Hepatic Failure in Dogs

It is considered hepatic failure when a dog’s liver has lost more than 75% of its function, a secondary occurrence to liver death (also called necrosis). As the liver cleans and detoxifies blood, stores reserves of nutrients and is responsible for producing hormones that regulate multiple processes, dogs experiencing hepatic failure may also experience dysfunction in many other systems, and other organs may be impacted. Hepatic failure may cause a variety of problems to include fluid in the abdomen of your dog, digestive ulcers, increased susceptibility to infection and liver-related brain disease. Immediate treatment is necessary in cases of acute hepatic failure, which can occur suddenly or be the end state of chronic liver disease.

Whether acute or resulting from chronic long-term liver disease, when the liver has lost more than 75% of its function, hepatic (liver) failure will be diagnosed.

There are a variety of symptoms of hepatic failure that can be seen in your dog. The first signs that are typically seen in hepatic failure are:

• Vomiting
• Poor appetite
• Weight loss

More severe symptoms may constitute an emergency requiring immediate attention. These include:

• Excessive thirst
• Frequent urination
• Bloody diarrhea
• Jaundice
• Gastrointestinal bleeding
• Fluid in the abdomen
• Sudden aggression
• Disorientation
• Excessive drooling
• Lack of coordination
• Seizures

Types

Hepatic failure may happen suddenly or develop slowly. Acute hepatic failure can occur in conjunction with any condition that affects the liver; for example, hepatic failure can be caused by poisoning if the toxins taken in by your dog are more than what his liver is able to handle. Hepatic failure can also occur as a result of long term, chronic liver disease where the disease progresses slowly, but over time your dog will develop symptoms of hepatic failure.

There are a number of conditions that may lead to acute hepatic failure in your dog. Poisoning is a common cause of hepatic failure. Types of poisoning include:

• Drugs or alcohol
• Antifreeze
• Herbicides, fungicides, insecticides
• Rat poison
• Certain types of mold, amanita mushrooms or blue-green algae

Infectious diseases to include:

• Infectious canine hepatitis
• Leptospirosis
• Fungal infections and toxoplasmosis 

Other causes of hepatic failure include:

• Chronic hepatitis causes inflammation of the liver leading to the destruction of tissue over time.
• Endocrine disease to include diabetes, Cushing’s Disease, hyperthyroidism, liver cysts and  cancer (that either starts in or spreads to the liver). 
• Congenital abnormality such as hepatic amyloidosis (abnormal protein), glycogen storage disease (resulting from a genetic enzyme deficiency), liver fibrosis (normal liver cells are replaced by scar tissue), or an abnormality in the liver’s vessels
• Heat stroke
• Shock
• Blood clot disease
• Disseminated intravascular coagulation

Hepatic failure can occur in any breed of dog, regardless of its gender or age.

Your veterinarian will conduct a full physical examination and ask you what symptoms you have noticed and when you first noticed them. If your veterinarian is not familiar with the medical (including medications) and family history of your dog, he will seek to determine whether there are any known conditions that may be contributing to his symptoms. It is likely that you will be asked if your dog could have been exposed to poison. Your veterinarian will request a complete blood count, biochemical profile and urine sample to get an understanding of the dysfunction and cause of his symptoms. Other tests that may be conducted are:

• X-rays and an ultrasound
• Serum bile acids
• Ammonia levels
• Coagulogram (clotting profile) 
• Liver biopsy
• Exploratory surgery
• Laparascopy

Immediate treatment is necessary should your dog be experiencing hepatic failure. Your veterinarian will first treat the symptoms your dog is experiencing and stabilize his condition. This will often involve intravenous fluids and electrolytes in order to decrease the toxicity of your dog’s blood. A diuretic or enema may be used to clean out your dog’s system. If there is excessive fluid in your dog’s stomach, your veterinarian may remove some of it and if there are issues with clotting your dog may require a transfusion as well as a medication like heparin or vitamin K. 

Once your dog is stabilized and your veterinarian understands the underlying issue or issues leading to your dog’s hepatic failure, he will be able to determine the best course of treatment. 

• Poisoning - Your dog’s condition may resolve itself once the toxins have been flushed from his system
• Endocrine condition - By treating the condition, the hepatic failure may resolve
• Bacterial and fungal infections - Antibiotics or antifungal medications may be prescribed
• Viral infections - Your veterinarian will seek to manage the symptoms your dog is experiencing
• Cancer and cysts - Depending on the health of your dog, surgery may be recommended once he is stabilized; chemotherapy is an option for some types of cancer
• Vascular abnormalities - Surgery may be recommended if your dog is healthy enough
• Chronic hepatitis - Long term medication to assist in reducing problems with copper storage
• Congenital enzyme and protein abnormalities - Dietary changes and medication may be recommended; your dog’s recovery will be dependent on how much of his liver was destroyed and the degree to which the underlying condition can be treated
• Should your dog be experiencing hepatic failure after long term or end-stage liver disease, supportive treatment will be provided in an effort to slow the progression of the disease

If your dog has experienced hepatic failure it is important to administer the medication that your veterinarian recommended and make appropriate changes to his diet. Regular follow up appointments will be required so that your veterinarian can keep an eye on his progress. 

It will be important to provide your dog with nutritional support and manage his diet in order to assist in his recovery from hepatic failure. For example, a low protein, low sodium diet served in small frequent meals will help minimize the stress on your dog’s liver. There are specific foods available for dogs who have problems with their liver. Antioxidants, zinc, B vitamins, Vitamin C and Vitamin E may also be recommended to help liver function.