West Highland White Terriers have been reported with two forms of chronic hepatitis: idiopathic (about 80% of cases) and copper associated (about 20% of cases). Two litters have also been reported with polycystic liver and kidney disease similar to autosomal recessive polycystic disease.

Clinical signs

Dogs with chronic hepatitis will present with lethargy, vomiting and diarrhea but also may be clinically normal but have abnormal copper accumulations in the liver. More advanced cases may have jaundice or hepatic encephalopathy.

Diagnosis

Biochemistry results may reveal raised liver enzymes for both ALT and ALP, but ALT is usually higher. Liver function tests may show raised bilirubin in more advanced cases. Hepatic biopsy may reveal abnormal copper accumulation in the liver. Histopathology testing may reveal signs of mononuclear cell inflammation with piece-meal necrosis and/or bridging fibrosis. Copper associated cases show macrophages, lymphocytes and plasma cells centrilobularly with copper-laden hepatocytes. Histochemical stains for copper (rhodanine or rubeanic acid) are essential in all cases.

Treatment

Initial symptomatic treatment is required for clinical signs, eg anti-emetics for vomiting and spironolactone for ascites. For idiopathic hepatitis cases, similar treatment to chronic hepatitis. There is currently insufficient evidence to routinely recommend immunosuppression in the breed, but it may be tried in some cases based on histological suspicion.

For copper associated cases, a copper restricted diet should be followed with the addition of antioxidants and vitamin E. Chelation treatment for copper accumulation with penicillamine in West Highland Terriers should be instituted with hepatic copper levels >1000 microg/g (<1000 microg/g may not require chelation).

Prognosis

The outcome is variable depending on the stage of the disease at diagnosis and response to treatment. Improved liver function with a reduction in liver enzymes and an improved clinical status is expected. Reasons for treatment failure include the owner or dog not adhering to the treatment, and a poor understanding of underlying etiology in idiopathic disease and thus ineffective treatment.

References

·       Liver: chronic hepatitis (West Highland White Terrier)

·       Liver: chronic hepatitis

·       Liver: acute disease

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