Liver Inflammation in Dogs

It's common for a pet owner to overlook the symptoms of liver inflammation in the early stages. You may notice your dog losing their appetite, needing to urinate more, vomiting or being generally lethargic. These signs are not specific to liver disease. The liver not only removes toxins from the blood, but is also needed for the production of bile and the metabolism of proteins, fats, and carbohydrates. An inflamed liver will severely compromise the health of your dog. It's important to note that taking a wait and see approach, or failing to treat inflammation, can result in death of your dog.

The most common (though not exhaustive) symptoms include:

• Yellowing skin, mucus membranes and whites of the eyes (jaundice)
• Swollen and/or painful abdomen
• Lethargy
• Increased thirst
• Increased urination
• Dehydration
• Lack of appetite
• Vomiting
• Diarrhea
• Fever

Types

Dogs rely a great deal on their livers. It is the second largest organ in their bodies after their skin (1.3-5.0% of body weight) and its malfunction results in many canine deaths. There are two types of liver inflammation in dogs.

• Acute
• Symptoms manifest within days, and your pet's health quickly declines. This is the less common type, but is all the more distressing for its quick appearance. This is likely to be caused by toxins - possibly drugs, chemicals or a reaction to medicine, trauma, poor circulation and metabolic disorders. It must be treated immediately or will likely result in death as all these factors will contribute to necrosis (tissue death) of the liver.
• Chronic
• This condition occurs over long periods and, while no less serious, will manifest itself more slowly, so it is less easily detected. This condition is caused by the slow death of liver cells due an underlying disease.

There are many things which can contribute to inflammation of the liver, some of which include:

• Fungal infection
• Trauma
• Bacterial infection
• Viral infection
• Parasites (heartworm and liver flukes)
• Anemia (low iron)
• Cancer
• Immune mediated disease 
• Excess copper retention (note that Bedlington Terriers, Doberman Pinschers, West Highland Terriers and Skye Terriers have genetic predisposition to copper retention)
• Drug Reactions
• Blockage within the liver itself or the surrounding ducts
• This may not be directly causal, but the gallbladder, pancreas or chronic swelling of the kidneys may happen simultaneously with liver inflammation.

If any combination of symptoms have appeared either quickly or over long-term, it is imperative to consult a veterinarian. Conclusive diagnosis cannot be made by the pet owner.

In order to determine there is liver inflammation, you will need to give a thorough history of your dog's health and, if possible, have a good idea how long the symptoms have persisted (when they started, any correlated events, etc.).

The veterinarian will complete several tests including:

• X-rays of the chest and abdomen
• Ultrasound of the abdomen
• Complete blood profile - check the levels of liver enzymes
• Bile Acid Stimulation Test
• Urinalysis

The veterinarian will be looking for select abnormalities, these include:

• High liver enzyme levels
• High bilirubin levels (The liver filters bilirubin. They are waste products from the blood which should not exist in high quantities)
• Low glucose levels
• High copper levels
• Protein, red or white blood cells in the urine. (These can indicate infection)
• Low vitamin B12 levels. (This may indicate absorption problems with the small intestine or pancreas)
• Poor blood clotting. It should be noted that a failure of blood clotting can be a sign of late-stage liver failure.
• High levels of abdominal fluid

The veterinarian may require a biopsy of the liver. This will naturally have a chance of infection associated with it, but will help the doctor determine whether the inflammation is acute, chronic, correlated to a separate condition or if there are any abnormalities in the tissue or the surrounding fluid. Clotting ability should be analysed first.

Treatment varies dramatically based on what caused the inflammation. The basic aim of treatment is to minimise inflammation, support the liver and to remove any toxins out of the body with the help of intravenous fluids.

The doctors secondary, and competing priority, will be preserving the core function of the liver. This is done through the surviving liver cells.

• Treatment of acute inflammation will be to address the immediate cause. This will involve flushing out the harmful toxins through an overnight stay (in some cases several nights are required). This will be somewhat invasive due to the need for intravenous fluids.
• If the underlying cause is chronic, the veterinarian will discuss further treatment options with you. Generally, dogs are managed long-term rather than cured.

Regular checkups after either an acute inflammation or chronic inflammation are critical for your dog's health and wellbeing. After severe liver inflammation, follow-up visits are recommended after a minimum of 2-3 days to ensure all is well. If you notice any changes in symptoms, make an appointment sooner.

Your pet will need time and a restful environment to recover from any disease. If inflammation is caught early, it can be reversed - this is especially true in young dogs. However, in the case of older dogs, the underlying cause must be evaluated and the liver disease may not be reversible. 

It is likely antibiotics will be prescribed to prevent or treat infection. The doctor may recommend a diuretic to help with water retention.

There will be a diet change due to the need to regulate food protein levels because protein affects blood ammonia levels and consequently neurologic function, though whether higher or lower levels will be needed will depend on your pet's condition. Talk with your veterinarian about the need for supplementing this diet with water-soluble vitamins such as B, E and possibly K if blood clotting is part of the problem. You may need to change from feeding 2 or 3 large meals every day to smaller meals throughout in order to minimize the strain on the liver.

The cost of liver inflammation depends greatly on the type. Cancer treatment can reach thousands of dollars while an infection will be less, albeit still expensive if surgery is required. The standard costs include the basic veterinarian examination and visit which should cost around $55 and the full blood work, which could range between $100-$180. The minimum, excluding if an emergency clinic is required, is $425, while the maximum, excluding specialty treatments such as cancer, is $2,777.