ISSN 2398-2969      

Liver: acute disease

icanis

Introduction

  • Cause: overwhelming toxic insult, infectious or metabolic disease.
  • Signs: non-specific; anorexia, vomiting, depression +/- polydipsia/polyuria, jaundice, ascites, bleeding, encephalopathy.
  • Diagnosis: biochemistry, hepatic function tests, ultrasonography, hepatic biopsy.
  • Treatment: underlying cause if recognized; otherwise supportive and symptomatic.
  • Prognosis: depends on severity and treatment of inciting factor.
  • See also Liver: chronic disease Liver: chronic disease - overview.

Pathogenesis

Etiology


Hepatotoxins

Infectious/parasitic

Infection

Metabolic

Neoplastic

  • Diffuse tumor infiltrate, eg lymphoma Lymphoma.

Specific

  • Unvaccinated animals.

Pathophysiology

  • Overwhelming hepatic insult → functional reserve capacity exceeded → failure to perform diverse metabolic functions → clinical signs.
  • Hepatic functional reserve large → 70% damage before capacity exhausted → peri-acinar zonal necrosis, infiltration of inflammatory cells due to toxins, living agents and metabolic disease will cause massive damage.
  • Local and systemic release of cytokines and other pro-inflammatory mediators → pyrexia, anorexia, depression.
  • Decreased production of clotting factors → bleeding tendency.
  • Inflammation of biliary system → partial obstruction to biliary flow → icterus.
  • Inadequate bile delivery to intestine → impairment of fat digestion → diarrhea.
  • Failure to maintain euglycemia →hypoglycemia Blood biochemistry: glucose.
  • Decreased production of albumin →hypoalbuminemia Blood biochemistry: albumin.
  • Failure to detoxify ammonia and other mercaptans from intestine →hepatic encephalopathy Hepatic encephalopathy.
  • Increased resistance to blood flow through liver due to hepatocytes swelling → development of portal hypertension →ascites.
  • Portal hypertension → gastrointestinal wall congestion and edema → gastrointestinal ulceration →hematemesis and melena.

Timecourse

  • Dependent on etiology, within days of ingestion of toxin, infection.

Diagnosis

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Treatment

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Watson P J (2004) Chronic hepatitis in dogs: a review of current understanding of the aetiology, progression and treatment. Vet J 167 (3), 228-41 PubMed.
  • Toshach K, Jackson M V V & Dubielzig R R (1997) Hepatocellular necrosis associated with SC injection of an intranasal bordetella bronchiseptica - canine parainfluenza vaccine. JAAHA 33 (2), 126-128 PubMed.
  • Maddison J E (1992) Hepatic encephalopathy. Vet Intern Med 6 (6), 341-353 PubMed.
  • Meyer D J & Williams D A (1992) Diagnosis of hepatic and exocrine pancreatic disorders. Semin Vet Med and Surg 7 (4), 275-284 PubMed.
  • Dayrell-Hart B, Steinberg S A, VanWinkle T J & Farnbach G C (1991) Hepatotoxicity of phenobarbital in dogs: 18 cases. JAVMA 199 (8), 1060-1066 PubMed.

Other sources of information

  • Scherk M A & Center S A (2005)Toxic, Metabolic, Infectious and Neoplastic Liver diseases.In:Textbook of Veterinary Internal Medicine. 5th edn. Eds: S J Ettinger & E C Feldman. Philadelphia: W B Saunders. pp 1464-1477.
  • Watson P J (2005)diseases of the liver.In:BSAVA Manual of Canine and Feline Gastroenterology. 2nd edn. Eds E J Hall, J W Simpson & D A Williams. BSAVA publications. pp 240-268.
  • Center S A (1996)Acute hepatic injury: hepatic necrosis and fulminant hepatic failure. In:Strombeck's Small Animal Gastroentererology. Eds W G Guilford. W B Saunders, Philadelphia. pp 654-705.
  • Watson T (1996)Nutritional management of canine liver disease.Waltham Symposium, Birmingham. pp 42-46.

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