that the canine patient is receiving the nutrition it needs and will also help to decrease the stress and workload of the liver. Furthermore, vitamin K can be helpful with respect to controlling bleeding disorders while vitamin E, as an antioxidant, helps to remove free radicals and to prevent continued oxidative damaged to the canine’s liver.
Certain homeopathic remedies can also be very helpful when treating canine liver disease. Natural herbs and substances such as burdock and greater celandine have properties that assist with the purification of blood, the stimulation of digestive enzymes, and the protection of the liver from toxic substances. Also, some such substances have anti-inflammatory and antibacterial properties.
Milk thistle is another natural ingredient that is known to be very effective in cases of canine liver disease. This natural substance acts as an antioxidant like vitamin E, stimulates production of new liver
cells, and helps to prevent certain toxins from attaching to the liver.
Thus, many natural substances and remedies can be very beneficial for dogs suffering from liver disease. However, it is always important to carry out any form of treatment under the supervision of a qualified veterinary doctor.
SPECIFIC TREATMENTS AND PROGNOSES
Portal Vascular Abnormalities
Fluids and Electrolytes – This corrects the dehydration that occurs with a poor appetite and supplies needed sodium, potassium, and chloride. This fluid is usually given intravenously (IV) at first. Pets
that are severely ill from PSS should not be given anything orally initially.
Cleansing Enemas – Enema’s will decrease the bacterial count of the intestines, leading to less ammonia absorption.
Lactulose – Lactulose works in the large intestine to minimize the production of ammonia by bacteria. It does this by changing the pH and converting ammonia to a form that is not readily absorbed into the bloodstream. It also stimulates normal colon bacteria to absorb ammonia, which is then passed in the feces. Finally, it stimulates the intestines so that ammonia passes through faster, which means there is less time for absorption.
Antibiotics – These drugs are also administered, especially if mental depression is present. They minimize the bacteria count in the colon, thus reducing the amount of ammonia that is absorbed
from the intestines into the bloodstream. They work well with lactulose to decrease the ammonia level.
Dietary Modification – A diet that is restricted in protein may be beneficial because less ammonia is produced as a by-product of metabolism. This protein needs to be of high biological value, such as eggs and dairy products. Meat based proteins should be avoided since they can increase the chance of HE. Most of the caloric needs of a pet with PSS should be supplied with carbohydrates like rice and pasta. Higher fiber diets might also be helpful, as long as the dog or cat is not undernourished. They can act to minimize ammonia production and absorption in a manner that is similar to lactulose
Surgical – For many PSS cases surgery is the treatment of choice. The abnormal vessel that is shunting blood around the liver is identified and closed (ligated) to minimize blood flowing through it. When the abnormal blood vessel is ligated blood will now flow through the liver instead of around it. This is readily accomplished for solitary extrahepatic shunts. Intrahepatic shunts can be more difficult
to identify and ligate. Post surgical monitoring is important. If the pressure within the liver becomes too high due to the increased blood flow through the liver then the ligation on the shunting vessel(s) must be reduced or removed.
In some cases medical management must also be utilized to affect a cure. The final outcome of treatment depends on what age the PSS started, how long it has been present, and whether it is intrahepatic (worse prognosis) or extrahepatic in nature.
Long Term Monitoring – Pets on long term medical care need to be monitored carefully. Body weight, albumin, and total protein are watched to ensure adequate protein in the diet. Initially, these tests should be performed monthly, then every 3 months. In addition to the above tests, bile acids are monitored monthly, then every three months to assess the vitality of the liver. Blood ammonia levels are monitored monthly to assess effectiveness of treatment. When stable, ammonia levels can be monitored every 3 months.
Prognosis – Many pets with isolated extrahepatic shunts return to a normal life after surgery. There is no guarantee that surgery will correct the problem, especially those pets that develop the disease very early in life. Some of them will need medical management simultaneously. The prognosis for pets that are treated only medically varies.
Chronic Active Hepatitis
Fluids and Electrolytes – This corrects the dehydration that occurs with a poor appetite and supplies needed sodium, potassium, and chloride. This fluid is usually given intravenously (IV) at first. It can be given subcutaneously (SQ) at home after the initial dehydration is corrected. B-Complex vitamins are routinely added to the fluid bag. Care must be taken not to give excessive amounts of fluids, especially if they contain sodium, in pets with fluid buildup in the abdomen (ascites).
Treating the Cause (when known) – Antibiotics are used to control bacterial infections and drugs that are suspected of causing this disease are stopped. We tend to use antibiotics that have minimal need for liver metabolism in order to minimize their toxic effects.
Rest – The liver has ability to heal itself if the disease is not too advanced. Rest can be a big aid, along with proper nutrition.
Ascites Reduction – Sodium restriction helps minimize fluid buildup (ascites) in the abdomen. This can be accomplished using Hills K/D Prescription Diet. Diuretics like Lasix are also used to help pull this fluid out of the abdomen.
Dietary Modification – Using a diet that is restricted in protein may be beneficial because less ammonia is produced as a by-product of metabolism. This protein needs to be of high biological value, such as eggs and dairy products. Meat based proteins should be avoided since they can increase the chance of HE. Higher fiber diets might also be helpful, as long as the dog or cat is not undernourished. This is the same basic diets as for pets with PSS (see above).
A diseased liver needs calories, which sometimes need to be supplied with a feeding tube.
Ulcer Treatment – This will make pets more comfortable, more inclined to eat, and prevent bleeding in the stomach.
Liver Specific Drugs:
Corticosteroids – Cortisone is used if there is evidence that the immune system is implicated as a cause
of the liver problem.
Ursodiol – This drug replaces toxic bile acids with a type of bile that is less toxic.
Zinc Supplementation – Might help reduce the effects of copper toxicity.
Long Term Monitoring – CCHID monitoring is similar to PSS (see above). In addition, repeating a liver biopsy 6 months after initiating therapy used.
Infectious Canine Hepatitis
Like most viral diseases therapy is directed towards symptoms. When symptoms are severe enough, intravenous fluids are administered. Since clotting factors can be disrupted particular attention needs to be paid to bleeding problems. If bleeding problems are severe enough, a whole blood transfusion must be administered. Dogs that are comatose may need intravenous glucose.
Copper Toxicosis (Copper Storage Disease)
Treatment has two goals – Enhance excretion of excess copper, and minimize further absorption of copper from the intestines.
Chelating agents – Drugs like penicillamine bind with copper to allow easier excretion.
Zinc – Zinc will help minimize further copper absorption from the intestines.
Supportive Care – Similar to other liver diseases previously described.
Long Term Monitoring – Serum, enzymes, and bilirubin should be monitored at least every 6 months.
Primary hepatic neoplasms are treated by removal of the affected liver lobe when possible. If multiple lobes are involved then surgery is usually not performed. Secondary hepatic neoplasms are treated with chemotherapy. The results vary, and depend on the duration, location, and degree of malignancy of the neoplasia.
The prognosis is poor for long term survival.
Supportive care that is similar to other liver diseases is also used in neoplasia.
**Information from this section was compiled from the following sources: