What is Liver Disease (Copper Storage)?
Copper is an important trace element for dogs. It is vital to the production of enzymes and other important cellular processes. Copper taken in through food is metabolized and stored in the liver. Any excess copper is excreted in bile and flushed out of the body via the stool and urine. If too much copper accumulates in the liver, it can cause copper-associated hepatopathy which leads to liver dysfunction and eventually failure. This problem is most commonly caused by a genetic abnormality. A specific gene that reduces bile excretion and causes copper to accumulate in the liver has been identified in some Bedlington terriers. Other breeds can have a similar problem, although the condition is usually not as severe and the exact genetic mechanisms have not been fully studied. Dogs with copper-associated hepatopathy can show varying symptoms. Some dogs have bloodwork that indicates a degree of liver dysfunction, but little or no sign of illness. Other dogs may have slowly developing symptoms of chronic hepatitis. Acute liver failure may develop suddenly with little warning. Sometimes the liver releases large amounts of the stored copper, killing red blood cells and causing copper related anemia. Over time, even mild conditions can cause scarring of the liver and eventually cirrhosis and end-stage liver disease. Some medications and diet change can help to stop the accumulation of copper in the liver.
Excessive copper storage in the liver is caused by a genetic abnormality. In dogs, veterinarians define this as copper-associated hepatopathy. It is more common in some breeds. Untreated, it can lead to cirrhosis and acute liver failure.
Symptoms of Liver Disease (Copper Storage) in Dogs
Any of the following symptoms should be evaluated by a veterinarian. Acute, life-threatening symptoms should be treated as an emergency.
- Vomiting
- Decreased appetite
- Weight loss
- Excessive thirst
- Frequent urination
- Bloody diarrhea
- Jaundice
- Anemia
- Ascites (fluid in the abdomen)
- Gastrointestinal bleeding
- Ulcers
- Hepatic encephalopathy (disorientation, circling, aggression, seizures coma)
Types
Three different manifestations of the disease have been noted.
- Sub-clinical disease – blood tests show signs of liver disease and high copper levels can be detected with a biopsy of the liver, but dogs don’t show symptoms of illness
- Chronic hepatitis – traditional symptoms of liver dysfunction; symptoms may progress slowly, but lead eventually to acute liver failure; sometimes copper accumulation can occur secondary to chronic hepatitis from another source
- Acute hepatic necrosis – dogs will develop the traditional symptoms of acute liver failure along with copper induced hemolytic anemia; death normally takes place within 2-3 days; survivors may experience bouts of intermittent illness
Causes of Liver Disease (Copper Storage) in Dogs
Three factors can affect copper storage in the liver.
- Failure to excrete copper in the bile – this is known to be a problem in Bedlington terriers
- Excessive copper storage – the liver can sometimes store too much copper, particularly if hepatic inflammation or chronic hepatic disease is present; it’s believed that this condition may be responsible for copper accumulation in other breeds
- Excessive copper ingestion – copper is found in trace elements in the diet; too much copper at one time can overwhelm the liver’s storage capacity and cause liver damage; this isn’t normally a problem, but dogs with a genetic tendency to excessive copper storage can be affected by a high copper diet; changes in dog food in the late 90’s made dietary copper in most brands more accessible to dogs and have led to higher levels of copper accumulation, even in dogs that don’t show symptoms
Breed and family heritage is a big factor, although it’s possible for any dog to have this problem. Some breeds tend to manifest the disease differently.
- Bedlington Terriers – most dogs with the gene will develop acute liver necrosis before they are 6; breeding management has helped to decrease the number of cases
- Doberman Pinschers – blood work can be abnormal as early as 1 year old, but liver disease doesn’t usually manifest until dogs are about 7
- West Highland White Terriers – disease can occur at any time, copper accumulation is apparent as early as 1 year old
- Skye Terriers – disease can occur at any time
- Dalmatians – middle aged dogs are often diagnosed with chronic hepatitis
- Labrador Retrievers – middle aged dogs are often diagnosed with chronic hepatitis
Diagnosis of Liver Disease (Copper Storage) in Dogs
Blood and urine tests will usually show signs of liver failure, especially if your dog has significant symptoms. Some blood tests may require fasting. X-ray’s and ultrasound may be taken to check for enlarged liver as well as eliminate some other causes of liver failure. A definitive diagnosis of copper-associated hepatopathy is made with a biopsy of the liver. This is an invasive procedure that will not be possible with dogs experiencing symptoms of acute liver failure.
The veterinarian will want to know your dog’s breed and family history to help determine how likely it is that your dog has this condition. Your dog’s age could also be relevant. Past and present medications can help determine if drug poisoning or toxicity could have contributed to the liver failure, and the veterinarian may also want to know the dates of your dog’s last vaccinations to eliminate some infectious causes.
Treatment of Liver Disease (Copper Storage) in Dogs
Acute liver failure will need to be treated supportively. Fluids and electrolytes will be given to help flush toxins out of the body. Blood transfusions may be necessary for dogs with high levels of red blood cell destruction and copper induced anemia. Severe acute attacks can end up being fatal even with treatment.
Several medications are given to help reduce copper accumulation. Copper chelators bind to the copper in the liver so that it can be excreted in the urine. Over time, this can reduce high copper levels and reverse liver dysfunction. These medications do have significant side effects, however, and they must be taken over a period of 4-6 months to have an effect. Copper deficiency can also be a problem.
Zinc can reduce copper absorption in the intestine. This medication is sometimes used in milder cases. It should not be with combined with chelators as the two medications can negate each other. Zinc can also have significant side effects in some dogs, and blood tests will be necessary to avoid toxic levels. The veterinarian may need to try several medications to see what works best for your dog. Vitamin E and other antioxidants are often given along with both medications to reduce liver damage.
Diet change may be prescribed in many cases. Some veterinarians may recommend dog food designed especially for dogs with liver disease. This type of food is lower in copper and protein. Others may recommend a homemade diet. Avoid feeding your dog any supplements that contain copper as well as organ meats that are high in protein and minerals. Small carbohydrate based meals put less stress on the liver.
Recovery of Liver Disease (Copper Storage) in Dogs
Full recovery from copper-induced hepatopathy is rare. At the very least your dog will need to follow a strict diet, probably for the remainder of his life. This is the best way of treating young dogs to avoid the accumulation of copper before it becomes problematic. Dogs with severe cases will need long term medication. Discuss the best medication with your veterinarian and monitor the side effects closely. You should return often for testing so the veterinarian can keep track of your dog’s progress.
Liver Disease (Copper Storage) Questions and Advice from Veterinary Professionals
Has Symptoms
My dog had a Cholecystoduodenostomy hes recovering well but he does have copper in liver and is taking denamarin and was just prescribed penicillamine which with this vet wants me to give 40mg of vitamin e from a capsule how do i figure out how much is 40mg?
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My dog was diagnosed recently and has been on penicillamine for three months now. Her ALT levels have lowered significantly but our vet wants us to do one more month for good measure. My dog has started having skin reactions (darkened, scaly spots), hair loss around the dried out skin, and weight loss. Our vet is encountering this disease for the first time so more opinions are optimal. I am worried about the severity and possible underlying causes of these reactions. I have found studies where humans show skin reactions, but might this be similar?
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I am working with my vet to diagnose the reason the my dog's liver enzyme numbers are so high (900's). She has no other presenting symptoms,just slow weight loss and a funny odor. She is six year old hound mix. We have tried antibiotics with no luck. She had an ultrasound and there were no masses or enlarged organs. The Dr. said her liver was darker than it should be. I am taking her to Cornell for a biopsy in two weeks. I am terrified that she has lymphoma and actually hoping it is a copper storage problem. I guess I was just looking for another vet's thoughts on the matter.
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My dog has severe liver disease which we found out via a biopsy and blood count. He is asymptomatic and the sonagram showed nothing.
He went on Depensilymine, Phoscal, Urisodol, Vitamin e, B6 and is on a home cooked diet.
His liver counts evened out and the vet reduced his DPencilyimine to once every other day. His liver counts went up so we went back to a month with the meds twice a day. His counts are not going back down. (When he was first diagnosed his liver counts went down within a month). They would like to do another biopsy. Any thoughts or other ideas?
(his parents are alive and healthy... The breeder has never heard of any other issues)
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Does penicillamine cause hair loss in dogs? My collie has been on it for copper chelation for 6 mos and has severe hair loss. We are also testing for hypothyroid.
So far most tests are normal, but TSH is high at 1.50. Waiting for results of premium
thyroid panel.
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My dog was diagnosed with Copper Storage Hepatophathy. I found this out through liver enzymes continuing to rise and then a biopsy. I tried Science Diet l/d and the enzymes continued to rise. I now have him on Royal Canin Hepatic dry and canned food. His appetite slowly began to decrease and now he is not eating it at all. I started baking treats out of his Hepatic dry dog food and he will eat them but still will not eat the dog food. It's been a week since he ate it but I do know he has an appetite because he wants table food. I feel helpless at this time because he's either going to starve himself or I can give him chicken, lean beef or a roast beef which will kill him because of his liver disease. I am a complete mess over this and don't know where else to turn. He does have an internal medicine doctor but this eating problem is a completely a different problem then treating his liver disease. He is currently on Denamarin, Penicillamine, Vitamin E, and now thyro tabs for a recently diagnosed thyroid issue. Please help us as I am feeling as helpless as I ever have.
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