Chronic hepatitis usually shows history of increased serum liver enzymes
Feb 01, 2004
Signalment: Canine, Shepherd cross, 11 years old, female spayed, 46.8 lbs.
Clinical history: The dog presents with vomiting and icterus. Therapy has included Actigall, metronidazole, Baytril and prednisone.
Physical examination: The findings include rectal temperature 101.6° F, heart rate 110/min, pink mucous membranes, and normal capillary refill time. Normal heart and lung sounds are heard.Laboratory results: A complete blood count, serum chemistry profile, and urinalysis were performed and are as follows.
Ultrasound examination: Thorough abdominal ultrasonography was performed.
Liver cytologic examination: The smears contain numerous large clusters of well-preserved hepatocytes. These hepatocytes show mild to moderate cytoplasmic fine vacuolar degeneration and intracellular accumulation of bile pigments. There are several extracellular bile casts. Multiple focal areas of hepatocytes show moderate to severe cytoplasmic fine infiltration – suggesting benign nodular regeneration. There is moderate infiltration by inflammatory cells composed of a mixture of neutrophils in good morphological condition, small lymphocytes, medium-sized lymphocytes and occasional plasma cells.
There is no evidence of sepsis or neoplasia. The cytologic diagnosis is moderate mixed suppurative and lymphocytic hepatitis with severe cholestasis and multifocal benign nodular regeneration.
Periodic use of prednisone (1-2 mg/kg BID for 5-7 days) and oral lactulose (0.25-0.5 ml/kg PO BID) are needed to get the dog back to eating again and improve the dog's activity.
I suspect that the liver disease in this dog may be controlled but will not be cured. I would from here on be careful with any drug use in this dog that requires metabolism by this dog's liver. Therapy of special diet and antioxidants is probably for a lifetime.
Early detection is important. The basic goals in treating dogs with chronic hepatitis are to arrest inflammation; resolve fibrosis; and correct nutritional imbalances and treat hepatic encephalopathy with dietary management.
Although there are no controlled trials involving glucocorticoids in the treatment of dogs with chronic hepatitis, many veterinarians have had success using them as part of the therapeutic regimen. The starting dosage of prednisone is 1 to 2 mg/kg/day. Once clinical remission is achieved (usually three to four weeks), the dosage of prednisone is gradually tapered to a low maintenance dosage (approximately 0.25 mg/kg daily or about five to seven days every four to six weeks). During the tapering process, animals may be monitored with serum chemistry profiles for relapses.
The use of the hydrocholeretic drug ursodeoxycholic acid (ursodiol; Actigall or Urso) may be helpful. It is believed that ursodeoxycholic acid has anti-inflammatory, immunomodulatory and choleretic effects. Use of ursodeoxycholic acid may be considered as either primary or adjunctive (in combination with immunosuppressive or anti-inflammatory drugs) treatment in animals with chronic liver diseases. A safe and effective dose is 15 mg/kg daily, administered either once daily or divided twice a day. The drug should be given with food. Studies need to be performed to substantiate its efficacy and dosage in the dog.