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The Liver

The Liver

By Lew Olson • March 2003 Newsletter
This liver is designed to filter the blood by removing toxins. It is also the central site where most drugs are metabolized. It does have the capability of regenerating itself, which is a unique feature of this organ. However, the liver does not work at its full capacity, and therefore, by the time most liver problems are diagnosed, the condition is quite severe. The liver organ can be 2/3 diseased and still function effectively. Liver disease occurs in about 3% of all dogs.

Liver Function
To understand the liver better, it helps to know when the function and capabilities of this organ are. They include:
– Metabolism of hormones
– Processing of bilirubin (bile pigment), which helps to alkalize intestinal contents
– Blood clotting ability
– Processes amino acids
– Converts ammonia to urea
– Metabolizing sugars from carbohydrates and also destroying insulin
– Fat metabolism (liver disease can cause ‘fatty liver’)
– Protein synthesis, the most important being albumin (involved with fluid and salt balance)
– Aids in transforming and storing vitamins A, D, E, K, C, B and K. Removes damaged or aged red blood cells
– Excretes endogenous waste products into bile

Symptoms of Liver Disease
When the liver is diseased or in distress, symptoms can include:
– Weight loss and debilitation
– Loss of energy and lack of interest in normal activities, which worsens with time
– Diarrhea
– Upset stomach
– Vomiting or constipation, which can come and go
– Light tan or grey stools
– Urine is darker and can also be orange
– Stomach area gets larger due to fluid accumulation
– Skin may turn yellow, due to jaundice
– Changes in behavior such as pacing, circling or even seizures
– May show pain when pressure is applied to abdomen
– Polydipsia and Polyuria, or excess water drinking and urination
Causes of Liver Disease
Viral or Bacteria diseases include canine hepatitis and leptospirosis. Fungal causes can be blastomycosis, histoplasmosis and coccidiomycosis.
Toxin poisoning can also cause liver failure. These would include (but not limited to) acetaminophen (Tylenol), ASA, anabolic steroids, Phenobarbital, primidone and phentoin, certain chemotherapy drugs, some antibiotics, glucosteroids (such as cortisone), anesthetics, parasite control drugs, diazepam, theophylline, cimetidine, barbiturates, antifungals, rifampin, NSAIDS such as Rimadyl, antifreeze products and phenylbutazone. www.cah.com/library/drugliver.htm
Altered blood flow disorders include portal vascular abnormalities. This is a condition that happens when the blood passes from the digestive tract directly to the blood supply without going through the liver first. The treatment for this is a surgical correction to try and redirect the blood flow through the liver before it enters the circulatory system.
Copper storage disease can occur in Bedlington Terriers, Doberman Pinchers, Sky Terriers, Cocker Spaniels, Keeshonds, Labrador Retrievers and West Highland White Terriers. This condition causes an accumulation of copper in the liver, due to a genetic inability to eliminate it.
Cancer is another disease that can plague the liver. Symptoms will vary and show as listed above, and often the only clear diagnosis is a sonogram and liver biopsy. Consult with a veterinarian oncologist is of utmost importance in these cases. The cancer is usually quite advanced before symptoms occur.
Injury can also cause liver disease. Most frequently this occurs in accident, trauma or a blow to the abdomen area. Quick diagnosis is important, and often rest will heal many of these injuries.
Pancreatitis can affect the liver, as the pancreas becomes inflamed and bile duct problems can result in liver damage. Treatment of the pancreatitis will most often aid the liver disease.
Chronic gastric upsets such as irritable bowel disease, colitis and other upsets that cause continued inflammation of the digestive tract can also affect the liver.
Diagnosis of Liver Disease
Liver problems are usually diagnosed after some of the symptoms are observed and a visit to the veterinarian determines problems. They can also be diagnosed during a routine wellness blood panel checkup.
A blood chemistry panel is the first step in assessing the health of the liver. Important factors to consider in the blood panel include:
ALT (alanine aminotransference)
This enzyme can determine the presence of cell damage in the liver.
AST (aspirate aminotransferase activity)
Similar to ALT, but can indicate more severe damage.
ALP (alkaline phosphatase)
Shows impairment of bile flow and the last enzyme to return to normal as liver heals
GGT (gamma-glutamyltransferase)
Demonstrates impaired bile flow
This is increased in dogs with liver disease, and can show the beginning of jaundice.
Biles Acids
Dogs with an increase of this often are showing the beginning of portosystemic shunt, which can mean an abnormal blood flow to the liver.
Other health conditions that can also show elevated liver tests include richettsial infections, diabetes mellitus, hyperadrenocorticism, hypothyroidism, immune mediated hemolytic anemia, shock, right-sided heart failure, protein losing enteropathy, severe protein restriction, splenitis and hyperthyroidism.
The next level of tests for diagnosing liver problems includes:
These can show enlarged or a small liver, but are definitive enough for a proper diagnosis. The X-rays can give a clue to liver health though.
This test gives a much clearer picture of the liver and the lobes. It can help differentiate between different types of liver disease and problems.
The results from taking a sample from the liver can help to look at cellular problems and help in diagnosing cancer. This is generally done with a laproscope or guided ultrasound for the least invasive method.
Bile Acid Test Response
This is done after a twelve hour fast and blood is drawn to test levels. A small meal is given and the test is repeated in two hours.
The choice of treatment will depend on the diagnosis. In the case of a portosystemic shunt, surgery and correction may be best opportunity. In the case of liver damage resulting from toxins, the best defense is to remove that substance from your dogs system and allow the liver to heal and regenerate. Always check all medications that your dog may be taking carefully and be sure to read all inserts and contraindications before proceeding. As mentioned substances that can cause liver damage include several medications (listed earlier in this article), along with poisons, contaminated water, garbage scavenging and even pollutants found in the soil (herbicides and pesticides). In the case of Copper storage disease, monitoring of the diet and certain prescriptions may be helpful such as Penicillamine and zinc acetate. Other support may include IV fluid therapy, and diuretics (as in the case of fluid build up in the abdomen).
There are also several supplements that can be helpful to support the liver during the recuperation and to aid in regeneration of the liver. These include:
SAM-e (S-adenosylmethionine)
This supplement helps to stabilize liver membranes by increasing levels of glutathione in the body. It is speculated to reduce inflammation and pain, and help to detoxify the liver. SAMe is also marketed as denosyl, but can be acquired over the counter as SAM-e. It is important to give a vitamin B supplement with SAM-e for best effect. www.loyalsockanimal.com/Denosyl.htm
Milk Thistle (Silymarin)
This herb comes from the thistle plant and has been proven to show great benefits in helping the liver regenerate itself and protect it from toxins and damage. It can be purchased in both capsules and liquid tincture. The liquid in a dropper bottle is the most convenient for dosing dogs in the gum line. It has been shown to help with bile flow and assist in recovery from cirrhosis. lochvale.freeservers.com/Silymarin.html
Digestive Enzymes
Animal based enzymes, such as pancreatin and pancrelipase can help assist the liver by aiding in breaking down of fats. It will also assist in the break down of carbohydrates and proteins as well. Equally important is betaine and bromelain.
B Vitamins
Vitamin B12 and vitamin B1 (thiamine) have both been found to be effective for support in both dogs and cats with liver disease. Since all B vitamins work synergistically, a good vitamin B complex would be a good addition to the diet.
Vitamin K
This vitamin helps with blood clotting disorders and is supportive in many liver diseases. Also, beneficial bacteria, such as acidophilus, bifidus and other probiotics help to maintain good bacteria growth, which promote Vitamin K synthesis in the large intestine.
Vitamin E
Since tissue insult in most liver diseases cause membrane oxidation, this vitamin is helpful in protecting tissues through its antioxidant properties and helping protect the liver.
Water Soluble Vitamins
These would include the B complex and also vitamin C.
This amino acid has been found deficient in human patients with advanced cirrhosis, and is being advised for dogs with liver disease as a supportive measure. L-carnitine deficiency can cause protein starvation. (Watham Focus, Vol. 10, No 4, 2000, by Sharon Center D.V.M. DipACVIM, Cornell University,, Ithaca, New York, USA)
Diet Considerations
Certain considerations are needed to be taken into account in order to prepare the best diet for this problem.
Dogs with liver disease can lose the ability to process the ammonia in the body to urea. This causes a build of ammonia in the system which can be fatal. Past recommendations stated to feed dogs with liver disease a low protein diet, but this has since been found to be just as lethal, as the liver needs protein to regenerate. Newer recommendations are to feed proteins of high quality or of good bioavailability. This would mean a good quality, easy to digest protein. Rather than feed a commercial dog food, which would contain processed ingredients including plant proteins which are very difficult to digest, a good homemade diet would be the most supportive. While meat proteins are considered to add the most ammonia to the system, some must be used for best amino acid content. But other good sources with less ammonia content would include eggs and dairy products, such as cottage cheese, yogurt and cheese. As the dogs condition improves, more protein may be added.
Fat can burden an already sick liver, so it may be best to use low fat proteins and remove any extra fat from meat. Dairy products can be purchased in lower fat content as well. Omega 3 fatty acids in fish oil can still be supplemented for their supportive benefits.
Interestingly enough, while you will rarely see me recommend carbohydrates for dogs, in this case it is well indicated. Both soluble and insoluble fiber helps to absorb ammonia in the digestive tract, thus removing so it can’t return to the body’s system. This would be helpful during the convalescence period, and also if a dog had a long term problem with the liver. Insoluble fiber would include bran muffins, whole grain pasta, corn, filberts, artichoke, boysenberries, wheat, and whole wheat sandwich bread, pulped vegetable skins and rinds (such as what is found after removing juice from vegetables), popcorn, ground physillum husks and canned plain pumpkin. Soluble fiber includes fresh fruits (especially apples and citrus), vegetables (such as potatoes), certain grains (oatmeal, barley and rye), legumes & seeds, asparagus, oatmeal, beans, peaches, carrots, green beans, variety of grains, flax seeds, apple, and dried fruits.
A chart for these can be found at www.fruit-eze.com/education/fiber/dietary_fiber.html
I would probably recommend leaning more towards the insoluble fiber for the bulk of the carbohydrates fed to reduce the sugar content as carbohydrates also can tax an already burdened liver through it’s metabolizing of sugars.
The ratio of this diet would probably be low fat, moderate to medium high quality protein and moderate use of mostly insoluble fiber. Supplements to include would be SAM-e, milk thistle, digestive enzymes, a B complex, vitamin K, vitamin E, and l-carnitine in cases of severe liver disease.
I hope the information you find here is useful. It is always important to work with a veterinarian and use diagnostic tests for a complete diagnosis and treatment recommendations. Links are also provided so you can continue to research this issues yourself, as new research always bring about new recommendations and discovery.
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