Changes

 

==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]]

**[[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

'''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. 

 

A number of aetiologies include:

A number of aetiologies include:

*Familial predisposition

*Familial predisposition

**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

===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

===Laboratory tests===

===Laboratory tests===

====Haematology====

Haematology:

*Mild non-regenerative anaemia and microcytosis

*Mild non-regenerative anaemia and microcytosis

====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

*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)]]

 

===Imaging===

==Imaging==

====Radiography====

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.

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.

 

===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.

==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.

==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.

 

|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]

 

==References==

==References==

*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''.