Copper Hepatopathy in Dogs

Copper is a regular part of the diet of most dogs. It is generally absorbed by the intestines and then escorted out of the liver and into the bile by specific proteins. If the bile or the proteins are deficient in any way, then the copper accumulates in the liver instead. The overabundance of copper in the liver causes inflammation and scarring of the tissues, which will eventually lead to liver failure if untreated. If your dog is exhibiting symptoms consistent with copper hepatopathy, it should be treated as an urgent health concern.

When copper builds up in the liver due to a defect in the way the organ is processing the copper it is known as copper hepatopathy and can cause permanent damage to the liver.

The symptoms of copper hepatopathy are rarely seen before damage to the liver has occurred and can include any or all of the following symptoms:  

• Abdominal pain
• Bleeding from gums
• Bruising
• Coma
• Dark urine
• Depression
• Diarrhea 
• Disorientation
• Distended abdomen
• Enlarged liver
• Excessive thirst
• Excessive urination
• Jaundice
• Lack of coordination
• Lethargy
• Loss of appetite
• Nose bleeds
• Pale gums
• Poor coat condition
• Seizures
• Vomiting 
• Weakness
• Weight loss

Types

There are three general categories of copper hepatopathy in dogs:

Subclinical disease - When this disease is subclinical, it is present in the liver, but not yet creating symptoms.

Acute or sudden onset - Acute onset of copper hepatopathy is seen more often in the younger dogs and often causes rapid death of liver tissues.

Chronic or progressive onset - Scarring of the liver over time, known clinically as cirrhosis, causes the symptoms to appear when the dog reaches middle age or older. Significant damage has usually occurred by the time symptoms arise.

Copper hepatopathy can occur in dogs of any size, gender, or age, but several breeds are predisposed to developing copper storage issues with the liver. Bedlington Terriers have been determined to have a particular autosomal recessive trait that causes a defect in the metabolism of copper that causes it to build up in the liver, rather than being excreted into the bile. Most of the other breeds that are prone to chronic hepatitis such as the Dalmatian, Beagle, and Labrador Retriever breeds also have a build up of copper in the liver, but it is not yet known if the build up is the cause of the hepatitis or if the hepatitis itself is the cause of the copper build up. Breeds prone to copper hepatopathy in dogs include:

• Beagle
• Bedlington Terrier
• Corgi
• Dalmatian
• Doberman Pinscher
• Keeshond
• Labrador Retriever 
• Skye Terrier
• West Highland White Terrier

Although symptoms of acute copper hepatopathy should indicate that the liver is likely to be involved, many of the symptoms of chronic hepatitis are somewhat vague and could signal several different conditions, particularly the earlier symptoms of the disorder. Your veterinarian will perform a physical evaluation of your dog, and if the liver is swollen, she may be able to feel this when she palpates the abdomen. In severely advanced cases of chronic injury, the liver may shrink instead, making it difficult to feel at all. Standard blood tests such as a biochemistry profile and complete blood count may show elevated liver enzymes, regenerative anemia, or coagulation disorders even before any symptoms become apparent. 

Ultrasound imaging can help determine the size and shape of the liver and may reveal abnormalities such as nodules on the liver or swelling in the abdominal cavity. The final diagnosis of copper hepatopathy requires a liver biopsy. The biopsy may be taken by ultrasound guided needle biopsy, laparoscopic biopsy, or a wedge biopsy, but samples taken by fine needle aspiration are not sufficient for proper testing.

Significant damage has often occurred by the time that symptoms are showing, and treatment will be aimed at stopping further progression of the disease and providing additional support to the liver. Any fluids that have built up in the abdominal cavity will need to be drained by a process known as abdominocentesis. To perform an abdominocentesis a needle is inserted directly into the abdominal cavity, and excess fluid is drawn out to relieve the pressure. Dogs who develop this type of fluid build up may have diuretics prescribed to them to prevent any further build up. 

Acute symptoms will generally result in a stay at the clinic, and IV fluids will be administered in order to prevent dehydration and to address any imbalances in blood chemistry. In situations in which the patient’s clotting has been compromised blood or plasma, transfusions may also become necessary, and gastroprotective medications may also be recommended. Chelating agents and zinc are generally utilized to bind the copper so that it is removed naturally through the urine, although this seems to be less effective when treating Doberman Pinschers.

Prognosis for this condition is guarded to poor and is dependent on several factors, including the amount of damage that has already occurred by the time the disease is diagnosed, and the breed and age of the dog. Dogs that develop acute onset copper hepatopathy are more likely to succumb rapidly to the disorder than dogs who have chronic or progressive hepatopathy. Management at home usually includes a change of diet to a high-quality, low copper diet to prevent any future buildup of copper and some dogs may need to have supplemental zinc or additional chelation treatments to maintain liver health for as long as possible.