Hepatitis, Chronic

Signalment

Common in dogs, especially young to middle-aged dogs.
Mixed and purebred dogs are affected but there is a familial predisposition in
- Doberman pinscher
- Bedlington Terrier
- Cocker Spaniel
- Dalmation
- Skye Terrier
- Poodle
- Labrador Retriever
- German Shepherd Dog
- Scottish Terrier
- Beagle

Description

Chronic hepatitis is an inflammatory-necrotising disease of at least 6 months duration. It is characterised by hepatocellular apoptosis or necrosis, a variable mononuclear or mixed inflammatory cell infiltrate, regeneration and fibrosis (1). It predominantly consists of lymphocytic-plasmacytic inflammatory infiltration.

A number of aetiologies include:

Familial predisposition
Copper accumulation (copper storage disease)
Chronic drug therapy
Infectious for examplae infectious canine hepatitis-
Autoimmune or steroid responsive disorder

Diagnosis

Clinical Signs

These include

lethargy, weakness, anorexia and weight loss
vomiting and diarrhoea
polyuria and polydipsia
ascites
and rarely icterus, seizures, fever and bleeding disthesis

Laboratory tests

Biochemistry

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

Imaging

Histopathology

This is required for definitive diagnosis. Histology reveals lymphoplasmacellular inflammation and necrosis of the hepatocytes adjacent to the portal tracts.

Treatment

Glucocorticoids at 1-2 mg/kg/day PO. Taper down with improved clinical signs and normal liver enzymes values
Ursodeoxycholic acid at 15mg/kg PO SID
Antioxidants
Copper chelation with Penicillamine or Zinc if copper exceeds 2000ppm

Prognosis

References

(1) Van den Ingh, TSGAM et. al. (2006). Morphological classification of parenchymal disorders of the canine and feline liver. In Rothuizen J et. al., editors: WSAVA standards for clinical and histological diagnosis of canine and feline liver disease, Oxford, England, Saunders.