Journal of Veterinary Clinics (한국임상수의학회지)

The Korean Society of Veterinary Clinics (한국임상수의학회)
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Hepatic Cirrhosis Secondary to chronic Hepatitis in an English Cocker Spaniel (ECS) Dog

잉글리쉬 코커스파니엘 견에서 발생한 만성 간염 및 간경화 증례

  • Park Chul (Department of veterinary internal medicine, college of veterinary medicine, Konkuk University) ;
  • Yoo Jong-Hyun (Department of veterinary internal medicine, College of veterinary medicine, Seoul National University) ;
  • Jung Dong-In (Department of veterinary internal medicine, college of veterinary medicine, Konkuk University) ;
  • Kim Ha-Jung (Department of veterinary internal medicine, college of veterinary medicine, Konkuk University) ;
  • Kang Byeong-Teck (Department of veterinary internal medicine, college of veterinary medicine, Konkuk University) ;
  • Lim Chae-Young (Department of veterinary internal medicine, college of veterinary medicine, Konkuk University) ;
  • Yoon Hun-Young (Department of veterinart surgery, college of veterinary medicine, Konkuk University) ;
  • Jeong Soon-Wuk (Department of veterinart surgery, college of veterinary medicine, Konkuk University) ;
  • Sur Jung-Hyang (Department of veterinary pathology, college of veterinary medicine, Konkuk University) ;
  • Park Hee-Myung (Department of veterinary internal medicine, college of veterinary medicine, Konkuk University)
  • 박철 (건국대학교 수의과대학 수의내과학교실) ;
  • 유종현 (서울대학교 수의과대학 수의내과학교실) ;
  • 정동인 (건국대학교 수의과대학 수의내과학교실) ;
  • 김하정 (건국대학교 수의과대학 수의내과학교실) ;
  • 강병택 (건국대학교 수의과대학 수의내과학교실) ;
  • 임채영 (건국대학교 수의과대학 수의내과학교실) ;
  • 윤헌영 (건국대학교 수의과대학 수의외과학교실) ;
  • 정순욱 (건국대학교 수의과대학 수의외과학교실) ;
  • 서정향 (건국대학교 수의과대학 수의병리학교실) ;
  • 박희명 (건국대학교 수의과대학 수의내과학교실)
  • Published : 2006.03.01
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Abstract

A 1-year-old, female English cocker spaniel (ECS) dog was presented with 3-month history of vomiting and retaking of the vomitus, and chronic weight loss. The client had noticed mild abdominal distension 10 days before. The dog was diagnosed as chronic hepatitis with hepatic cirrhosis based on complete blood count (CBC), serum chemistry profiles, radiography, ascites assessment, bile acid evaluation, and liver biopsy through exploratory laparotomy and necropsy. CBC and serum chemistry profiles revealed mild anemia, slightly elevated hepatic enzymes (ALT and AST), increased creatinine kinase (CK), hyperammonemia, and hypoproteinemia with hypoalbuminemia. Ascites was transudate according to analysis of components. Bile acid assessment (fasting; $174.4{\mu}mol/L$ and postprandial; $198.4{\mu}mol/L$) showed strongly suspected hepatic insufficiency. On radiological findings, ascites was evident. Atrophied liver (especially left side lobes) and distended mesenteric vasculatures were observed by exploratory laparotomy. Histopathological examination of marginal lesion of left lateral lobe of liver by biopsy revealed the necrosis of hepatic cells, dilation of sinusoids, infiltration of neutrophils in sinusoids, and vacuolation of hepatic cytoplasm. The patient had been managed with careful low protein diet and specific supportive therapy (ursodeoxycholic acid, prednisolone, vitamine E, and interferon). Vomiting and ascites disappeared with medical management. The dog was monitored periodically by CBC, serum chemistry and radiographic examination. The dog survived more 18 months with medical therapy. After spontaneous death, necropsy and histopathologic examination were performed.

1년령의 암컷 잉글리쉬 코커스파니엘 견이 3개월 병력의 구토와 구토물의 재섭취, 그리고 체중감소로 내원하였다. 이 환자는 일반혈액 검사, 혈청화학 검사, 방사선 검사, 복수 분석, 담즙산 농도 측정, 탐색적 개복술, 그리고 사후 부검을 통한 간 생검으로 만성 간염 및 간경화증으로 진단되었다. 혈액 검사상 경미한 빈혈, 경미한 간효소치의 상승, CK치의 상승, 저알부민혈증을 동반한 저단백혈증이 관찰되었다. 복수는 분석을 통해서 누출성 복수인 것으로 판명되었다. 담즙산 농도를 측정해 본 결과(fasting; $174.4{\mu}mol/L$ and postprandial; $198.4{\mu}mol/L$)로부터 간기능 부전을 강하게 의심할 수 있었다. 방사선 검사상 복수가 관찰되었고 결국 탐색적 개복술을 실시하여 좌측엽 부위의 간 위축, 장간막 혈관 구조들의 팽창된 소견이 관찰되었다. 간 좌측 후엽모서리 부위에서 봉합법을 통해 생검을 실시하였다. 간 조직의 조직병리학적인 검사 결과 간 세포의 괴사, 동양 혈관의 확장, 동양 혈관 내 호중구의 침착, 그리고 간 세포질의 공포화 등이 관찰되었다. 환축은 저단백 사료 급여 그리고 특수보조제 (ursodeoxycholic acid, prednisolone, vitamine E and interferon)등을 사용하여 관리했다. 구토와 복수는 치료 후 사라졌다. 환축은 정기적으로 혈액 검사, 혈청 화학 검사, 방사선 검사 등을 실시하였다. 이 환축은 내과적인 치료를 받으며 18개월간 생존하였다가 폐사하였다. 사후 부검을 실시했고 조직병리학적인 검사가 시행되었으며 그 결과 간세포에 림프구의 침윤된 진행성의 간경화증으로 판정되었다.

Keywords

References

  1. Adamus C, Buggin-Daubie M, Izembart A, Sonrier-Pierre C, Guigand L, Masson MT, Andre-Fontaine G, Wyers M. Chronic hepatitis associated with leptospiral infection in vaccinated beagles. J Comp Pathol 1997; 117: 311-328 https://doi.org/10.1016/S0021-9975(97)80079-5
  2. Andersson M, Sevelius E. Breed, sex and age distribution in dogs with chronic liver disease: a demographic study. J Small Anim Pract 1991; 32: 1-5 https://doi.org/10.1111/j.1748-5827.1991.tb00844.x
  3. Bennett AM, Davies JD, Gaskell CJ, Lucke VM. Lobular dissecting hepatitis in the dog. Vet Pathol 1983; 20: 179-188 https://doi.org/10.1177/030098588302000205
  4. Benyon RC, Iredale JP. Is liver fibrosis reversible? Gut, 2000; 46: 443-446 https://doi.org/10.1136/gut.46.4.443
  5. Bishop L, Strandberg JD, Adams RJ, Brownstein DG., Patterson R. Chronic active hepatitis in dogs associated with leptospires. Am J Vet Res 1979; 40: 839-844
  6. Chouinard L, Martineau D, Forget C, Girard C. Use of polymerase chain reaction and immunohistochemistry for detection of canine adenovirus type I in formalin-fixed, paraffin-embedded liver of dogs with chronic hepatitis and cirrhosis. J Vet Diagn Invest 1998; 10: 320-325 https://doi.org/10.1177/104063879801000402
  7. Crawford MA, Schall WD, Jensen RK, Tasker JB. Chronic active hepatitis in 26 Doberman pinschers. J Am Vet Med Assoc 1985; 187: 1343-1349
  8. Ettinger SJ, Feldman EC. In: Textbook of Veterinary Internal Medicine, 5th ed. W.B. Saunders, Philadelphia, 2000: 1298-1311
  9. Gocke DJ, Morris TQ, Bradley SE. Chronic hepatitis in the dog: the role of immune factors. J Am Vet Med Assoc 1970; 156: 1700-1705
  10. Gow PJ, Mutimer D. Treatment of chronic hepatitis. Brit Med J 2001; 323: 1164-1167 https://doi.org/10.1136/bmj.323.7322.1164
  11. Hardy RM, Stevens JB, Stowe CM. Chronic progressive hepatitis in Bedlington terriers associated with elevated liver copper concentrations. Minn Vet 1975; 15: 13-24
  12. Hardy RM. Chronic hepatitis in cocker spaniels another syndrome? In: Proceedings of the 11th ACVIM Forum. pp 256-258. Washington DC, May 1993
  13. Haywood S, Rutgers HC, Christian MK. Hepatitis and copper accumulation in Skye terriers. Vet Pathol 1988; 25: 408-414 https://doi.org/10.1177/030098588802500602
  14. Herrtage ME, Seymour CA, Jefferies AR, Blakemore WF, Palmer AC. Inherited copper toxicosis in the Bedlington terrier: a report of two clinical cases. J Small Anim Pract 1987a; 28: 1127-1140 https://doi.org/10.1111/j.1748-5827.1987.tb01337.x
  15. Holmes NG., Herrtage ME, Ryder EJ, Binns MM. DNA marker CO4107 for copper toxicosis in a population of Bedlington terriers in the United Kingdom. Vet Rec 1998; 142: 351-352 https://doi.org/10.1136/vr.142.14.351
  16. Jarrett WFH, O'Neil BW. A new transmissible agent causing acute hepatitis, chronic hepatitis and cirrhosis in dogs. Vet Rec 1985; 116: 629-635 https://doi.org/10.1136/vr.116.24.629
  17. Jarrett WFH, O'Neil BW, Lindholm I. Persistent hepatitis and chronic fibrosis induced by canine acidophil cell hepatitis virus. Vet Rec 1987; 120: 234-235 https://doi.org/10.1136/vr.120.10.234
  18. Jensen AL, Nielsen OL. Chronic hepatitis in three young standard poodles. J Am Vet Med Assoc 1991; 38: 194 https://doi.org/10.1111/j.1439-0442.1991.tb01001.x
  19. Johnson G.F, Zawie DA, Gilbertson SR, Sternlieb I. Chronic active hepatitis in Doberman pinschers. J Am Vet Med Assoc 1982; 180: 1438-1442
  20. Lindsay KL, Hoofnagle JH. Chronic hepatitis. In: Textbook of Medicine, 21st ed. W.B. Saunders, Philadelphia, 2000: 790-796
  21. Rakich PM, Prasse KW, Lukert PD, Comelius LM. Immunohistochemical detection of canine adenovirus in paraffin sections of liver. Vet Pathol 1986; 23: 478-484 https://doi.org/10.1177/030098588602300419
  22. Rothuizen J, Ubbink GJ, Van Zon P, Teske E, Van Den Ingh TE, Yuzbasiyan-Gurkan V. Diagnostic value of a microsatellite DNA marker for copper toxicosis in West European Bedlington terriers and incidence of the disease. Animal Genetics 1999; 30: 190-194 https://doi.org/10.1046/j.1365-2052.1999.00451.x
  23. Sevelius E, Andersson M, Jonsson L. Hepatic accumulation of alpha-I-antitrypsin in chronic liver disease in the dog. J Comp Pathol 1994; 111: 401-412 https://doi.org/10.1016/S0021-9975(05)80098-2
  24. Starzl TE, Jones AF, Terblanche J, Usui S, Porter KA, Mazzoni G. Growth-stimulating factor in regenerating canine liver. Lancet 1979; 1: 127-130 https://doi.org/10.1016/S0140-6736(02)83679-0
  25. Szawlowski AW, Saint-Aubert B, Gouttebel MC, Astre C, Joyeux H. Experimental model of extended repeated partial hepatectomy in the dog. Eur Sur Res 1987; 19: 375-380 https://doi.org/10.1159/000128725
  26. Thornburg LP, Rottinghaus G, Dennis G., Crawford S. The relationship between hepatic copper content and morphological changes in the liver of West Highland white terriers. Vet Pathol 1996; 33: 656 https://doi.org/10.1177/030098589603300604
  27. Thornburg LP. A perspective on copper and liver disease in the dog, J Vet Diagn Invest 2000; 12: 101-110 https://doi.org/10.1177/104063870001200201
  28. Twedt DC. Clinical, morphologic, and chemical studies on copper toxicosis of Bedlington terriers. J Am Vet Med Assoc 1979; 175: 269
  29. Twedt DC, Diehl KJ, Lappin MR, Getzy DM. Association of hepatic necrosis with trimethoprim sulfonamide administration in 4 dogs. J Vet Intern Med 1997; 11: 20-23 https://doi.org/10.1111/j.1939-1676.1997.tb00068.x
  30. Van De Sluis B, Rothuizen J, Pearson PL, Van Oost BA, Wijmenga C. Identification of a new copper metabolism gene by positional cloning in a purebred dog population. Human Molecular Genetics 2002; 11: 165-173 https://doi.org/10.1093/hmg/11.2.165
  31. Watson PJ. Chronic hepatitis in dogs: a review of current understanding of the aetiology, progression, and treatment. Vet J 2004; 167: 228-241 https://doi.org/10.1016/S1090-0233(03)00118-7