Liver Inflammation (Granulomatous) in Dogs

Your dog’s liver (just like ours) is one of the most important organs of the body with more than 1,000 essential functions to keep the body healthy. Some of the most important jobs of the liver are producing bile, protein, cholesterol, and protein as well as converting extra sugar to glycogen. It also keeps blood stored in case the body needs it from a sudden loss of blood. Another important function (maybe the most important) is to keep the blood free of any foreign materials, which is what happens in the case of granulomatous hepatitis. Inflammation (swelling) of the liver (hepatitis) is a result of any kind of liver irritation or infection. This swelling is caused by granulomas (a group of cells) that are formed to try to fight off the underlying disease or affliction ( fungus, bacteria, parasite, cancer, immune system, medication reaction). What makes this disorder dangerous is that the actual cause of granulomatous hepatitis may not be easy to determine, slowing down the start of treatment.

Liver inflammation (granulomatous hepatitis) is a symptom of other diseases of the liver, such as bacterial infection, fungal infection, cancer, virus, or parasitic disease. This disorder is not common and can affect any sex, age, or breed of dog and the causes most often seen for granulomatous hepatitis are fungal infections. A granuloma is a group of chronically inflamed (swollen and irritated) cells that have both giant multinucleated and epithelioid cells, which happens when the immune system tries to block materials it sees as foreign. This is a difficult disorder to diagnose because it is usually accompanied by symptoms from other systems (multisystem disorder).

The symptoms of granulomatous hepatitis are extremely varied because this condition is really a symptom in itself. The underlying disease or disorder causing granulomatous hepatitis is what will usually cause the symptoms:

Infectious

• Lack of appetite
• Vomiting
• Diarrhea
• Weight loss
• Lethargy
• Increased urination (polyuria)
• Increased thirst (polydipsia)
• Abdominal pain
• Yellowish discoloration of the skin and the whites of the eyes due to jaundice
• Distended abdomen
• Fever

Autoimmune Disease

• Skin disorders
• Mouth ulcers
• Lesion, especially in the nose
• Seizures
• Anemia
• Enlarged lymph nodes
• Change of gait
• Unusual body odor

Drug Related

• Jaundice
• Fatigue
• Loss of appetite
• Nausea and vomiting
• Headache
• Abdominal pain
• Dark urine
• Diarrhea

 Types

• Infectious can be fungal, bacterial, parasitic
• Immune-related can be caused by several diseases, including lupus and autoimmune hemolytic anemia.
• Idiopathic is of unknown origin
• Drug-related possibly from accidental overdosage

While there are many causes for granulomatous hepatitis, there are also many situations where the cause is never found (idiopathic). In those cases, you and your veterinarian may spend a lot of time looking for the cause just to end up determining that there may be no cause.

• Fungal infections: coccidioidomycosis, histoplasmosis, blastomycosis, systemic mycosis
• Bacterial infections: brucellosis, tuberculosis, bartonella
• Parasites: liver flukes, leishmania, visceral larval migrans
• Cancer
• Immune disease (like  lupus or autoimmune hemolytic anemia)
• Reactions to certain medications
• Idiopathic (unknown cause)

If your dog needs immediate treatment for dehydration or other life-threatening symptoms, the veterinarian will first start IV fluids and possibly oxygen therapy if he thinks it is necessary. Once your dog is stable enough, the veterinarian will ask you to describe the issues that brought you to the office and how long they have been going on. At this time, it is important to be sure your veterinarian has your dog’s medical records, vaccination history, and information about any injury, illness, and behavior changes.

The next thing your veterinarian will do is a detailed physical examination including weight, blood pressure, pulse rate, temperature, and respirations. It will also be necessary to get some radiographs (x-rays) of the abdomen to check for abscesses, blockages, tumors, or other abnormalities in the liver or bile ducts. If necessary, they may also get an abdominal ultrasound, MRI, or CT scans.

Some of the lab tests that your veterinarian will perform are a blood glucose level, biochemistry panel, complete blood count, urinalysis, liver enzyme evaluation, and a fine needle biopsy. If a mass or tumor is found and more information is needed for diagnosis, the veterinarian may do a wedge biopsy to get a piece of tissue for histopathology.

Treatment will depend on the underlying cause. Further treatment to continue IV fluids and oxygen therapy may require an overnight hospital stay until your dog is stable enough to be released. Examples of medications that may be used are antibiotics ( amoxicillin) for a bacterial infection, antifungal ( ketoconazole) for a fungus infection, and parasitic medication (paromomycin) if the cause is parasitic. If the cause is found to be a cancerous tumor, surgery will be required to remove the tumor and possibly radiation and chemotherapy if the veterinarian thinks it may have metastasized. The most often prescribed medications for idiopathic granulomatous hepatitis are anti-inflammatory medication (cyclosporine), antioxidant (vitamin E), antifibrotic medication ( colchicine) and choleretics to replace the bad acid with good acid.

If the source of granulomatous hepatitis is found and treated, the chances for your dog’s recovery are good. Idiopathic granulomatous hepatitis can become a chronic disorder if none of the treatments your veterinarian has a positive result, leaving your dog at risk for liver failure and this is usually fatal.