Spring 2017

Diagnosing Liver Failure

Biopsies can often determine the cause of the disease, but that procedure carries its own risks.

By Genevieve Rajewski

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A dog’s liver with lymphoma, a cancer that develops from the white blood cells that help fend off infection. Photo: Richard Jakowski

Veterinarian Cynthia Webster has seen enough dogs with acute liver failure to know that most of them will die when the organ can no longer filter toxins out of the bloodstream. Human patients have the option of a transplant; dogs do not.

The more frustrating piece of the medical puzzle is that it is impossible to determine the cause of 60 percent of acute liver failure cases. The diagnosis often requires a biopsy, and because the liver makes all the proteins that control blood clotting, most veterinarians are reluctant to do that procedure for fear the animal will bleed out and die.

These were the major findings of a case review that Webster and a team of Cummings School veterinarians conducted on 49 dogs with acute liver failure that were seen at the Foster Hospital for Small Animals between 1995 and 2012.

The researchers found that 13 dogs had liver cancer and identified a few others that likely had infections or severe reactions to medications. In many of the other cases, a tissue biopsy might have determined the specific cause of organ damage, each of which would have required a different treatment, said Webster, an internist who specializes in treating liver disease in dogs and cats.

“We can’t change the outcome for some of these pets if we don’t even know what underlying disease or condition we should be treating,” she said.

The study also validated Webster’s clinical experience that these animals have a grave prognosis. “Only one out of every seven dogs lived,” she said, noting that the 14 percent survival rate is akin to that in human medicine if patients don’t receive a transplant. The research was published last summer in the Journal of Veterinary Emergency and Critical Care.

In follow-up research, published in the Journal of Veterinary Internal Medicine, Webster and her colleagues set out to determine the safety of liver biopsies.

Blood tests on 21 other dogs being treated for liver disease at the Foster Hospital determined that “some of these dogs have a unique clotting abnormality that we never would have suspected—but one that we can try to reverse” with medication, Webster said. In eight dogs, the blood clotted, but the clots would dissolve more quickly than normal.

More research is needed to determine the cause of the clotting abnormality, she said. In the meantime, she said, veterinarians can give these dogs a drug that inhibits protease, the enzyme that breaks down clots, before doing a biopsy. “We’ve tried that before in the hospital and [have] seen some benefit,” she said, “and this study suggests that it’s time to look at this approach in a controlled clinical trial.”

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