Page 743 - Clinical Small Animal Internal Medicine

65 Cirrhosis and its Consequences 711

been proven to have superior acid‐blocking effects com­ superoxide dismutase (SOD). It has proven efficacy in
VetBooks.ir pared to H2 blockers in dogs and should be utilized in veterinary medicine against hepatic toxicity from
Amanita mushroom and acetaminophen toxicity. It was
these cases. Sucralfate may also be of benefit in rapid
healing and prevention of continued bleeding.
also shown to decrease CCNU‐induced hepatotoxicity
when used in combination with SAM‐e. Again, its use
for treatment of cirrhosis has not been evaluated.Further
Coagulation Disturbances details on the use of hepatoprotectants in dogs with
chronic liver disease can be found in Chapter 62.
Disturbances in coagulation will usually only need to be
treated in the face of active bleeding, or if a biopsy is to
be pursued. Vitamin K1 therapy may also be beneficial
either for acute hemorrhage or prior to biopsy, especially Monitoring
in cats. For active bleeding, cryoprecipitate (1 unit/10 kg)
should be administered for hypofibrinogenemia, as it The frequency of monitoring depends on the severity of
provides the most concentrated source of fibrinogen. illness and the underlying disease. Rechecking electro­
Fresh‐ frozen plasma (10–20 mL/kg) may also be utilized lytes and renal parameters is of the utmost importance
for fibrinogen and other factor replacement. when utilizing and adjusting doses of diuretic therapy.
Liver enzymes, most importantly ALT, should be evalu­
ated every 2–4 weeks in animals being treated with glu­
Hepatoprotectants
cocorticoids for inflammatory liver disease. If HE is
The evidence regarding hepatoprotectant therapy in vet­ present, monitoring fasting ammonia levels may provide
erinary medicine is generally lacking. It is unclear when useful information regarding response to HE treatment.
and which hepatoprotectant might be most beneficial for
specific hepatic diseases in dogs and cats. Therefore, it is
difficult to make recommendations regarding their use in Prognosis
animals with cirrhosis. However, the use of ursodeoxy­
cholic acid, S‐adenosyl‐L‐methionine (SAM‐e), silymarin, Prognosis for cirrhosis is generally guarded, as cirrhosis is
N‐acteylcysteine, and vitamin E have all been anecdotally an irreversible condition. Prognosis may also vary widely
or experimentally recommended as potentially beneficial based on whether or not the underlying hepatic disease is
in the treatment of severe liver disease. treatable, and the severity of cirrhotic complications such
One of the more promising hepatoprotectant medica­ as HE and PH. One study evaluated dogs diagnosed with
tions is ursodeoxycholic acid (ursodiol, UDCA). Ursode­ CH with and without cirrhosis, and found that noncir­
oxycholic acid is a synthetic hydrophilic bile acid that is rhotic dogs with CH had a median survival time (MST) of
thought to provide a cholerhetic effect, decreasing levels 33 months, compared to cirrhotic dogs MST of only 1.3
of more “toxic” hydrophobic bile acids. It is also thought months. Ascites has been reported to be a negative prog­
to have immunomodulatory and antioxidant effects. It has nostic indicator in dogs with CH, with survival time from
been advocated for use in CH and gallbladder mucoceles. onset of clinical signs to death of only two months, when
Its utility in the treatment of cirrhosis is unknown. compared to dogs with CH and no ascites.
S‐adenosyl‐L‐methionine has also been advocated for
use in cases of hepatic disease. It is thought to increase
available levels of glutathione, an important antioxidant Conclusion
of the liver, by increasing levels of the glutathione pre­
cursor methionine. Glutathione production may become Cirrhosis is a severe, irreversible condition that occurs as
inadequate in cases of chronic inflammation and con­ a consequence of underlying liver disease. It often leads
tinuous oxidative stress. SAM‐e was reported to be to additional complications including portal hyperten­
effective in veterinary medicine in a case of acetami­ sion, ascites, multiple aPSS , HE, gastric ulcers, and coag­
nophen toxicity, and may provide protection against ulopathy. Early recognition and diagnosis of liver disease
steroid hepatopathy. It is unknown if it provides benefit followed by specific treatment are always warranted to
in cases of cirrhosis. prevent the development of cirrhosis. Once cirrhosis and
Silymarin, silybinin, or milk thistle, is another antioxi­ its complications are present, supportive care is the only
dant and free radical scavenger that increases levels of treatment option and prognosis is guarded to poor.