Canine Chronic Active Hepatitis Guide 2025 🩺🐶

By Dr. Duncan Houston BVSc

🧬 What Is Chronic Active Hepatitis?

Chronic active hepatitis (CAH), also known as chronic inflammatory hepatic disease, is a persistent inflammation of the liver marked by immune cell infiltration and progressive fibrosis, often diagnosed via liver biopsy.

👥 Who Is at Risk?

• Tends to affect middle-aged to older dogs, especially breeds like Cocker Spaniels, Dobermans, Bedlingtons, and Westies; often idiopathic.
• Underlying causes include chronic infections (e.g., leptospirosis, adenovirus), toxins, immune-mediated disorders, copper storage diseases, and drug reactions.

⚠️ Clinical Signs

Signs may be subtle until late stages:

• Appetite loss, lethargy, weight loss, vomiting or diarrhea.
• Polyuria/polydipsia, ascites, jaundice, coagulopathy (bruising/bleeding).
• Neurologic signs due to hepatic encephalopathy—disorientation, head-pressing, seizures.

🔍 Diagnostic Process

1. Bloodwork: CBC, chemistry, elevated liver enzymes (ALT/ALP), bilirubin, bile acids; clotting panels may show prolonged times.
2. Urinalysis: to support overall assessment.
3. Imaging: abdominal ultrasound—assesses liver texture, size, ascites; X-rays are often normal.
4. Biopsy: the definitive test—identifies inflammatory infiltrates, fibrosis, necrosis.
5. Copper quantification: especially for predisposed breeds.

🛠️ Treatment Strategies

1. Address the Underlying Cause

• Infections: treat with appropriate antibiotics or antivirals.
• Copper storage: copper chelation therapy with D-penicillamine or zinc supplementation.
• Toxic/drug-induced cases: remove offending agents and provide supportive care.

2. Immunosuppression & Anti-inflammatory Therapy

• Corticosteroids (e.g., prednisone) often reduce inflammation; cyclosporine for steroid-resistant cases.

3. Hepatoprotective Support

• SAMe and silybin to support liver regeneration.
• Vitamin K supplementation improves clotting in coagulopathic patients.

4. Supportive & Symptomatic Care

• Fluid therapy, antiemetics, GI protectants, and diuretics for ascites.
• Manage encephalopathy with lactulose, dietary protein restriction, and antibiotics (e.g., metronidazole).

5. Dietary Management

• Low–moderate protein, highly digestible hepatic diet to reduce liver workload.

6. Anti-fibrotic Strategies & Monitoring

• Emerging therapies targeting fibrosis are under evaluation; biopsy remains the gold standard for staging.
• Monitor liver enzymes, albumin, bilirubin, bile acids, and coagulation every 3–6 months.

📈 Prognosis & Outcomes

• Guarded but manageable with early diagnosis and treatment; remission is possible.
• Presence of hyperbilirubinemia, hypoalbuminemia, ascites, prolonged clotting, or hepatic encephalopathy worsens prognosis.
• Post-biopsy data show survival at 1–2 years is influenced by ascites, elevated GGT, male sex, and clotting times.

📱 Ask A Vet Telehealth Integration

• 📸 Upload lab results and ultrasound images for specialist review.
• 🔔 Treatment reminders for meds, SAMe, diet changes, and rechecks.
• 🩺 Virtual check-ins to monitor body condition, neurologic signs, and ascites.

🎓 Case Spotlight: “Rosie” the Cocker Spaniel

Rosie, a 7-year-old Cocker, presented with lethargy, vomiting, jaundice, and mild ascites. Biopsy confirmed chronic active hepatitis with copper accumulation. Treatment included prednisone taper, D-penicillamine, SAMe/silybin supplementation, prescription hepatic diet, and vitamin K. Ask A Vet guided lab monitoring and coordinated diet and med. One year later, Rosie's enzymes normalized, ascites resolved, and she remains clinically well. 📲🐾

🔚 Key Takeaways

1. Chronic active hepatitis is a progressive, inflammatory and fibrotic liver disease requiring biopsy for definitive diagnosis.
2. Susceptible breeds include Cocker Spaniels, Bedlingtons, Dobermans, WHWT, among others.
3. Management includes identifying cause, immunosuppression, liver support, diet, symptomatic care, and fibrosis monitoring.
4. Prognosis depends on the severity of clinical signs and laboratory abnormalities.
5. Ask A Vet telehealth provides comprehensive support—specialist reviews, treatment coordination, and monitoring through every stage 📲🐕

Dr Duncan Houston BVSc, founder of Ask A Vet. Download the Ask A Vet app to support your dog with chronic active hepatitis—getting lab reviews, diet plans, medication reminders, and long-term health tracking for optimal care 🐶📲