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174 Cirrhotic/Fibrosing Liver Disease

handling. Therefore, minimal handling is • Complications of thoracocentesis: pneu- SUGGESTED READING
important. mothorax and hemothorax. Monitor for McAnulty JF: Prospective comparison of cisterna
VetBooks.ir • Avoid dorsal recumbency for radiographs in after pleural drainage and alert clinician if spontaneously occurring idioipathic chylothorax
effort
respiratory
tachypnea/increased
• Supplemental oxygen is helpful in a dyspneic
chyli ablation to pericardectomy for treatment of
patient with pleural effusion.
identified.
in the dog. Vet Surg 40:926-934, 2011.
animals with pleural effusions.
• Supplies for emergency thoracocentesis: clip- Client Education AUTHOR: Graham Swinney, BVSc, DVCS
EDITORS: Megan Grobman, DVM, MS, DACVIM
pers, skin preparation materials, a butterfly Chylothorax can be a frustrating disease and
needle or needle with an extension set, 3-way requires diagnostic assessment to identify
stopcock, and syringes treatable underlying causes.
Cirrhotic/Fibrosing Liver Disease Client Education
Sheet

BASIC INFORMATION and steatorrhea, hypoglycemia, and hypoal- • Possible underlying causes include cholangitis
buminemia may result from fibrosing liver (cats), copper storage disease and high-copper
Definition disease. diets in predisposed breeds (dogs), drugs
• Fibrosis: replacement of hepatic parenchyma • Rare occurrence of pulmonary edema and/or toxins (aflatoxin, anticonvulsants,
with extracellular matrix (ECM), collagen, (hypoalbuminemia), chronic kidney disease/ azole antifungals, timethoprim-sulfadiazine),
and connective tissue uremia (hepatorenal syndrome), or transient immune-mediated disease, leptospirosis,
• Cirrhosis: diffuse hepatic fibrosis with erythropoietic protoporphyria. canine infectious hepatitis virus, hypoxia,
concurrent formation of regenerative nodules Clinical Presentation extrahepatic biliary obstruction, a single
that results in irreversible loss of normal episode of massive hepatic necrosis (i.e.,
hepatic architecture HISTORY, CHIEF COMPLAINT postnecrotic cirrhosis), or COMMD1
• Sometimes a sequella to chronic hepatitis, this • Chronic condition of varied severity that deficiency (which leads to hepatic copper
disorder is being recognized with increasing usually includes lethargy, anorexia, and accumulation and chronic hepatitis).
frequency in a variety of breeds. weight loss • Hepatic vascular resistance may increase,
• Vomiting, diarrhea, melena, and polyuria/ resulting in portal hypertension, ascites,
Epidemiology polydipsia also frequently are part of the acquired portosystemic shunts, and encepha-
SPECIES, AGE, SEX history. lopathy.
• Incidence is highest in middle-aged to older • Owners occasionally note jaundiced color
dogs (>7 years) with chronic liver disease. of sclera or skin. DIAGNOSIS
• Middle-aged cats with chronic cholangitis • Owners may report abdominal distention
may suffer from biliary cirrhosis. from ascites as weight gain, even as the Diagnostic Overview
• Copper storage hepatopathy (≈1-5 years) and patient loses muscle mass. Although plasma markers of this condition
idiopathic hepatic fibrosis (<2 years) occur • Neurologic signs can occur as a manifestation are being developed (transforming growth
in younger dogs. of HE (p. 440). factor beta-1, others), histopathologic analy-
sis of a liver biopsy specimen remains central
GENETICS, BREED PREDISPOSITION PHYSICAL EXAM FINDINGS to the diagnosis. It is particularly important
• Doberman pinschers, cocker spaniels, • May be unremarkable except for weight loss to look for excess copper accumulation
Scottish terriers, Labrador retrievers, and and muscle wasting as a treatable cause of progressive hepatic
English springer spaniels have a familial • Icterus occurs commonly. lesions.
predisposition to idiopathic chronic hepatitis • Ascites and evidence of coagulopathy in
(pp. 450 and 452). advanced cases Differential Diagnosis
• Copper storage disease is inherited in • Microhepatica may be present (dogs), although • Idiopathic chronic hepatitis (dogs)
Bedlington terriers, West Highland white cats with biliary cirrhosis may have large livers. • Ductal plate abnormalities
terriers, Labrador retrievers, and Dalmatians • Manifestations of cerebral dysfunction • Congenital hepatic fibrosis
(p. 458). (depression, stupor, others) due to HE • Cholangitis (cats)
• German shepherds and standard poodles • Noncirrhotic portal hypertension
develop juvenile idiopathic hepatic fibrosis. Etiology and Pathophysiology • Biliary duct obstruction
• ECM deposition (fibrosis) is stimulated • Pancreatitis
RISK FACTORS by inflammatory mediators and cytokines, • Hepatic neoplasia (primary or metastatic)
Idiopathic chronic hepatitis (formerly chronic which activate hepatic stellate cells to produce • Exposure to hepatotoxic drugs or toxins
active hepatitis) in dogs, excess hepatic copper collagen (congenital or idiopathic). • Feline infectious peritonitis, toxoplasmosis
or iron storage, extrahepatic biliary obstruction, • Chronic fibrosis and regenerative nodule • Chronic fibrosing pancreatitis
drug administration (phenobarbital, others) formation results in cirrhosis. Chronic • Congenital portosystemic shunt
(p. 1231) progressive collagen deposition irreversibly • Hepatic lipidosis (cats)
destroys normal hepatic architecture.
ASSOCIATED DISORDERS • Normal hepatic blood flow and bile flow are Initial Database
• Portal hypertension, ascites, hepatic encepha- disrupted, perpetuating hepatocellular injury. • CBC
lopathy (HE), coagulopathies, urolithiasis, • Any chronic inflammatory hepatic condition ○ Nonregenerative anemia (normocytic,
acquired portosystemic shunts, gastric ulcer- may be responsible, although a specific cause normochromic, or microcytic)
ation, portal vein thrombosis, fat malabsorption is not often identified (i.e., idiopathic). ○ Acanthocytes (cats)

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