ISSN 2398-2969      

Liver: chronic hepatitis

icanis
Contributor(s):

Kyle Braund

Synonym(s): Chronic active hepatitis


Introduction

  • Cause: includes hepatitis due to copper accumulations, etc may have immunological basis.
  • Signs: ascites, coagulopathy, hepatic encephalopathy.
  • Diagnosis: hepatic biopsy.
  • Treatment: supportive and symptomatic; use of glucocorticoids may be indicated.
  • Prognosis: reasonable in early stages.

Pathogenesis

Pathophysiology

  • Chronic hepatitis is a heterogenous group of inflammatory-necrotizing diseases of the liver in which lymphocytes and plasma cells are the predominant inflammatory infiltrate.
  • Pathophysiologic mechanisms of chronic hepatitis in dogs are poorly understood; although immune mechanisms and copper accumulation may play roles, anti-epileptics and leptospirosis also implicated.
  • Chronic hepatitis can progress to hepatic cirrhosis (end-stage liver disease).
  • Copper accumulation in liver → significant hepatic injury → acute/chronic hepatitis → cirrhosis.
  • Immune mechanisms directed against cell nuclei, liver membranes, smooth muscle and mitochondria may → chronic active hepatitis.
  • Ascites may develop due to portal hypertension +/- hypoalbuminemia.
  • Decreased production of clotting factors → bleeding tendencies.
  • Hepatic cellular damage → cellular release of bilirubin → icterus.
  • Inflammation of biliary system → partial obstruction to biliary flow → icterus.
  • Inadequate bile delivery to intestine → impaired fat digestion → diarrhea.
  • Decreased production of albumin → hypoalbuminemia.
  • Failure to detoxify ammonia and other mercaptans from intestine → hepatic encephalopathy.

Timecourse

  • Weeks to months.

  • Note: because of large functional reserve capacity of liver, onset of signs may appear recent, suggesting an aucte rather than chronic hepatic disorder.

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.
  • Twedt D C (1998) Reactive hepatopathies and chronic hepatitis in the dog. Vet Quarterly 20 (Suppl 1), S46-47 PubMed.
  • Meyer D J et al (1997) Use of ursodeoxycholic acids in a dog with chronic hepatitis - effects on serum hepatic tests and endogenous bile acid composition. J Vet Intern Med 11 (3), 195-197 PubMed.

Other sources of information

  • Johnson S E (2000)Chronic hepatic disorders.In:Textbook of Veterinary Internal Medicine. 5th edn. Ettinger S J & feldman E C (eds). W B Saunders, Philadelphia. pp 1298-1325.
  • Leveille-Webster C R (2000)Ursodeoxycholic acid therapy.In:Kirk's Current Veterinary Therapy XIII. Bonagura J E (ed). W B Saunders, Philadelphia. pp 691-693.

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