David C. Twedt, DVM, DACVIM
"Treatment of liver disease: Medical and nutrition aspects."
Treatment
*look for a primary etiology (cause)
*define a specific therapy
*diet change/quality
*hepatic "support"
Nutritional Goals
*promote hepatic regeneration
*meet caloric needs
*PROTEIN! most hepatic disease cases need more protein than maintenance
*protein restriction is only necessary if protein intolerance (hepatic encephalopathy)
*palatability- whatever these patients WILL eat
*fat restriction is NOT necessary because fat is highly digestible, high in calories, maintains glucose levels in patients that don't eat a whole lot
*feed multiple small meals
*feed low copper diets
*avoid feeding "light" diets
Chronic Hepatitis Survival
*live less than two years on average AFTER diagnosis
*steroid treatment prolongs life
--> increase albumin
--> decrease inflammation of liver
--> increase enzymes
*takes several months to be rid of steroid effects
*cyclosporine use can be more effective than prednisone use
Increased Copper
*many breeds have a predisposition: #1 is the Lab, #2 is the Doberman
*use copper chelators to treat this to de-copperize the liver
Zinc
*essential trace element
*deficiency can cause chronic liver disease
*treatment of copper hepatotoxicity by blocking copper absorption
*give 100mg zinc supplement BID
Antibiotics
*leptosporosis
*bacterial cholangitis --> E. coli infections
*granulomatous hepatitis (granulomas of bacteria in liver determined with FISH)
Bile Acids
*increase disease
*cause membrane damage
*hydrophobic (bad acids so they are only fat absorbed)
*bear bile (yes, from a bear) are good acids that are hydrophilic (water soluble so they can be taken out of the liver unlike the hydrophobic (bad) acids)
--> hepatoprotective
--> antioxidants
--> antiapoptotic (programmed cell death- cut down on this)
*safe and non toxic to use on dogs
Hepatic Support
*provide optimal environment
*antioxidants, nutraceuticals and vitamins
Vitamin E
*essential nutrient
*plant derived
*membrane associated antioxidant
*dose: ~10IU/kg/day
Glutathione Depletion
*~50% of hepatic cases are deficient
*nutraceutical: food nutrient/pharmaceutical "mix" of those two
*BUT NOT approved by the FDA
S-adenosylmethionine (SAMe)
*produced in the body
*play a role in membrane function
*detoxification
*cell regeneration
*liver support/therapy
*minimal toxicity
*anti-depressant in people, may have similar function in dogs
Milk Thistle
*ancient liver therapy
*Silymarin: active extract
*Slybin: active isomer
*low toxicity
*antioxidant properties, prevents membrane lipid peroxidation
*proven cure/therapy for Amantia (mushroom) poisoning in dogs
***Denamarin is the RX drug***
"Treatment of liver disease: Medical and nutrition aspects."
Treatment
*look for a primary etiology (cause)
*define a specific therapy
*diet change/quality
*hepatic "support"
Nutritional Goals
*promote hepatic regeneration
*meet caloric needs
*PROTEIN! most hepatic disease cases need more protein than maintenance
*protein restriction is only necessary if protein intolerance (hepatic encephalopathy)
*palatability- whatever these patients WILL eat
*fat restriction is NOT necessary because fat is highly digestible, high in calories, maintains glucose levels in patients that don't eat a whole lot
*feed multiple small meals
*feed low copper diets
*avoid feeding "light" diets
Chronic Hepatitis Survival
*live less than two years on average AFTER diagnosis
*steroid treatment prolongs life
--> increase albumin
--> decrease inflammation of liver
--> increase enzymes
*takes several months to be rid of steroid effects
*cyclosporine use can be more effective than prednisone use
Increased Copper
*many breeds have a predisposition: #1 is the Lab, #2 is the Doberman
*use copper chelators to treat this to de-copperize the liver
Zinc
*essential trace element
*deficiency can cause chronic liver disease
*treatment of copper hepatotoxicity by blocking copper absorption
*give 100mg zinc supplement BID
Antibiotics
*leptosporosis
*bacterial cholangitis --> E. coli infections
*granulomatous hepatitis (granulomas of bacteria in liver determined with FISH)
Bile Acids
*increase disease
*cause membrane damage
*hydrophobic (bad acids so they are only fat absorbed)
*bear bile (yes, from a bear) are good acids that are hydrophilic (water soluble so they can be taken out of the liver unlike the hydrophobic (bad) acids)
--> hepatoprotective
--> antioxidants
--> antiapoptotic (programmed cell death- cut down on this)
*safe and non toxic to use on dogs
Hepatic Support
*provide optimal environment
*antioxidants, nutraceuticals and vitamins
Vitamin E
*essential nutrient
*plant derived
*membrane associated antioxidant
*dose: ~10IU/kg/day
Glutathione Depletion
*~50% of hepatic cases are deficient
*nutraceutical: food nutrient/pharmaceutical "mix" of those two
*BUT NOT approved by the FDA
S-adenosylmethionine (SAMe)
*produced in the body
*play a role in membrane function
*detoxification
*cell regeneration
*liver support/therapy
*minimal toxicity
*anti-depressant in people, may have similar function in dogs
Milk Thistle
*ancient liver therapy
*Silymarin: active extract
*Slybin: active isomer
*low toxicity
*antioxidant properties, prevents membrane lipid peroxidation
*proven cure/therapy for Amantia (mushroom) poisoning in dogs
***Denamarin is the RX drug***