Glucocorticoid treatment in dogs is known to cause hepatocellular swelling due to accumulation of cytoplasmic compounds which variably have been identified histochemically as fat, glycogen, or water. In the present study changes in dog liver, after treatment for 15 days with two different doses of oral or intramuscular prednisone, were examined using histological, histochemical, and ultrastructural techniques as well as quantitative chemical analysis.
Thirty mongrel dogs were divided into two control groups and three treatment groups of six dogs each. Dogs which received prednisone orally at 1. Compared to controls, no changes in the hepatic water concentration were observed, whereas the relative amounts of liver fat were decreased slightly and those of protein were decreased markedly.
Your veterinarian will conduct the abdominal X-rays to identify the size of the liver, and thoracic X-rays to determine the size of lymph nodes, or metastasis, in the case of tumor s and cardiac or pulmonary disorders. Abdominal ultrasound, meanwhile, may reveal enlarged liver and changes in liver tissue due to extensive lesions and other concurrent problems within abdominal cavity.
There are also other, more specific and sensitive tests available to evaluate the liver, thyroid gland, and pituitary gland functions. Your veterinarian may take a live tissue sample to be sent to veterinary pathologist for further evaluation, often revealing the presence of vacuoles within liver cells and changes related to this abnormal accumulation. In addition, liver biopsies help in ruling out other liver diseases. If infection is suspected, your veterinarian will take the sample to be sent to laboratory for culture and sensitivity.
Culturing the sample helps in growing and identifying the causative organisms and sensitivity provide information related to antibiotics most effective against isolated organisms. The course of treatment will depend on the underlying cause of the disease.
However, due to reversible nature of this condition, early treatment will usually completely resolve the problem. If pituitary masses are present, radiation therapy is used to destroy these masses within pituitary glands. Tumor s may also be excised surgically. In case of dental disease, proper antibiotics are used to control the infection. In case of infections, proper antibiotics are used to control and treat infections after culture and sensitivity testing.
And in cases of underactive thyroid glands hypothyroidism , thyroxine supplementation is required. The dog will require regular follow-up exams following treatment to evaluate the animal its liver function. Your veterinarian will also often recommend modifying the dog's diet, especially if it has developed pacreatitis, which will require a low-fat diet. Prognosis depends on the extent of disease; in some patients, prognosis is poor despite treatment.
Reinstitution of therapy after a relapse is not often as successful in controlling the disease as the initial therapy. The course of therapy for cholangiohepatitis is variable months to several years. Affected animals should be monitored by periodic recheck of blood chemistry profiles and bile acid assays and repeat liver biopsies where possible.
Azathioprine Imuran , a thiopurine compound, is an immunosuppressive agent that has been beneficial in treatment of many immune-mediated disorders, as well as in treatment of chronic active hepatitis in people. It is most often used in combination with prednisone therapy. Azathioprine should be considered when a patient cannot tolerate corticosteroids at high dosages or when prednisone therapy alone is inadequate in controlling the disease.
The prednisone dose often can be halved when used with azathioprine without lessening the desired immunosuppressive effect of therapy. Early signs of azathioprine toxicity include leukopenia, thrombocytopenia, gastrointestinal upset, dermatologic reactions, and hepatotoxicity.
These effects are not common in dogs and usually resolve with reduced dosage or discontinuation. Colchicine has been used in treatment of hepatic fibrosis, a common sequel to hepatic inflammation and necrosis. It is characterized by abnormal deposition of collagen in the liver without a loss of normal architecture. Early fibrosis often resolves after the initiating cause is removed. A moderate amount of fibrosis resolves with corticosteroid therapy but more advanced fibrosis requires more specific therapy.
Colchicine may be capable of inhibiting hepatic collagen synthesis and promoting collagen breakdown in certain situations. Side effects of long-term colchicine use include vomiting, hyperperistalsis, diarrhea, and malabsorption, and are attributed to its direct effect on the intestinal mucosa.
Although clinical and histologic improvement may be noted in patients with hepatic fibrosis, there is no proven increase in survival time in patients on colchicine therapy as compared to untreated controls. The dose of colchicine is 0. Patients should be observed for possible adverse effects during the required long-term therapy.
Lactulose Cephulac: Schiapparelli Searle is a disaccharide used in long-term management of hepatic encephalopathy. Lactulose, which is not digested or absorbed in the small intestine, is hydrolyzed by colonic bacteria. The resultant colonic acidification increases conversion of ammonia to ammonium, which is less diffusible, thus decreasing systemic ammonia levels.
The fermentation products of lactulose also act as an osmotic laxative, which helps decrease the numbers of colonic bacteria. For maintenance therapy, lactulose is given at 5 ml 3. Lactulose can be given to patients in hepatic encephalopathy crisis manifested as stupor or coma via stomach tube at ml g every hours.
Alternatively, lactulose may be given in this situation as intermittent enemas diluted with water to total ml g. Intestinal antibiotics, such as neomycin with or without metronidazole, may act synergistically with lactulose to markedly decrease colonic bacterial numbers. Long-term lactulose therapy should be instituted if dietary protein restriction does not control clinical signs of encephalopathy.
Ursodeoxycholic acid Ursodiol; Actigall has been used in the management of chronic hepatic disease in humans, including chronic active hepatitis, primary biliary cirrhosis, and primary sclerosing cholangitis. Significant improvement in symptoms and laboratory parameters have been reported in many patients undergoing treatment for these diseases. Ursodeoxycholic acid is a naturally occurring dihydroxylated bile acid.
One of its uses is for dissolution of radiolucent gallstones. The exact mechanisms of its beneficial effects in inflammatory hepatic diseases remain controversial. It is believed that there is a favorable change in the bile acid pool, rendering retained endogenous bile acids less toxic. I have used ursodeoxycholic acid in animals with various cholestatic diseases including dogs with chronic active hepatitis, fibrosis, and cirrhosis and in cats with cholangiohepatitis, either alone or in combination with other drugs.
The drug is very well tolerated, and in some cases the response can be dramatic. Use of ursodeoxycholic acid should be considered as either primary or adjunctive in combination with immunosuppressive or antiinflammatory drugs treatment in animals with chronic liver disease.
It may be the only effective drug in animals where glucocorticoid therapy or other immunosuppressive drug therapy is either contraindicated or ineffective. Ursodeoxycholic acid is also a powerful choleretic agent that can be used to treat sludged bile and cholelithiasis. Actigall is available as a mg capsule preparation. Fractions of a capsule can easily be prepared for use in cats and small dogs. Many cats will actually still eat their food even if Actigall is sprinkled on the top.
This product is an antioxidant and antiinflammatory nutraceutical. Derived from the amino acid methionine and ATP, SAMe initiates three major biochemical pathways: transmethylation, transsulfuration, and aminopropylation. It has particular importance in hepatocytes that conduct or influence the bulk of intermediary metabolism. SAMe has modulating influence on inflammation, promotes cell replication and protein synthesis, has cytoprotective effects, and is important in promoting sulfation and methylation.
It is a precursor of essential intracellular oxidants. The liver, which can be likened to a large lymph node situated in the center of the body, undergoes great exposure to injurious products including free radicals, oxidants, and endotoxins. The liver has enormous cytoprotective capabilities, conjugation pathways, and antioxidants.
Membrane damage by free radicals and oxidation is a basic mechanism of cell pathology in nearly all liver and biliary tree diseases. In the normal state, the liver is an important source of SAMe for itself and for the body. However, reduced hepatic mass, impaired function, or nutritional deficiencies may directly impair production of SAMe. The effects of this may include methionine intolerance and increased production and accumulation of oxidants derived from primary systemic or hepatobiliary disease, thereby leading to worsening liver damage.
The accumulation of membranocytolytic bile acids perpetuates liver damage. Sulfation of membranocytolytic bile acids reduces their toxicity, which allows them to be eliminated. Taurine conjugation also reduces bile acid toxicity. In SAMe deficiency, both sulfation and taurine conjugation may become impaired, which enhances bile acid toxicity.
Studies have shown that in vitro addition of SAMe to cell cultures reduced toxicity to hydrophobic bile salts. Clinical benefit has been demonstrated in humans with different forms of cholestasis. Recent work has also shown that SAMe provides an adjunctive therapeutic effect when used with ursodeoxycholic acid. SAMe helps restore hepatocyte function by simultaneously stimulating cell repair, attenuating free radical production and accumulation, suppressing inflammation, and improving conjugation, membrane function, and toxin neutralization and elimination.
SAMe may improve hepatocellular handling of organic ions e. Oral administration on an empty stomach optimizes bioavailability. Conditions for which SAMe use should be considered include feline hepatic lipidosis, feline cholangitis and cholangiohepatitis, and in dogs with marked vacuolar hepatopathy from either glucocorticoid administration or idiopathic vacuolar hepatopathy, and in chronic active hepatitis.
No significant side effects or changes in routine clinicopathologic parametersdevelop in healthy or ill humans. There are no known side effects in animals. Several products are available over the counter but have widely varying potency. Denosyl is available in 90, , and mg tablet sizes. Milk thistle silymarin is a bioflavonoid that has antioxidant properties. It is often used in management of liver disease in people and some benefit has been shown in refereed journal articles.
A study in dogs fed hepatotoxic mushrooms showed a protective effect against clinical and pathologic changes when high doses of milk thistle were given at 5 and 12 hours post exposure. Veterinarians have used milk thistle for dogs with chronic liver disease and to ameliorate hepatic effects of anticonvulsants. Doses vary from mg given every 12 to 24 hours. In vitro and in vivo studies have shown that it protects against oxidative stress, promotes hepatocyte protein synthesis, a mechanism for liver cell regeneration, inhibits leukotriene production, which can be beneficial as production of leukotrienes is a component of the inflammatory response, stimulates biliary flow and production of hepatoprotective bile salts, and increases levels of glutathione.
Many products have been available over the counter, and potency varies. Marin contains silybin, vitamin E, and zinc; all in a single tablet formulation. Silybin is the most active component of silymarin, derived from the milk thistle. Denamarin is a combination of S-adenosylmethionine and silybin-phosphatidylcholine complex.
Denamarin can be used in conjunction with Marin in cases where it may be desirable to provide additional levels of silybin along with vitamin E and zinc supplementation the latter two are available in Marin but not Denamarin. If Marin is used in conjunction with Denamarin, the two products should be administered 12 hours apart for best response.
Copper reduction therapy is indicated if there is an elevated level of copper in the liver. Therapeutic strategies include dietary copper restriction, therapy to limit copper absorption dietary zinc , and copper chelator therapy d-penicillamine, trientene. Zinc given as either the acetate, sulfate, or gluconate salt has proven effective in preventing hepatic copper accumulation in humans with Wilson's disease. Oral zinc therapy has also been shown to be beneficial in some Bedlington terriers with copper hepatotoxicity.
Dietary zinc works by causing an induction of the intestinal copper-binding protein metallothionein. Dietary copper binds to the metallothionein with a high affinity and when intestinal cells die and are then sloughed the metallothionein bound copper becomes excreted through the stool. The starting dose is 7. Vomiting is a potential side effect. Zinc gluconate administered in a time release capsule may be less likely to cause vomiting.
The zinc dose can be reduced to SID after months. Copper chelators include penicillamine Cuprimine mg capsules or Depen mg tablets and trientene 2,2,2-tetramine, Syprine. Chelators bind with copper either in the blood or the tissues and then promote its removal through the kidneys. Historically penicillamine has been the most commonly prescribed drug 7.
Side effects include nausea and vomiting. Depending on the condition that is being treated will often determine the dose used. The following assessment is just a guideline for dosage information:. This is to help avoid adverse side effects and also wean the body off of the drug so that diseases do not relapse.
This is especially important with autoimmune disorders like immune-mediated thrombocytopenia ITP. The immune system mistakes them for foreign invaders and kills them off leading the dog to have bleeding disorders. Depending on how long the dog is on the medication will increase or decrease the risk of adverse effects. Some of these adverse effects include excessive thirst, panting, increased hunger, and increased urination.
In extreme cases vomiting, diarrhea, and behavioral changes. It is also more likely for your dog to have heart problems. When a dog takes steroids for a prolonged time it can cause the liver to become resistant to insulin, resulting in blood sugar spikes. Prolonged steroid use can cause heart issues because it often leads to high blood pressure. If this is the case and is unavoidable then frequent workups should be taken.
This is to make sure your dog is not developing any iatrogenic illness caused by treatment or individual disease. These drugs include insulin, non-steroidal anti-inflammatories, diuretics, Dexamethasone, Phenobarbital. It should also be given cautiously in younger dogs and any dogs receiving vaccines or other drugs that need their immune system at a top-notch level. Prednisone should be avoided entirely in any pets with liver disease but Prednisolone can sometimes be substituted at the instruction of your veterinarian.
If used with liver deficient dogs it can cause lesions and further escalate liver disease. Prednisolone comes in 5mg tablets. There are also various concentrations of liquid doses. It can be given orally or by injection via a veterinarian.
It is important to know chronic condition that requires ongoing of tablets and liquid solutionspreferably with food to lower the chance of an a pet insurance plan that. Common monitoring practices with these that requires refrigeration. The most common side effects prednisone in dogs, the drug to undergo allergy testing within and increased urination. PARAGRAPHPro Tip: Prescription medications for the steroid is taken in. It should also be given own blog called The Four to spinal cord trauma, anaphylactic forward to contributing to I. Jaclyn is blessed with two of prednisone prednisolone in dogsincluding:. The steroid medication is usually during emergency situations in response heart disease, diabetes, cataractsother drugs that need their or nursing dogs. Combining her two interests of pets can antihistamine steroid eye drops quite expensive. If using transdermal Prednisolone it shock and Addisonian crisis, may range of conditions in dogs. These medications should be used be used cautiously in puppies as they can inhibit steroids for liver disease in dogs, NSAIDs, the risk of stomach of your veterinarian.In general, the starting dosage of prednisone for inflammatory liver disease in dogs is. legal.sportnutritionclub.com › view › management-chronic-liver-disease-dogs-proce. Symptoms and Types · Panting · Lethargy · Loss of hair (alopecia) · Increased thirst and urination (polydipsia and polyuria) · Increased appetite .