Chronic Active Hepatitis (CAH)



CAH is a progressive inflammation state that cause the liver to break down to the point of liver failure and death. There is not a standard treatment avaiable yet, nor is a cause known. Females are prone than males, and it can show up at any age. The average age however is middle aged, 4 to 6 years old. Most likely this is a genetically inherited disease which results in toxic levels of copper to be stored in the liver. It is not an infection disease, it is hereditary. If the disease is in one of the parents, it may or may not be in the litter.

CAH Symptoms

Symptoms usually show up when almost 1/2 the liver has already been destroyed. With CAH, the liver cells die and are replaced by scar tissue. Proteins are release as well, that will elevate ALT values. It largely effects the blood vessels leaving the liver (the liver is a major filtering organ).
  • Intermittent recurrent abdominal or gastrionintestional upset:
    • Loss of Appetite
    • Vomiting
    • Diarrhea
    • Constipation
  • Lethargic
  • Fluid Accumulation in the Abdomen, Abdominal distension
  • Pale or Gray Feces
  • Orange Urine
  • Jaundice to skin, gums and white of eyes
  • Abdominal Pain
  • Weight Loss and loss of body condition
  • Excessive (Increased) Thirst and Urination
  • Anorexia

One of the first symptoms to show is, excessive drinking. It may be intermittent. The next common symptom to show is lack of appetite. Vomiting and weight loss may soon follow. As the disease progresses, the gums may begin to turn yellowish in color. It is easy to see in the white's of the eyes. This jaundice stage is brought when the liver is dysfunctioning and allowing bilirubins (bile pigments) to accumulate in the blood stream. Weight loss will begin to increase, and body condition will lesson. Fluid will behind to distend the abdomen.

The goal is to not wait, excessive drinking is enough to talk to your vet about. CAH is nothing to wait on. The earlier it is caught, less damage has been caused to the river. Annual testing after you Doberman is 2 years old is advised.

CAH Diagnosis

It is found out through blood work typically, usually there is an elevated level of copper found in the liver during the early stages. Removing the copper in the early stages may slow the disease down.

Urinalysis, ultrasounds, X-rays and liver biopsies are considered basic for any disease process involving the liver.

The presence of continually elevated ALT values, and then by liver biopsy aids in CAH being diagnosed. At times an individual may have an abnormal value on a test, that is why it is stated the "presence of continually elevated" values. The liver biopsy is used to make the definitive diagnosis after 2 or three consecutive test showing high ALT values. Dobermans with ALT values over normal laboratory range (typial normal range is 24 - 136 U/I) more than once require further testing to learn what is going on. Different laboratories have different normal ranges for ALT. You can learn more on our Blood Work and Lap Reports page

If the dog is not diagnosed and treated, they often die within 2 years.

There have been projects that showed tests will show elevated ALT values for a long time before the individual showed clincial signs of the disease. Get your dogs liver enzymes check annually, especially if it is found to be in the blood line. Testing typically start when your dog is around 2 or 3. The diease can show at any time, and tyipcally shows in females between ages of 4 and 6. Males develop CAH less often.


CAH Treatment

Treatment should be started as early as possible! Before clinical signs show up. Once clinical signs show, the situation is worse. Blood test will show ALT values to be higher than normal, other blood parameters are often off. Since the cause is unknown, it is difficult to cure with specific treatment. Medications are used to relieve the symptoms. Drugs the help in eliminate the cause of the inflammation are seen most helpful. For those who do not respond to drugs, one can try to make things easier for the liver to function. However drugs such as corticosteroids have side effects. Drugs can also help eliminate toxins, antibiotics can support the liver's inability to remove infections. Supplements that support the liver can reverse some of the toxic effects on the body and the accumulation of fluid. It has been learned that the difference between the beginning of the symptoms and the start of treatment makes a large difference in survivial time. Drugs are being researched, however, there are not many promising alternatives. You can weeks to hopefully serval years. Make sure to know your dog, and keep track of their parents and grandparents so you have a heads up what to watch out for. If you know your dog well, hopefully you can easily pick up on when they are not themselves.

Prevention

Doberman's often suffer from the hereditary form of CAH. They should not be in any breeding program. With the hereditary factor, it is important to prevent factors that may predispose liver inflammation. Monitoring the liver for signs of toxicity is important. Be aware of administering certain drugs is also very important. Feeding a high quality kibble, and keeping your dog fit and not over weight helps their over all health.

Liver Healthy Diet

Need to provide all the necessary nutrients which may be lost do to the liver the liver not functioning well. We need to replace these without over working the liver. Top quality protein provides the essential amino acids as an easily digestible carrier which will not produce high levles of ammonia during digestion. Cottage cheese is a good one! Meat tends to produce ammonia. High levels of complex carbohydrates helps keep metabolism up. Fat is needed, but should be kept low.
  • Nutrients and adequate energy to fulfill basic requirements
  • Limit liver damage by preventing accumulation of copper
  • Support liver cell regeneration
  • Minimize possible complications
Protein is ESSENTIAL. Dogs with liver disease often have less protein being broken down, resulting in loss of energy, they therefore need more protein. Top quality protein provide essential amino acids in an easily digestible carrier that will not produce high levels of ammonia during digestion.

Many veterinarians recommend owners feeding their dogs a mix of animal and plant proteins. Soybean or dairy protein can cause diarrhea, but if a the dog can tolerate them well, cottage cheese and yorgurt are good foods to try.

Non-protein calores some what prevent the use of proteins for energy and reduce the need for the body to create glucose in the liver by converting protein molecules (gluconeogenesis).

Energy norally comes from fat, and it is a concentrate source. 30% of fat in the diet can be easily tolerated with dogs with liver disease.

Fiber can help a dog system out, as a preventative and with the liver disease. Soluble fiber such as beet pulp lowers the production and absorption of ammonia and helps the growth of beneficial bacteria. Fiber also helps the dogs system get rid of bile acids. Insoluble fibers help dog's feces have a have a normal transit time, preventing constipation and bind toxins.


Vitamins & Mineral Supplements for Liver Health

Supplements and antioxidants can help reduce liver injury.
Vitamin B - Just for basic health, can double if the liver disease is there.
Vitamin C - Do not give to much, as it increases the intake of copper.
Vitamin E - A water soluble form is best, it may help in reducing free radical injury.
Vitamin K - Helps with blood clotting, recommend in cases with chronic liver disease
Zinc - Is an anti-oxidant and also reduces the accumulation of copper in the liver

    Some good foods:
  • Cottage Cheese, Yogurt (proteins easily broken down)
  • Eggs (whites, yoke has fast)
  • White Fish
  • Oatmeal (souble fiber will help remove ammonia)
  • Pasta
  • Meat tends to produce high levels of ammonia
  • Reduce sodium intake
  • There are some RX kibbles available as well

Supplements and antioxidants TO AVOID
Potassium
Sodium
Copper
    Foods high with copper
  • Organ meats, esp beef liver
  • Lamb, pork, duck, and salmon are high in copper
  • Turkey, Chicken and other fish have moderate amounts
  • Beef and eggs are low in copper
  • This link list copper levels of various foods Foods with Copper




Causes of Elevated Liver Enzymes in Dogs
The following are some causes of elevated liver enzymes in dogs:
  • Jaundice usually occurs when the liver can not remove bilirubin, a waste product generated from the break down of hemoglobin. It gets accumulated and causes a yellow color formation around the whites of the dog eyes, the pale areas of the gums, or skin around the ears and stomach
  • Pancreatitis - You can learn more on our Pancreatitis page. Liver issues are common after a bout with pancreatitis. Read more on this link.
  • Blockage in the bile duct causes a rise in GGT which is concentrated in the kidney and pancreas.
  • Cushing's Disease: Cushing's disease causes excessive generation of adrenal hormones, specifically corticosteroids. As a result, there is an increase in alkaline phosphatase in the liver which imbalances the salt levels.
  • Hepatitis: Herpes gets transferred from one dog to another through contact or ingestion. Along with herpes, the parasites may attack the liver and increase the number of liver enzymes in order to remove the assailants.
  • Copper accumulation, obesity as fat is deposited in the liver, diabetes, and hypothyroidism.
  • Corticosteroids or epilepsy medicine
  • Hepatic shunts, congestive heart failure, cancer, and other Congenital diseases.


Other causes of Jaundice in Dobermans

Icterus, or Jaundice, is the yellow color taken on by the body's tissue to to elevated levels of bilirubin. Bilirubin is a by product of red blood cells breaking down.

Jaundice is abnormal. It is often seen in the whites of the eyes, along the gums, the skin at the base of the ears, and on the abdomen.

Three types of Jaundice:

  • Prehepatic Causes aka Hemolytic Causes: these occur before the blood passes through the liver, resulting from a breakdown of red blood cells.
    • Toxins: such as onion, zinc
    • Tumors of the blood vessels
    • Heartworm Disease
    • Blood Parasites (ex babesiosis)
  • Hepatic Causes: disorder associated with the liver
    • Hepatitis (Inflammatory Disease)
    • Cholangitis (Bile Duct System)
    • Heavy metals, Toxins
    • Cancer
    • Viral, Bacterial, Protozoal Infections
    • Cirrhosis (end stages of liver disease)
  • Posthepatic Causes: disorders that occur after the blood passes through the liver
    • Gall Bladder stones, cancer, or inflammation of gall bladder and bile duct
    • Pancreatic Cancer, Pancreatitis, and other Pancreatic diseases
    • Intestinal diseases that block the bile ducts
      • When jaundice is due to obstruction of the bile duct, the person will often notice that their urine becomes dark and stools become pale because the excess bilirubin 'spills over' into the urine and no longer colours the stool.


Some links I've kept track of:

Liver cleansing diet formulated by W. Jean Dodds, DVM

Special Considerations in Interpreting Liver Function Tests DAVID E. JOHNSTON, M.D.

Those pesky elevated liver enzymes

Liver Health for Pets - Denamarin, Denosyl, and Marin

NZYMES.COM: Official Site! Natural Supplements for Pets and People www.nzymes.com

**** Many of us are not vets or even close to an expert on these topics. Many articles have come from hours spent online reading and talking with others while trying to figure out what is best. If you have any questions, or information to add, feel free to contact me at web@dobermandata.com

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