INTERNAL MEDICINE
sin– aldosterone system, or a combination thereof.
Although the diagnostic work-up (eg, histopathology,
metal analysis, culture) is similar to that of less marked
cases of chronic hepatitis, it is often too late for specific beneficial treatment, even if a primary cause is
identified (eg, copperassociated hepatitis). Supportive
care may include palliative abdominocentesis if the
ascites compromises respiration, but the newly emptied space will likely refill. Spironolactone (1–2 mg/kg
q24h) combined with furosemide may be used when
fluid removal is less critical; however, it may increase
risk for hepatic encephalopathy from alkalosis or hypokalemia effects.
Cirrhosis and ascites are negative prognostic indicators against which colchicine at 0.025 mg/kg q24h
may be tried; however it lacks proven benefit. Prednisone and nonspecific liver protectants are indicated,
but the prognosis can be grave.
*Editor's Note: These cases with hypertension will/
may eventually develop acquired shunts, managing
the ascites clinical sign.
ly had success using
cyclosporine at a starting
dose of 5 mg/kg q24h.2 Unlike prednisone, cyclosporine does not induce canine liver enzyme elevation.
Hepatitis cases (acute and chronic) can be treated
with ursodeoxycholic acid at 7.5 mg/kg q12h to enhance bile flow, dilute toxic bile acids, and provide
both immunomodulatory and antioxidant effects.
Antioxidants may benefit cases of canine hepatitis:
S-adenosylmethionine (SAMe; 10 mg/kg q12h), silymarin (100–200 mg/dog q24h), and vitamin E (100–
400 IU/day).
2
Hepatic fibrosis or cirrhosis
Chronic hepatitis may progress to a cirrhotic liver as
fibrin replaces liver parenchyma, causing permanent
changes in hepatic architecture. This is a morphologic diagnosis of prognostic significance.
The presentation, often severe, can