Mottled liver

canine liver problem

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Mottled liver

#1  Postby Dawn » May 25, 2012 9:33 pm

Does anyone know what a mottled liver could mean in a dog? My Scottish terrier had a wedge liver biopsy today. His surgeon said his liver looked mottled and had some areas that were bumpy (small bumps). I know I have to wait for the biopsy results to know anything and the surgeon wouldn't guess, but I am anxious to have a clue about what is going on. I am not asking for a definite diagnosis just an idea of what mottled liver might be related to. Going in we were thinking he could have some kind of nodular hyperplasia or chronic hepatitis. He has taken the medicine Ursodiol, which is some kind of bile acid, given for hepatitis and it didn't help. He has very high ALP (over 2000) and elevated ALT also. He is 5 years old.

I thank any of you that can help me with info. We hope he can come home tomorrow and will ask the vet more, but she is a surgeon and is referring us back to the internal medicine vet who isn't available right now. I am just anxious to have some idea what we might be dealing with.
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Re: Mottled liver

#2  Postby Dawn » May 26, 2012 12:41 am

Bumping - I know no one may know the answer to my question, but I am hoping one of our medical professionals will see this and have some ideas.
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Re: Mottled liver

#3  Postby Dawn » May 28, 2012 9:03 pm

I knew it was a long shot to ask such a specific medical question. I can't get any answers researching online either. I will post his biopsy results when I get them in a week or so.
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Re: Mottled liver

#4  Postby AlohaChris » May 28, 2012 9:08 pm

Is you dog fat/overweight? It could be steatosis or steatotic hepatitis (fatty liver disease). I don't know canine physiology, but if it's anything like human, an ALT over 2,000 is severe liver failure.
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Re: Mottled liver

#5  Postby AlohaChris » May 28, 2012 9:10 pm

Did it occur suddenly? Could the dog have ingested some type of poison or toxin?
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Re: Mottled liver

#6  Postby Dawn » May 28, 2012 9:18 pm

Hi Chris, thanks for responding. This has been going on for awhile. The ALT wasn't that elevated, it was the alkaline phosphatase that was over 2000. The ALT has been elevated at various times and then it will go down, but it doesn't get very high - maybe only 2 or 3 times the normal amount. He has had cushing's disease ruled out. He is a bit chunky, but he has always been "wide" and the vet says it is normal for him. The vet is very weight conscious and says Charley has a wide ribcage and his weight is okay.
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Re: Mottled liver

#7  Postby Dawn » May 28, 2012 9:19 pm

Also - no, he hasn't ingested anything. We keep a good eye on him and he wears a basket muzzle in the back yard to prevent eating bad things.
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Re: Mottled liver

#8  Postby AlohaChris » May 28, 2012 11:38 pm

Dawn wrote:Hi Chris, thanks for responding. This has been going on for awhile. The ALT wasn't that elevated, it was the alkaline phosphatase that was over 2000. The ALT has been elevated at various times and then it will go down, but it doesn't get very high - maybe only 2 or 3 times the normal amount. He has had cushing's disease ruled out. He is a bit chunky, but he has always been "wide" and the vet says it is normal for him. The vet is very weight conscious and says Charley has a wide ribcage and his weight is okay.


Ok. Sorry, I miss-read your post. Again, I don't know canine physiology, but in humans, high ALT/AST suggests hepatocellular (liver cell) damage and high Alkaline phosphatase (ALP) suggests cholestasis (bile, a product of the liver, not moving to the digestive tract normally).

If the liver biopsy appeared grossly abnormal as described then my guess at the diagnosis would be a primary biliary cirrhosis of some type:

Primary sclerosing cholangitis
Tumors (cholangiocarcinoma)
Biliary obstruction due to gallstones, bacterial infection etc. (Do dogs even have gallbladders?)
Drug/Toxin hepatotoxicity

Weird/rare causes would be autoimmune disorders:

Autoimmune cholangiopathy
Sarcoidosis

I do hope your pet pulls through, is it the little guy in your avatar?
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Re: Mottled liver

#9  Postby Dawn » May 29, 2012 1:39 pm

Thanks again, Chris! That is his older brother in my avatar. Charley is my black Scottish terrier.

When he had an ultrasound recently the vet said his gallbladder looked good and his adrenal glands looked normal. The only thing off was his liver. She said it was a normal size without irregular margins. It just looked "slightly bright" and had a couple of nodules. Then when they saw it during the biopsy they said it was mottled looking and bumpy in some areas.

He does have CUPS which is chronic ulcerative paradental stomatitis. It is an autoimmune disease where the body rejects the teeth. He had to have all his teeth removed and he had a bit of a jaw infection with it. That was hell. He is much better now and has adapted to living toothless pretty well.

His regular vet is puzzled. He is thinking Charley might have some weird kind of autoimmune hepatitis since he had the CUPS thing. We were hoping treating him with medicine would help, but it didn't so we went for the biopsy.

Thank you so much for taking time to give me some ideas about what could be going on with him. I will post the results of his biopsy when they come in.
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Re: Mottled liver

#10  Postby AlohaChris » May 29, 2012 4:39 pm

Given that info, autoimmune cholangiopathy of some type is my best guess. The biopsy may show inflammation of the bile ducts with leukocytic infiltration.
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Re: Mottled liver

#11  Postby Dawn » May 29, 2012 8:37 pm

Thanks again, Chris. I hope to get the results by the end of the week. I just hope it is treatable and we will have him around for a normal life span.
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Re: Mottled liver

#12  Postby Dawn » Jun 03, 2012 9:40 pm

I got a voice mail call from my dog's vet specialist today. She isn't in the hospital to call back until Wednesday, but the news sounds pretty good. She says he has hepatic vacuolar degenerative changes that can be genetic in Scottish terriers. I found an article about it here: http://www.cincyvma.com/files/BreedHepatopathies.pdf

The part about Scottish terriers says:

Scottish Terriers
Recently, Scottish terriers with a benign diffuse vacuolar hepatopathy have been described [3]. The suggested term is idiopathic vacuolar hepatopathy. Although the lesion appears typical for “steroid hepatopathy” with glycogen accumulation, clinical findings or laboratory evidence of Cushing’s disease are absent. Rarely, some dogs may be polydipsic and polyuria. Physical examination is unremarkable. Laboratory findings include marked elevations of ALP (predominantly the corticosteroid-induced isoenzyme) with normal GGT, ALT, AST, and bilirubin). Serum bile acid concentrations are normal or mildly increased. Adrenal glands are normal size on ultrasound. Further evaluation of other adrenal steroids such as progesterone, estradiol, DHEAS-S or 17-hydroxyprogesterone revealed that most affected dogs have increases in 17-hydroxyprogesterone or progesterone. These hormones could cause glycogen accumulation in the liver [3].
Most affected dogs can live out their lives without clinical significance to the increased enzymes and vacuolar change. However, some dogs become polydipsic and polyuric; rarely, signs of overt Cushing’s disease develop. Treatment with ketoconazole or Lysodren® as for Cushing’s disease will decrease the ALP, supporting an adrenal mechanism for the vacuolar change and increased ALP activity. Trilostane (Modrenal®), a competitive inhibitor of the enzyme 3β-hydroxysteroid dehydrogenase that converts pregnenolone to progesterone, may be a safer therapy but the drug is currently unavailable in the US. Consequently, adrenolytic treatment is not currently recommended for this benign disorder [3].
Hepatoprotective therapy with antioxidants or S-adenosylmethionine may be helpful but have not been studied in this disorder.
The cause of idiopathic vacuolar hepatopathy in Scottish terriers is currently unknown. Potential mechanisms could include pituitary or adrenal hyperplasia producing aberrant steroids or a deficiency in an enzyme pathway in adrenal metabolism of steroids [3]. Healthy Scottish terriers have also been shown to have higher ALP activity than other breeds of dogs [21]. A benign asymptomatic hyperphosphatemia has been proposed [22].


This sounds better than most of the alternatives. She said dogs with this often live a normal life span.
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Re: Mottled liver

#13  Postby AlohaChris » Jun 04, 2012 4:54 am

Interesting. Glycogen accumulation. Well, I hope your K9 lives a long happy doggy life. :thumbup:
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Re: Mottled liver

#14  Postby Dawn » Jun 04, 2012 3:04 pm

Thanks, Chris.

I just got an email from my regular vet who hasn't seen the biopsy results yet and he says he wants to know the exact contents of the cells. He says they could be glycogen, fat, etc. He says we will have to monitor Charley and that he may end up with atypical cushing's at some point that we would treat with trilostane if Charley developed clinical signs, but so far no treatment and hopefully he will continue to do well!
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Re: Mottled liver

#15  Postby Dawn » Jun 05, 2012 7:22 pm

Okay, now I am a bit more worried. The comments on the biopsy report says he has a 25 percent chance of getting liver fibrosis.

Also, the pathologist did not say what the exact content of the vacuoles were. I am kind of pissed that he went through an exploratory biopsy which a huge incision and they didn't test to find out about the content of the cells. I am going to talk to the vet specialist tomorrow when she is back at work to ask more about that.
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Re: Mottled liver

#16  Postby AlohaChris » Jun 09, 2012 11:37 pm

Hepatocytes typically store fat or glycogen in their vacuoles. If the disease is as you described, I would guess glycogen would be in the vacuole.

The fibrotic changes (in humans anyway) come from excess fat getting stored in the vacuoles (Non-alcholic steatotic hepatitis) and this causes thickening of the connective tissues that provide the scaffold for the hepatocytes, blood vessels, and bile ducts, thus distorting the livers 'architecture'.
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Re: Mottled liver

#17  Postby Dawn » Jun 11, 2012 3:15 pm

Thanks so much, Chris. That helps me understand.
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