09/01/2024
Wishing Blue all the best 🐕🦺
🐾 Blue
🏥 Referral - Internal Medicine
🩺 Advanced Practitioner - Alison Irwin
Blue, a beautiful young Labrador retriever, was referred to NIVS following a 3 month history of inappetence, weight loss and persistently elevated liver enzymes.
On presentation Blue was underweight and had a slightly elevated temperature 🤒 Blood work confirmed marked increases in her liver enzymes and a mild increase in her bilirubin level. A hepatopathy can be due to a primary liver problem or secondary to extra hepatic disease e.g. anaemia, gastrointestinal disease etc. Screening for infectious diseases which can cause liver inflammation was negative. Tests for malabsorption (due to the weight loss) did not support this diagnosis and a rare disease, which can lead to poor body condition, called Addison’s disease was excluded by measuring Blue’s cortisol levels 🩸
An abdominal ultrasound examination did not reveal any marked abnormalities however this does not completely exclude inflammatory disease.
To investigate the cause of the elevated liver enzymes further Blue required a liver biopsy. Her blood clotting times were checked prior to surgery as the liver is responsible for producing clotting factors. In cases where liver function is a concern it is a wise precaution to ensure these times are not prolonged due to deficiency of clotting factors before considering surgery. We can sometimes supplement the dog prior to the biopsy being taken and if there is a high risk of bleeding we can have typed blood available in case a transfusion is necessary. Luckily Blue’s clotting times were normal and a feeding tube was placed (to be able to provide nutrition) at the same time as biopsies were obtained under general anaesthetic.
Blue’s liver biopsies revealed inflammation with some mild areas of fibrosis (scarring). Culture of her liver tissue and a bile sample were both negative. A separate sample was submitted for copper estimation and Blue’s level came back as being markedly elevated leading to a diagnosis of Copper associated hepatitis.
In some breeds, this disease is an inherited defect in copper metabolism however in others it is unclear whether copper accumulation is a primary or secondary condition.
Blue was started on a copper restricted diet and prescribed chelation therapy – a drug to try to remove copper from the liver. She also receives some liver support drugs, antinausea medication and appetite stimulants and will require close monitoring of her liver parameters and possible repeat liver biopsy to recheck her copper levels.
We keep fingers crossed for a good response for beautiful Blue 🤞
Thank you to our colleagues at Rathfriland Veterinary Clinic for the referral 🏥
