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 SymptomsSymptoms 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).
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 DiagnosisIt 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 TreatmentTreatment 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.
PreventionDoberman'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 DietNeed 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.
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 HealthSupplements and antioxidants can help reduce liver injury.
Supplements and antioxidants TO AVOID
Causes of Elevated Liver Enzymes in Dogs
The following are some causes of elevated liver enzymes in dogs:
Other causes of Jaundice in DobermansIcterus, 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:
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 firstname.lastname@example.org
|The purpose of this database is to provide online access to a Doberman registry/pedigree that aims to further gather and provide information that may help researchers in understand more about genetic health issues effecting our beloved Dobermans.|