ACVIM consensus statement on the diagnosis and treatment of chronic hepatitis in dogs

Abstract

This consensus statement on chronic hepatitis (CH) in dogs is based on the expert opinion of 7 specialists with extensive experience in diagnosing, treating, and conducting clinical research in hepatology in dogs. It was generated from expert opinion and information gathered from searching of PubMed for manuscripts on CH, the Veterinary Information Network for abstracts and conference proceeding from annual meetings of the American College of Veterinary Medicine and the European College of Veterinary Medicine, and selected manuscripts from the human literature on CH. The panel recognizes that the diagnosis and treatment of CH in the dog is a complex process that requires integration of clinical presentation with clinical pathology, diagnostic imaging, and hepatic biopsy. Essential to this process is an index of suspicion for CH, knowledge of how to best collect tissue samples, access to a pathologist with experience in assessing hepatic histopathology, knowledge of reasonable medical interventions, and a strategy for monitoring treatment response and complications.

Keywords: ascites; bile acids; bilirubin; biopsy; coagulation; copper; hepatic; inflammation; liver; portosystemic shunting.

Figure 1

Primary and secondary chronic inflammatory hepatopathies in dogs. Inflammatory changes on a hepatic biopsy can be due to a primary or secondary hepatopathies. The primary hepatopathies represent a disease process centered on the liver and include chronic hepatitis which can progress to cirrhosis and lobular dissecting hepatitis. Primary hepatopathies are typically accompanied by evidence of hepatocyte necrosis/apoptosis as well as varying degrees of ductular proliferation and fibrosis. Secondary hepatopathies however occur due to a primary disease process elsewhere in the body, often involving the splanchnic circulation, that damage the liver. In this case inflammatory changes are limited to the portal areas and are not accompanied by fibrosis or hepatocyte necrosis/apoptosis. In this case the liver lesions do not represent the primary problem and one should search for the presence of an extrahepatic disorder. ALP, alkaline phosphatase; ALT, alanine aminotransferase; APSS, acquired portosystemic shunts; E, eosinophilic; L, lymphocytic; M, granulomatous; N, neutrophilic; P, plasmacytic; TSBS, total serum bile acids