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Healing & Alternative Health
Dr. Carson's Holistic Animal Care:
Signs of the Aging
Dog and Cat
Part 14:
Organs of the Abdomen: Diseases of the Diagnosis
by Kathleen M. Carson, D.V.M
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In last month’s column on liver diseases, I wrote that, broadly speaking, the diseases of the liver are of four types: 1.) inflammatory, 2.) infectious (from bacteria, viruses, fungi, and/or parasites), 3.) toxic (from chemicals, drugs, and poisons), and 4.) neoplastic (tumors - either benign or cancerous).
There is another liver condition called hepatic lipidosis which overweight cats are prone to if they don’t eat, sometimes for as short a time as a few days. Fat stores throughout the body are mobilized in the fasting cat; some of this fat gets deposited in the liver and causes serious problems.
The liver diseases listed above very often show up in the years before your dog or cat’s geriatric years. However, in some animals, these conditions first appear in their geriatric years.
If a geriatric animal has had liver disease before he reaches old age, when he does so, the disease is more advanced and more likely to cause serious problems.
If there is cancer in the liver, it can either be primary, where the cancer originates in the liver or secondary, where the cancer starts elsewhere and then spreads (metastasizes) to the liver. The latter is especially likely since, as I wrote last month, all the body’s blood is filtered through the liver.
What signs would you see if your geriatric dog or cat has liver disease? You may see none at all. More than one geriatric animal’s liver disease has only been diagnosed on routine geriatric labwork and/or pre-dental labwork. However, most animals at some point do show signs. Most commonly, there are the generalized signs of lethargy, decreased appetite, and weight loss. Other common signs are vomiting and/or diarrhea. Less commonly, an animal with liver disease may be excessively thirsty and urinate large quantities. However, as you’ve read in my previous columns, these signs are seen in the diseases of many other organs; they aren’t exclusive to liver disease.
There are signs of liver disease which are less common and which are more likely to be caused by liver disease (though they can be seen in a narrow range of other diseases as well). These are: 1) jaundice, called icterus in medical terms; it is a yellowing of certain tissues: the skin, the gums, and the eyes; a jaundiced animal also usually has deep golden urine; 2) petechiae or ecchymoses, which refer to bruises seen on the skin or gums; and 3) fluid in the abdomen, called ascites; if your animal has ascites, her belly will become larger than normal.
Icterus comes about in liver disease when there is backup of the bile in the bile ducts of the liver (cholestasis). Instead of flowing out of the liver into the gall bladder or small intestine, its movement is impeded - usually by a swelling of the bile ducts from inflammation or infection. It eventually gets into the bloodstream and from there to the skin, gums, eyes, and the kidneys.
The petechiae/ecchymoses or bruising (bleeding under the skin) comes about when the sick liver doesn’t make enough clotting factors.
The ascites results from the sick liver not producing enough of the protein, albumin. Last month I wrote about how albumin helps regulate the movement of water from the bloodstream into the body’s tissues. When there’s a deficiency of albumin, fluids leak out into the abdominal cavity.
How is liver disease diagnosed? A thorough history, including whether your animal is taking drugs which could potentially damage the liver (a non-steroidal antiinflammatory drug like Rimadyl is one example), or whether your animal has been exposed to hepatotoxic (harmful to the liver) chemicals would be the first step.
The next step is a thorough physical exam. Your veterinarian will look for signs of icterus, petechiae/ecchymoses, and/or ascites, as well as the general signs of weight loss and dehydration. He’ll also palpate (feel) your animal’s abdomen, for some animals with liver disease have enlarged livers (hepatomegaly).
After that, blood tests, urinalysis, and possible radiographs (X-rays) are indicated. Elevated liver enzymes (ALT, Alkaline Phosphatase, GGT) are usually seen with liver disease. If there’s jaundice, the blood will show increased levels of bilirubin, a major component of bile. Cholesterol is often elevated as well. Your veterinarian will also look to see if your animal’s albumin levels are low. If your veterinarian wants further information about your animal’s liver, she may also run a test called bile acids.
Diagnosis of liver disease isn’t always clear-cut, however. Some cats have serious liver disease but only mildly elevated liver enzymes. On the other hand, many older dogs have elevated liver enzymes from a benign liver condition called nodular hyperplasia.
Also, corticosteroid drugs can cause an elevation in liver enzymes; this is called steroid hepatopathy. If your animal has been on one of these prior to the blood test, then other tests are necessary to see if there’s true liver disease.
If the blood and urine tests and radiographs don’t give satisfactory or complete results, then your veterinarian may schedule an abdominal ultrasound, which will provide detailed information about the physical state of your animal’s liver. During the ultrasound, fine needle aspirations (FNAs) may be taken so that the liver tissue can be examined microscopically.
If even further diagnostic tests are needed (because FNAs don’t contain enough tissue to always be diagnostic), your veterinarian may want to do exploratory surgery where he can look at the liver directly and take liver tissue samples (biopsies) for histopathology (microscopic examination) and to culture the samples to see if infection is involved.
Because the liver has so many blood vessels in it, FNAs and biopsies could potentially cause liver bleeding, so your veterinarian will first run a blood panel which indicates how well your animal’s blood will clot. He will also give your animal some Vitamin K, an important factor in clotting, prior to the procedure.
Next month I’ll write about the treatment of liver disease.
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Dr. Kathleen Carson, DVM
Veterinarian & Author
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Dr. Carson received her Doctor of Veterinary Medicine degree from the University of California at Davis in 1968. She's been a small animal practitioner (dogs and cats ) for all the years since, except for a short stint at the San Diego Zoo when she first graduated.
She belongs to the American Veterinary Medical Association and the American Holistic Veterinary Medical Association.
Since 1974 she's lived and practiced in the South Bay Area near Los Angeles. She started the area's first house call practice in 1976 and the first pet crisis/loss group in 1989. The human-animal bond is of special interest to her.
She started exploring complementary veterinary medicine in 1987. Her practice became 100% holistic in 1996. She utilizes acupuncture, herbs, supplements, Bach Flower Remedies, homeopathic remedies, nutrition and medications for her patients in her practice.
She's currently taking a leave of absence from her house call practice due to health reasons but continues to do phone consultations and to write.
E-mail:
Critterhlr@aol.com
website:
http://www.holistic
vetconsult.com
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