Chronic active hepatitis is and inflammatory disease of the liver common in small to medium breed dogs, but can occur in any breed of dog, male or female, can occur at any age, although most affected dogs fall in the middle age to senior age range. Spaniels specifically seem especially predisposed to the development of chronic active hepatitis. Other breeds that represent higher than typical incidence of this disease include: Bedlington Terriers, Doberman Pinschers, Skye Terriers, Standard Poodles, and West Highland White Terriers.
Term “chronic active hepatitis” refers to the fact that the disease is a long term inflammatory assault to the liver and its cells. The inflammation is likely the result of the body’s own immune system attacking the liver, in sense, behaving as if the liver were a transplant that it is trying to reject. The term we use to describe disease where the immune system is attacking the body’s own tissues is “autoimmune disease.”
This notion that autoimmune disease is the cause for chronic active hepatitis in dogs, comes from analysis of fine needle aspirate and biopsy samples taken from affected dogs both antemortem (while the patient is still alive) and postmortem (after death). With the exception of very specific cases of copper accumulation in the liver (specific to only a few breeds) and aflatoxins accumulating from eating moldy corn (also a rare occurrence), the vast majority of case of chronic active hepatitis in dogs are autoimmune in origin. The fact that chronic active hepatitis has a higher incidence in certain breeds, suggests an underlying genetic cause.
Clinical signs of disease often begin with poor to no appetite and lethargy. Some cases will have a fever especially as disease progresses. Once disease is advanced, chronic active hepatitis often causes a yellow pallor to the whites of the eye, skin, and gums, resulting in a clinical condition known as jaundice. The yellow color comes from a pigment present in the bile acids of the gall bladder called bilirubin. Liver inflammation can cause a back-up of gall bladder circulation into the bloodstream, where it eventually is deposited into and accumulates in the patient’s tissues. Also in advanced cases, the patient will begin to progress to experiencing diarrhea, vomiting, and dehydration.
Diagnosis of chronic active hepatitis in dogs begins with history, jaundice appearance, and a palpable enlarged liver on physical examination. In cases where physical examination does not allow for a good assessment of liver size (patient is tense or obese, for example), imaging through x-rays and ultrasound will reveal a large, blunted liver. Some veterinarians like to confirm disease by using ultrasound to perform a non-surgical biopsy of the liver.
Bloodwork in cases of chronic active hepatitis usually reveals elevated liver enzymes, elevated total bilirubin, and sometimes an elevated white blood cell count.
Once the veterinarian is convinced of a diagnosis of chronic active hepatitis, treatment begins with IV fluids to hydrate the patient and support the liver, antibiotics to treat any potential secondary infections, and a steroid to halt and prevent inflammation. If the patient is vomiting, anti-nausea medication is administered by injection.
Once the patient is no longer vomiting and is able to hold down food, I then like to begin treatment with a gall bladder contracting medication called ursodiol that serves as a liver flush, and also begin supplementation with milk thistle and SAM-E, two nutritional supplements that protect the liver and support regeneration of liver tissue. My favorite supplement to this end that has both of these ingredients is Denamarin.
Nutritionally, patients with chronic active hepatitis fair best with a protein limited, GI friendly diet. Hills L/D, Hills I/D, and Eukanuba Low Residue are all good prescription diet choices. The patient should remain on this type of diet for life. Feeding of table food, especially highly proteinaceous foods, should always be avoided.
Once the patient is discharged, able to eat, drink, and be administered oral medication, at home treatment long term includes a steroid, ursodiol, and an aforementioned liver supportive supplement. Follow up bloodwork should be evaluated in 2 weeks after discharge from the hospital.
Steroid treatment is lifelong in most cases, using follow up bloodwork as a guide to scale back the dose to a minimum maintenance level over time. Once bilirubin is back to within the normal range, I will try the patient without the drug, but some end up needing to remain on it for life. The patient should also always remain on a liver protective supplement that has both milk thistle and SAM-E.
Prognosis for dogs with chronic active hepatitis is guarded in the early phases of disease. If the acute presentation is initially controlled, then with vigilant owner
owner compliance and regular monitoring, patients often enjoy a good quality of life, often for many years. Dogs affected by chronic active hepatitis are predisposed to cirrhosis later in life, but owner compliance in my experience plays a big role in whether or not this will occur.
Roger L. Welton, DVM
Founder and Chief Editor, Web-DVM.net
President, Maybeck Animal Hospital
Article updated 9/17/2012