Chronic Inflammatory Hepatic Disease
(Chronic Active Hepatitis)

Patty Khuly

Summary

When the liver becomes inflamed beyond a period lasting six weeks, we consider the process a “chronic hepatitis” or “chronic inflammatory hepatic disease.”

Though many diseases can lead to this process, the one we call “chronic active hepatitis” and typically also designate as “chronic inflammatory hepatic disease” is one veterinary medicine reserves for a syndrome involving an inflammatory process of the liver. Sometimes we can pinpoint a cause (such as viruses and toxins), but other times we’ve noted that it tends to occur in certain breeds of dogs for reasons we don’t completely understand.

If that sounds convoluted, that’s because most syndromes are. And this one can be especially confusing...and frustrating. In fact, with this non-specific disease entity only one thing is certain: Dogs develop inflammation of the liver that leads to a fibrosis, or scarring down, of the liver.

Though the liver has regenerative properties, at some point these can become exhausted and the liver can reach an end-stage state we call “cirrhosis.” This ultimately leads to complete liver failure unless the process can be halted.

A hereditary predisposition marks this relatively common condition for some breeds of dogs. Gender and age are also a risk factor; females are overrepresented while the mean age of diagnosis is about six.

Symptoms and Identification

Vomiting, inappetance/anorexia, weight loss and jaundice may be noted. In later stages of the disease, ascites (fluid in the abdomen) and encephalopathy (neurological symptoms) are also common.

Because the signs of this condition are so non-specific and because specific causes of this process must be ruled out individually, diagnosis can be especially complex. Blood work to investigate the liver and other organs, tests for infectious diseases (like Leptospirosis), urinalysis, ultrasounds, X-rays and liver biopsies are considered basic for any disease process involving the liver.

Ultimately, the liver biopsy is what seals the diagnosis of chronic active hepatitis.

Affected Breeds

The following breeds have been targeted for genetic study of this syndrome:

Among these, the Cocker spaniel and Doberman Pinscher seem most predisposed. In West Highland White Terriers, as for others, Copper Hepatopathy, another distinct, hereditary disease process, may be involved in initiating the condition.

Treatment

Treatment is the hard part. In cases where we can identify a cause (an infection, a toxic drug, etc.) eliminating the cause of the inflammation is key. For those whose condition progresses in spite of an identifiable inciting cause, all we can do is make things easier for the liver to do its work by providing drugs that help eliminate toxins from the body, antibiotics to support the liver’s inability to clear infections, supplements that support the liver and medications that reverse some of the effects of whole body toxicity (anti-nausea drugs, etc.) and fluid accumulation (furosemide, etc.).

It’s largely a supportive role we play as we try to handle a diseased liver’s failings. Unfortunately, liver transplants are not yet available for dogs, except very experimentally.

Veterinary Cost

The cost of diagnosing a dog with this condition usually runs from $500 to $2,500, depending on the facility and the degree of testing required to reach a conclusive diagnosis. Treatment, however, can become very expensive if ICU services are required or if the disease is longstanding and requires expensive drugs for years of life.

Dogs in these situations can run up bills between $500 and $5,000 or more, depending on the condition’s longevity and the owners’ ability to pay. Unfortunately, this means that many dogs will eventually be euthanized.

Prevention

Preventing factors that predispose pets to liver inflammation is the way to go. Vaccination against infectious diseases that cause liver swelling is considered basic. Monitoring the liver for signs of toxicity when certain drugs are being administered (phenobarbital, NSAIDs, etc.) is also a fundamental rule of prevention.

Beyond these basic modes, dogs who seem to suffer the hereditary forms of this disease should be excluded from breeding programs. Their siblings and parents should also be checked for the syndrome’s presence before including them in any breeding programs.



References

Dill-Macky E. Chronic hepatitis in dogs. Vet Clin North Am Small Anim Pract 1995 (In Press).

Franklin JE, Saunders GK. Chronic active hepatitis in Doberman pinschers. Comp Cont Ed Pract Vet 1988; 10:1247-1254.

Leveille-Webster CR, Center SA. Chronic hepatitis: therapeutic considerations. In: Bonagura JD, ed. Kirk's current veterinary therapy XII. Philadelphia: WB Saunders, 1995:749-756.

Magne ML, Chiapella AM. Medical management of canine chronic hepatitis. Comp Cont Ed Pract Vet 1986; 8:915-921.

Strombeck DR, Miller LM, Harrold D. Effects of corticosteroid treatment on survival time in dogs with chronic hepatitis: 151 cases (1977-1985). J Am Vet Med Assoc 1988;193:1109-1113.