Changes

**Bedlington Terrier

**Bedlington Terrier

**Cocker Spaniel

**Cocker Spaniel

**Dalmation

**Dalmatian

**Skye Terrier

**Skye Terrier

**Poodle

**Poodle

**This may be a cause or consequence of chronic hepatitis.  Copper is normally excreted in bile, therefore it can occur with any cholestatic hepatobiliary disorder.

**This may be a cause or consequence of chronic hepatitis.  Copper is normally excreted in bile, therefore it can occur with any cholestatic hepatobiliary disorder.

*Chronic drug therapy

*Chronic drug therapy

*Infectious for examplae infectious canine hepatitis-

*Infectious, for example infectious canine hepatitis-

*Autoimmune or steroid responsive disorder

*Autoimmune or steroid responsive disorder

*polyuria and polydipsia

*polyuria and polydipsia

*ascites - most consistent in dogs with cirrhosis

*ascites - most consistent in dogs with cirrhosis

*and rarely icterus, seizures, fever and bleeding disthesis

*and rarely icterus, seizures, fever and bleeding diathesis

===Laboratory tests===

===Laboratory tests===

====Biochemistry====

====Biochemistry====

*Increased alanine aminotransferase (ALT) and alkaline phosphatase (ALP).  However these may not be incrased if end-stage cirrhosis is reached.

*Increased alanine aminotransferase (ALT) and alkaline phosphatase (ALP).  However these may not be increased if end-stage cirrhosis is reached.

*Hyperbilirubinaemia

*Hyperbilirubinaemia

*Hypoalbuminaemia

*Hypoalbuminaemia

===Imaging===

===Imaging===

*Abdominal radiographs will only reveal microhepatica or ascites when advanced stages of disease is reached.

*Abdominal radiographs will only reveal microhepatica or ascites when advanced stages of disease are reached.

*Ultrasonographically, a normal liver or non specific changes in echogenecity may be seen in early stages of the disease.  In cases of cirrhosis, microhepatica, irregularity in hepatic margin, focal lesions corresponding to regenerative nodules, hyperechogenicity of liver parenchyma associated with increased fibrous tissue and ascites may be seen.

*Ultrasonographically, liver may be normal or non specific changes in echogenecity may be seen in early stages of the disease.  In cases of cirrhosis, microhepatica, irregularity in hepatic margin, focal lesions corresponding to regenerative nodules, hyperechogenicity of liver parenchyma associated with increased fibrous tissue and ascites may be seen.

===Histopathology===

===Histopathology===

This is required for definitive diagnosis and to differentiate chronic hepatitis from other hepatopathies.  Chornic hepatitis is characterised by moderate to severe lymphoplasmacellular inflammation and necrosis of the hepatocytes adjacent to the portal tracts.

This is required for definitive diagnosis and to differentiate chronic hepatitis from other hepatopathies.  Chronic hepatitis is characterised by moderate to severe lymphoplasmacellular inflammation and necrosis of the hepatocytes adjacent to the portal tracts.

*Glucocorticoids at 1-2 mg/kg/day PO

*Glucocorticoids at 1-2 mg/kg/day PO

**Taper down with improved clinical signs and normal liver enzymes values.

**Taper down with improved clinical signs and normal liver enzymes values.

**This is not indicated for causes such as drug therapy, primary copper accumulation or infectious agents.

**This is not indicated for chronic hepatitis caused by drug therapy, primary copper accumulation or infectious agents.

**Response to treatment should be followed up by liver biopsy 3-6 months later as glucocorticoid causes steriod induced ALP

**Response to treatment should be followed up by liver biopsy 3-6 months later as glucocorticoid causes steroid induced ALP

*Ursodeoxycholic acid at 15mg/kg PO SID

*Ursodeoxycholic acid at 15mg/kg PO SID

**It is a synthetic hydrophilic bile acid that has hepatoprotective (anti-inflammatory, immunomodulatory and antifibrotic effects) properties and choleretic effect.  It expands the bile acid pool and displaces potentially hepatotoxic hydrophobic bile acids that accumulate in cholestasis.

**It is a synthetic hydrophilic bile acid that has hepatoprotective (anti-inflammatory, immunomodulatory and antifibrotic effects) properties and choleretic effect.  It expands the bile acid pool and displaces potentially hepatotoxic hydrophobic bile acids that accumulate in cholestasis.