Cirrhosis of the Liver in Dogs

Cirrhosis of the liver

Question: Hello Dr. Richards, I have written to you a couple of times and your answers have been so helpful in my coping with Cushing's disease. Well, my Bichon Muffin who has Cushing's disease was diagnosed this week with cirrhosis of the liver. She had been trembling and I knew something was wrong. Her Cushing's has been under control with the use of anipryl, so her vet did another physical and a bile acid test. She had a physical just this March and her albumin number was 3.2; however this time, we were at 2.9 (below normal). Her bile acid test was below 20 on the pre, but 35 on the post. So we went on to an ultra sound and this is where the cirrhosis showed up. Her adrenal gland was perfect. I found this doctor via the Internet at the University of Missouri, at their liver institute, who studies currently are on cirrhosis and I called him. I was so afraid that maybe I had chosen the wrong medication for Cushing's disease, so I asked him if excess cortisol could cause cirrhois and he said no. That made me feel a lot better. She is now going to have a needle guided biopsy ultra sound. Also without my knowledge, I found that the men who mow by lawn have been putting down Roundup. I called animal poison control and they told me they did not think this could be the reason but opened up a case history on her. I know I may never find the reason, but also I can't find anything in detail about cirrhosis in dogs on the Internet. My own vet is still in the process of consulting and studying and wants to get everything together before we start doing whatever we have to do. He did change her over to the L/D diet and she has been on silymarin for her Cushing's anyway. She has never lost any fur or had hind leg weakness from her Cushing's and still to look at her, she looks normal for a 13 year old dog, never mind one who has Cushing's disease. No change in eating and water consumption is normal. She is not jaundice in any way. I guess my big question to you is what can I expect from cirrhosis, and can you direct me to any detailed information (books, the Internet, etc.) on this disease. By the way, this is a wonderful service that you offer and I use your site very often whenever I have a question. Your site has pulled me through many anxious moments. Thank you, Cathy Answer: Cathy- Cirrhosis of the liver can occur as the end result of several liver diseases, which may be why it is hard to find information on this condition as a separate entity. Cirrhosis can occur in copper storage diseases of the liver, as the end result of idiopathic chronic hepatitis (also called chronic active hepatitis, chronic canine inflammatory hepatic disease and probably other names), as a breed related disorder (several terrier breeds, Dobermans, Labs, cockers and standard poodles), due to anti-seizure medications and possibly due to carprofen and oxibendazole (a dewormer). It is sometimes the end result of infectious illnesses, especially leptospirosis and infectious canine hepatitis (pretty rare now). Of these conditions, the one that usually shows up without much warning is the idiopathic chronic hepatitis. This condition can sometimes go on for long periods of time with no really obvious clinical signs and affected patients may have markedly decreased liver size and function when the condition finally causes clinical signs. Even at this point it is often possible to help make patients feel better for some time, though. The usual recommendations are to use a low to moderate protein diet to try to decrease the liver's work load, use metronidazole or neomycin orally if there are signs of central nervous system disturbance, to give lactulose for the same reason, to consider the use of cholchicine, ursodiol (Actigal Rx), SAMe (Denosyl SD-4 Rx), copper chelating agents if necessary and to provide general supportive care, such as gastrointestinal protects if GI ulceration occurs, fluid therapy if there is dehydration, Vitamin K if blood clotting problems occur, and possibly Vitamin E as an anti-oxidant. In liver disease, at least if copper toxicosis is possible, it is best to avoid Vitamin C supplementation as it can make the copper toxicity worse. As the diseases mentioned above progress, they slowly destroy liver cells, resulting in scarring and an increase in fibrosis in the liver, or cirrhosis. Some patients live for extended periods of time even after it is clear that they have reached the stage that liver cirrhosis is occurring. I can think of two or three patients who lived for two or more years in our practice and seemed to have a good quality of life during that time. Other patients don't do as well but it is still worth trying to control the secondary problems and to make the liver's job as easy as possible and then to see what happens. It can be pretty hard to go back at at the time that there is cirrhosis and to figure out why it occurred, so when the liver disease is discovered at this stage, it may not be possible to give you information on the underlying disease and thus the diagnosis of cirrhosis, rather than a more specific diagnosis. I hope that Muffin is one of the patients who does do well. It may be hard to find information on cirrhosis itself, but if you want to read good descriptions of liver disease that might lead to it, there are pretty good chapters in several of the veterinary textbooks, such as the "Textbook of Veterinary Internal Medicine" by Ettinger and Feldman and the "Handbook of Small Animal Practice" by Morgan. There was a good review of liver disease in one of the Clinics of North America (I can't remember exactly when), if your vet subscribes to this journal. Mike Richards, DVM 8/20/2001

Cirrhosis of the liver

Question: Dear Dr.: Last weekend my 10yr old ibezan hound had a distended abdomen. After doing x-rays, lab work (all her liver enzymes were elevated) an ultrasound and an ekg, my vet diagnosed cirrhosis of the liver. He felt a biopsy was not needed. He kept her in the hospital for several days on iv fluids antibiotics and diurectics. He sent her home on lasix, amoxicillin and a kd diet. Wouldn't an l/d diet be better for her, and doesn't she need K+ when she is on lasix? I am considering taking her to a specialist, is there such a thing as an internist for dogs, and do you think this would be a good idea? I do love her so. Thanks in advance, A. Answer: A.- There are specialists for dogs. In this case, a board certified internal medicine specialist would probably be the best choice. I strongly support referral when the client desires it because specialists usually have diagnostic capabilities, such as being able to do ultrasound guided biopsies, that general practices do not have. If there is not a board certified specialist close to you, then considering going to one of the veterinary schools is a good idea. I think that Hill's would recommended l/d over k/d in most cases but k/d actually does meet the requirements for low protein, but high quality, protein that is the strongest dietary recommendation in pets with liver diseases other than hepatic lipidosis. The newer diet, l/d, does have some other ingredients, such as the essential fatty acids, that may be more beneficial in liver disease. Most of the time in dogs potassium depletion does not seem to be a problem with the use of furosemide (Lasix Rx). I do not routinely advise potassium supplementation when using furosemide, either. This is a possible side effect, though, and there is no harm in supplementing potassium that I am aware of. It is always reasonable to ask your vet about referral to a specialist. He or she may not feel that this is necessary but if you desire a second opinion this is the best way to ensure getting a knowledgeable one that I know of. Mike Richards, DVM 11/16/99