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Vacuolar Hepatopathy 1025

the patient’s systemic health. This is especially Technician Tips SUGGESTED READING
important in areas of the country where Ensure that ancillary ocular diagnostics Townsend WM: Canine and feline uveitis. Vet Clin
VetBooks.ir • Idiopathic/immune-mediated uveitis is quite are performed for uveitis at all recheck visits. RELATED CLIENT EDUCATION Diseases and Diseases and Disorders Disorders
fungal or tick-borne disease is prevalent.
(fluorescein staining and IOP measurement)
North Am Small Anim Pract 38:323-346, 2008.
common, in which case systemic disease will
Client Education
not be identified.
• Inflammation may worsen as treatment • Depending on the cause and response SHEETS
frequency is tapered; close monitoring is to therapy, uveitis may cause permanent Consent to Perform Abdominal Ultrasound
indicated. blindness. Consent to Perform Enucleation
• Although a cause cannot always be deter-
Prevention mined, a search for the cause should be How to Administer Eye Medications
• Preventive health care, including vaccinations attempted because some causes are readily How to Assemble and Use an Elizabethan Collar
and ectoparasite control. amenable to early treatment but can prove AUTHOR: Thomas Chen, DVM, MS, DACVO
• Refer animals with cataracts early so that fatal if not addressed. EDITOR: Diane V. H. Hendrix, DVM, DAVCO
surgical options can be discussed. • Long-term treatment may be necessary.
• Refer complicated ulcers/corneal perforations
and lens luxations immediately if the eye is
to be saved.

Vacuolar Hepatopathy Client Education Bonus Material
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BASIC INFORMATION ○ Immune-mediated disease (10%) • In dogs with VH secondary to chronic
○ Gastrointestinal diseases (9%) illness, clinical signs are associated with the
Definition ○ Many less common conditions, including underlying disease process.
Vacuolar hepatopathy (VH) is a commonly infections
detected canine liver syndrome characterized PHYSICAL EXAM FINDINGS
by the cytosolic accumulation of glycogen in ASSOCIATED DISORDERS • Physical exam findings are typically associated
hepatocytes, resulting in cell distention, fragility, • Rarely, dogs develop hepatic insufficiency with excess cortisol.
and degeneration. with biochemical evidence of cholestasis, ○ Overweight
parenchymal stromal collapse, and/or ○ Dermatologic abnormalities (e.g., truncal
Synonyms formation of regenerative nodules. Rarely, alopecia, pustules, striae)
Steroid hepatopathy, glucocorticoid hepa- acquired portosystemic shunts, ascites, ○ Abdominal distention without fluid
topathy, hepatocellular steatosis, hepatocellular and even death have been reported, but wave
lipidosis these features might not have been due ○ Hepatomegaly with rounded liver border
to VH. • In dogs with VH secondary to chronic
Epidemiology • Dogs with VH have been reported to have illness, findings can be markedly different
SPECIES, AGE, SEX biliary mucoceles (p. 374), but it is likely and are associated with the underlying disease
• Dogs of any age, sex, or breed these conditions have a common underly- process.
○ Typically older dogs (median age, 9 years; ing cause rather than VH causing biliary
range, 1-19 years) mucoceles. Etiology and Pathophysiology
○ Neutered females are overrepresented; • Scottish terriers with progressive VH seem to • Common liver disorder: in a review of hepatic
neutered males are underrepresented. be predisposed to hepatocellular carcinoma biopsies from 500 dogs, VH was detected
• Rare in cats (p. 444) (p. 446). Frequent serum biochemical in 19%.
analysis and ultrasonographic surveillance • VH is characterized by the cytosolic
GENETICS, BREED PREDISPOSITION for early tumor detection is recommended accumulation of glycogen in hepatocytes,
Vacuolar hepatopathy in Scottish terriers may for the breed. resulting in cell distention, fragility, and
be linked to adrenal steroidogenesis. • Progressive VH is seen with hepatocutaneous degeneration.
syndrome (p. 952). • The majority (55% of dogs in one study)
RISK FACTORS develop VH associated with iatrogenic,
• In one study, severe VH occurred three times Clinical Presentation typical, or atypical hyperadrenocorticism.
more often in dogs exposed to glucocorti- DISEASE FORMS/SUBTYPES ○ The remaining dogs are theorized to
coids than other dogs, and 55% of dogs with The severity of hepatocellular vacuolation is develop VH secondary to stress-induced
VH had exogenous or excessive endogenous categorized as mild, moderate, or severe based hypercortisolemia associated with illness,
steroid hormone exposure. on acinar zonal distribution of hepatocyte including cancer, infections, and inflam-
• It is commonly diagnosed secondary to or vacuolation on histopathology. matory disease.
concurrent with the following diseases: • Although previously considered a benign
○ Neoplastic diseases (28% of cases in one HISTORY, CHIEF COMPLAINT transformation, later observations raise the
study) • Clinical signs are often those associated concern that VH may be associated with
○ Acquired hepatobiliary disease (13%) with excess glucocorticoids (e.g., polyuria/ pathogenic scenarios, including hepatic
○ Adrenal gland dysfunction (12%) polydipsia, polyphagia, panting, bilateral insufficiency, hepatocellular carcinoma, or
○ Neurologic diseases (11%) symmetric truncal alopecia [p. 485]) biliary mucoceles.

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