Liver damage in dogs can be caused by numerous disorders, toxins or infections, and can be congenital or inherited such as occurs with portocaval shunts. Some of the acquired causes include blue-green algae, herbicides, fertilizers, insecticides, parasiticides, copper storage, aflatoxins (mold; particularly corn), certain mushrooms, leptospirosis, infectious canine hepatitis, leishmaniosis, Cushing’s Disease, diabetes, corticosteroids, pancreatitis, cancer, toxoplasmosis and aging. Sadly, sometimes the cause may be unknown or may be multifactorial.
In this Blog post, Hemopet will be focusing on one particularly complex consultation case of liver damage that crossed Dr. Dodds’ desk recently.
Romy was a quirky, delightful, loved and well-cared for Pug who used to ride the ‘L’ train in Chicago before moving to sunny California. After a pampered life, Romy was put to rest at the age of 13. What we know is that Romy’s mom tried her level best to prolong Romy’s life.
Romy was seen at an emergency veterinary hospital for “severe, acute gastrointestinal pain and vomiting”.
The emergency hospital referred Romy to an urgent care hospital where she was admitted and stayed for approximately one week.
She was treated for acute pancreatitis with antibiotics and other medications. Her liver and gallbladder both had inflammation.
Eventually, her right lung was injured due to the systemwide (systemic) organ failure of her liver, gallbladder and lungs.
The cause of Romy’s liver damage was more than likely pancreatitis, but she possibly had underlying, age-related, chronic liver deterioration as well. After reviewing the medical records, Dr. Dodds strongly believes that the pancreatitis was resolving but Romy unfortunately passed away from the high bilirubin in her bloodstream, as well as severe damage and dysfunction in her liver as bile flow was stagnant.
Did Romy get into anything or was fed fatty food to cause the acute pancreatitis?
No. She was not fed outside of her diet and she did not get into anything. While we usually associate acute pancreatitis with dogs being fed copious amounts of high fat foods, in all actuality we often do not know the cause of this form of pancreatitis.
There could be several disease progression components building up over time to cause acute pancreatitis. Acute pancreatitis is when the pancreas becomes inflamed. Then, pancreatic digestive enzymes burst inside the pancreas instead of where they are supposed to, in the small intestine, thus causing acute pancreatitis.
The pancreas is not directly connected to the liver or gallbladder, how did the pancreatitis affect her liver and gallbladder?
The inflammation of the pancreas allows digestive enzymes from the pancreas to spill into the abdominal cavity and affect other organs around it such as the liver and gallbladder.
Why do we think it was the liver damage and not the pancreatitis that ultimately was the cause of Romy’s death?
Based on Romy’s symptoms, ultrasounds and test results, Dr. Dodds focused on the elevated bilirubin in Romy’s bloodstream.
For background, red blood cells are produced in the bone marrow. Hemoglobin (heme) is a protein in red blood cells. Heme carries oxygen to organs and tissues and transports carbon dioxide from organs and tissues back to your lungs. Bilirubin is a byproduct of heme and can be toxic. The spleen removes old red blood cells and separates out the cellular components. One of which, bilirubin, is then sent to the liver.
The liver then combines the bilirubin with bile and sends it over to the gallbladder for storage.
When the small intestine needs bile to break down fat, the bile then goes into the small intestine.
If the liver becomes severely inflamed (hepatitis), it causes an elevation of bilirubin levels in the bloodstream. Liver cells (hepatocytes) are hexagonal in shape and the blood and bile channels all flow through the center of the cell. Thus, when the liver cell is inflamed and swollen, it squeezes the center area and bile flow becomes stalled and damaged the liver, causing the high bilirubin.
To determine liver damage or disorder, veterinarians run a complete blood count (CBC), a serum biochemical profile, and a urinalysis. The results can help categorize the liver damage to figure out the cause. Liver enzyme levels may point to one cause and bilirubin may point a veterinarian in another direction. For instance, certain drugs – such as corticosteroids and carprofen – may increase the liver cell-specific enzyme alanine aminotransferase (ALT) values, indicating some degree of liver cell injury. Phenobarbital, on the other hand, induces and increases expression of the alkaline phosphatase enzyme (ALK P) but does not actually damage the liver cells – despite much misunderstanding of this point.
How did her lungs get damaged by the other organs?
The body creates an excess of reactive oxygen species (ROS), which causes cellular oxidative stress to many tissues – especially lung tissue. So, the lung damage compromised her breathing on top of her already being a brachycephalic (smooshed face) dog.
Did anything else contribute to her passing?
Romy did have an age- and breed-related condition that may have contributed to her weakened state but did not cause her death. This is called a “comorbidity”.
Romy had significant dental disease that may have contributed bacterial showers in her bloodstream.
Dental disease is common in older dogs. Romy’s mom did brush Romy’s teeth regularly. Like humans, thorough dental cleanings are required. Unlike humans, however, a dental cleaning at a veterinary clinic requires the staff to put the dog under general anesthesia.
Remember, Romy was a 13 year-old Pug. Pugs are brachycephalic, which creates narrow passageways to the lungs. Anesthesia poses a big risk to brachycephalic breeds. So, what do pet companion parents do in this situation with an older brachycephalic dog? It’s a catch-22.
I’m confused; what caused Romy’s passing?
Romy died of liver failure that was probably degenerative along with the natural aging process, which was aggravated by the pancreatitis. Ultimately, we don’t know what caused Romy’s pancreatitis. It could have been food, aging, environment, breed, genetics, or all of the above.
We all know as companion pet parents how painful it is not to know the ultimate cause of a disease. What could we have done differently? Did we do what was best for our fur baby? Just remember, if you loved them and gave them the best and happy life, you did the very best you could.
A Tribute to Romy from Mom
My dear sweet Romy,
My heart imploded 4 weeks ago.
I had been preparing for that day, but I was unprepared for the weeklong illness, the fragility, the deterioration, the worry, the sleepless nights, the helplessness, the finality.
I spent days afraid to look at your photos, afraid of re-experiencing the immense sadness and heaviness. But when I finally did look, I was comforted. The sight of your chunky, smiling, joyful, snorting, loving, BFF-to-all self. Who knew that your first road trip at 9 weeks old from a remote farm in Ohio would be the start of miles of travel all across this great beautiful country, including two cross country drives from Chicago to LA.
Author Glennon Doyle wrote, “Grief is the receipt we wave in the air that says to the world: Look! Love was once mine.”
Well, my receipt is long.
For years, it was just You and Me. In our little 550 sq ft city condo, next to the rumble of the L train, amid the hustle of downtown Chicago (though the noise never seemed to bother you), enduring long winter days (the salt and snow did bother you) and walking many cement blocks alongside tourists and “Suits”.
You journeyed with me through relationships, bad decisions, unemployment, new employment, marathons, marathon training and one grad school degree and not once decided to call it quits (I wouldn’t have blamed you if you did).
You weren’t just a pet, you were my partner – we did life *together*. Not unlike great friendships throughout history like Thelma and Louise, Lucy and Ethel, Maverick and Goose, Winnie the Pooh and Piglet and, of course, Romy and Michelle.
If the depth of our sadness truly reflects the depth of our love, then I know I loved you very much.
13.5 years was not enough time. No number of years ever are. But I’m so grateful to be the one who you shared your time on Earth with. Every life has great love stories — My Queen Romy, how can I repay you for being one of mine?
Thank you for the rest of this life and the next, and I cannot wait to continue our story again.
Love, Mom ❤️