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− | {{unfinished}}
| + | ==Introduction== |
− | | + | '''Chronic hepatitis''' is an inflammatory-necrotising disease of at least 6 months duration. It is characterised by hepatocellular [[Adaptive Immunity to Viruses|apoptosis]] or [[Necrosis - Pathology|necrosis]], a variable mononuclear or mixed inflammatory cell infiltrate, [[Liver Regeneration|regeneration]] and [[Liver Fibrosis|fibrosis]] (1). It predominantly consists of lymphocytic-plasmacytic inflammatory infiltration, and the disease process typically involves a slowly progressive inflammation which leads to fibrosis and possibly cirrhosis. |
− | {{dog}}
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| ==Signalment== | | ==Signalment== |
| *Common in dogs, especially young to middle-aged dogs. | | *Common in dogs, especially young to middle-aged dogs. |
− | *Mixed and purebred dogs are affected but there is a familial predisposition in: | + | *Mixed and purebred dogs are affected but there is a familial predisposition in the following breeds: |
− | **[[Canine Breeds - WikiNormals #Working Group|Dobermann Pinscher]]
| + | <gallery> |
− | **[[Canine Breeds - WikiNormals #Terrier Group|Bedlington Terrier]]
| + | Image:Dobermann.jpg|'''Dobermann'''<p>John Adams (2007) WikiMedia Commons |
− | **[[Canine Breeds - WikiNormals #Gundog Group|Cocker Spaniel]]
| + | Image:Bedlington.jpg|'''Bedlington Terrier'''<p> Pleple2000 (2006) WikiMedia Commons |
− | **[[Canine Breeds - WikiNormals #Utility Group|Dalmatian]]
| + | Image:Cocker_spaniel.jpg|'''Cocker Spaniel'''<p> Ellen Levy Finch (2004) WikiMedia Commons |
− | **[[Canine Breeds - WikiNormals #Terrier Group|Skye Terrier]]
| + | Image:Dalmatian.jpg|'''Dalmatian'''<p> Miroslav Cacik (2006) WikiMedia Commons |
− | **[[Canine Breeds - WikiNormals #Utility Group|Poodle]]
| + | Image:Skye_terrier.jpg|'''Skye Terrier'''<p> Pleple2000 (2007) WikiMedia Commons |
− | **[[Canine Breeds - WikiNormals #Gundog Group|Labrador Retriever]]
| + | Image:Standard_poodle.jpg|'''Standard Poodle''' <p> John Leslie (2007) WikiMedia Commons |
− | **[[Canine Breeds - WikiNormals #Pastoral Group|German Shepherd Dog]]
| + | Image:labrador.jpg|'''Labrador Retriever'''<p> Ellen Levy Finch (2004) WikiMedia Commons |
− | **[[Canine Breeds - WikiNormals #Terrier Group|Scottish Terrier]]
| + | Image:GermanShep.jpg|'''German Shepherd (Alsatian)'''<p> Ellen Levy Finch (2004) WikiMedia Commons |
− | **[[Canine Breeds - WikiNormals #Hound Group|Beagle]]
| + | Image:Scottish_terrier.jpg|'''Scottish Terrier'''<p> Svencb (2003) WikiMedia Commons |
− | | + | Image:Beagle.jpg|'''Beagle'''<p> sannse (2003) WikiMedia Commons |
− | ==Description==
| + | </gallery> |
− | '''Chronic hepatitis''' is an inflammatory-necrotising disease of at least 6 months duration. It is characterised by hepatocellular [[Adaptive Immune System - WikiBlood #Adaptive Immunity to Viruses|apoptosis]] or [[Patología General - Necrosis|necrosis]], a variable mononuclear or mixed inflammatory cell infiltrate, [[Liver General Pathology - Pathology#Regeneration|regeneration]] and [[Liver General Pathology - Pathology#Fibrosis - Repair|fibrosis]] (1). It predominantly consists of lymphocytic-plasmacytic inflammatory infiltration. | + | ==Aetiology== |
− | | |
| A number of aetiologies include: | | A number of aetiologies include: |
| *Familial predisposition | | *Familial predisposition |
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| **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 example [[Canine Adenovirus 1 (Infectious Canine Hepatitis)|infectious canine hepatitis]] | + | *Infectious, for example [[Infectious Canine Hepatitis|infectious canine hepatitis]] |
| *Autoimmune or steroid responsive disorder | | *Autoimmune or steroid responsive disorder |
| | | |
− | ==Diagnosis==
| |
| ===Clinical Signs=== | | ===Clinical Signs=== |
| These include: | | These include: |
| *anorexia, lethargy and depression | | *anorexia, lethargy and depression |
| *weight loss | | *weight loss |
− | *[[Stomach and Abomasum Consequences of Gastric Disease - Pathology|vomiting]] and [[Intestine Diarrhoea - Pathology|diarrhoea]] | + | *[[Vomiting|vomiting]] and [[Diarrhoea|diarrhoea]] |
| *polyuria and polydipsia | | *polyuria and polydipsia |
− | *ascites - most consistent in dogs with [[Liver General Pathology - Pathology#Cirrhosis|cirrhosis]] | + | *ascites - most consistent in dogs with [[Cirrhosis|cirrhosis]] |
− | *and rarely [[Liver General Pathology - Pathology#Jaundice (Icterus)|icterus]], seizures, fever and bleeding diathesis | + | *and rarely [[Icterus|icterus]], seizures, fever and bleeding diathesis |
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| ===Laboratory tests=== | | ===Laboratory tests=== |
− | ====Haematology====
| + | Haematology: |
| *Mild non-regenerative anaemia and microcytosis | | *Mild non-regenerative anaemia and microcytosis |
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− | ====Biochemistry====
| + | Biochemistry: |
− | *Increased alanine aminotransferase (ALT) and alkaline phosphatase (ALP). However these may not be increased if end-stage [[Liver General Pathology - Pathology#Cirrhosis|cirrhosis]] is reached. | + | *Increased alanine aminotransferase (ALT) and alkaline phosphatase (ALP). However these may not be increased if end-stage [[Cirrhosis|cirrhosis]] is reached. |
| *Hyperbilirubinaemia | | *Hyperbilirubinaemia |
| *Hypoalbuminaemia | | *Hypoalbuminaemia |
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| *Increased bile acids | | *Increased bile acids |
| *Abnormal ammonia tolerance test | | *Abnormal ammonia tolerance test |
− | *Increased prolonged activated partial thromboplastin time (APTT) and prothrombin time (PT) indicates severe liver dysfunction or [[Disseminated Intravascular Coagulation - Pathology|disseminated intravascular coagulation (DIC)]] | + | *Increased prolonged activated partial thromboplastin time (APTT) and prothrombin time (PT) indicates severe liver dysfunction or [[Disseminated Intravascular Coagulation|disseminated intravascular coagulation (DIC)]] |
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− | ===Imaging===
| + | ==Imaging== |
− | ====Radiography====
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| Abdominal radiographs will only reveal microhepatica or ascites when advanced stages of disease are reached. | | Abdominal radiographs will only reveal microhepatica or ascites when advanced stages of disease are reached. |
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− | ====Ultrasonography====
| + | Ultrasonographically, liver may be normal or non specific changes in echogenecity may be seen in early stages of the disease. In cases of [[Cirrhosis|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 [[Liver General Pathology - Pathology#Cirrhosis|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. | |
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− | ===Histopathology===
| + | ==Histopathology== |
− | This is required for definitive diagnosis and to differentiate chronic hepatitis from other hepatopathies. Chronic hepatitis is characterised by moderate to severe lymphoplasmacellular [[Inflammation - Pathology|inflammation]] and [[Liver General Pathology - Pathology#Necrosis|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 - Pathology|inflammation]] and [[Liver Necrosis|necrosis]] of the hepatocytes adjacent to the portal tracts. |
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| ==Treatment== | | ==Treatment== |
− | *[[Steroids|Glucocorticoids]] at 1-2 mg/kg/day PO | + | *[[Steroids|Glucocorticoids]] |
| **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 chronic hepatitis caused by 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. |
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| ==Prognosis== | | ==Prognosis== |
− | Response to treatment is variable. Poor prognosis for dogs with [[Liver General Pathology - Pathology #Fibrosis - Repair|fibrosis]] and [[Liver General Pathology - Pathology #Cirrhosis |cirrhosis]]. | + | Response to treatment is variable. Dogs with [[Liver Fibrosis|fibrosis]] and [[Cirrhosis |cirrhosis]] carry a poorer prognosis. |
| + | |
| + | {{Learning |
| + | |Vetstream = [https://www.vetstream.com/felis/Content/Disease/dis01088.asp Liver: chronic disease in feline]<br>[https://www.vetstream.com/canis/Content/Disease/dis01089.asp Chronic heptatitis in canines] |
| + | }} |
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| ==References== | | ==References== |
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| *Ettinger, S.J. and Feldman, E. C. (2000) '''Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2''' (Fifth Edition) ''W.B. Saunders Company''. | | *Ettinger, S.J. and Feldman, E. C. (2000) '''Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2''' (Fifth Edition) ''W.B. Saunders Company''. |
| *Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''. | | *Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''. |
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| + | [[Category:Liver_-_Inflammatory_Pathology]] |
| + | [[Category:Liver Diseases - Dog]][[Category:To Do - Clinical]] |