The goals of treating a dog with chronic hepatitis are to stop the progression of the disease, provide excellent nutrition and other support for the liver, remove the inciting cause if it can be identified and keep the dog as comfortable as possible so as to maintain a comfortable, pain-free quality of life. If the dog has acute complications associated with its chronic disease, it may need to be hospitalized. That will enable the veterinary team to administer intravenous fluids, electrolytes and other essential nutrients as necessary. Blood or plasma transfusions may be appropriate, especially in advanced cases where coagulation/clotting problems have become problematic. When gastric (stomach) ulceration is present, the veterinarian may recommend one or more protective medications that sooth the stomach lining and help to manage the production of irritating gastric acids. In the clinic, the dog can be kept calm, inactive, warm and well-hydrated.
If the dog develops severe abdominal ascites, which is the abnormal accumulation of free fluid inside the abdominal cavity, the veterinarian may perform an abdominocentesis. This is a fairly simple, but still an invasive procedure that involves inserting a sterile needle through the body wall and suctioning off the excess fluid. Most animals handle this procedure very well, and it quickly makes them much more comfortable. Oral diuretics can be used for long-term management of ascites in affected animals, with intermittent abdominocentesis for drainage as appropriate. Dogs with recurrent ascites should also be kept on a low-sodium diet.
Management of chronic hepatitis, when there is no particular acute problem, involves an assortment of things. Diet is extremely important. A number of kibble and canned diets that are designed specifically for dogs with liver disease are commercially available. Typically, they have a high quality, moderate protein content and are quite palatable. If the animal develops hepatic encephalopathy (a neurological condition associated with liver damage), a low protein diet, with the protein primarily coming from milk or vegetable sources rather than from meat, fish or eggs, may be recommended. It is important to feed the dog enough calories to sustain its body weight. Many veterinarians recommend feeding multiple small meals throughout the day, rather than feeding one or two large meals. The attending veterinarian can discuss appropriate dietary management with the dog’s owner.
Anti-inflammatory medications may be used to combat hepatitis, including steroids such as prednisone or prednisolone. Other drugs may be prescribed as necessary, including antibiotics if the dog develops secondary bacterial infections. If the animal has accumulated an abnormal amount of copper in its liver, products are available to help remove that copper from the liver tissue. This process is called “copper chelation.” Various supplements that have antioxidant and/or antifibrotic effects, or which otherwise are beneficial in cases of liver disease, may be suggested. These may include zinc, ursodeoxycholic acid, vitamin E, thiamine, polyunsaturated phosphatidylcholine (PPC), colchicine, silibinin, S-adenosylmethionine (SAMe) and milk thistle, among others. Of course, the appropriateness of using any drug or supplement can change over time as medical research advances.
Periodic blood evaluation, together with ongoing monitoring of the dog’s appetite, body weight, behavior, attitude and overall condition, are all part of the ongoing “treatment” of chronic canine hepatitis. Periodic liver biopsies may also be recommended to monitor the dog’s response to treatment and to reassess the progression of the disease.
It is highly unlikely that a dog with chronic hepatitis will ever be “cured.” The outlook for most dogs with hepatitis is guarded to fair. The prognosis is influenced by the clinical signs of disease at the time the dog is diagnosed, as well as by the extent of liver damage that then exists. If hepatitis is diagnosed early in the course of the disease, and if treatment is started early, survival times may be prolonged. Unfortunately, most dogs with hepatitis are diagnosed only after they develop noticeable symptoms, and this usually happens only after the disease is quite advanced. In those cases, the prognosis for long-term survival is guarded to grave.