By Dr. Becker
Chronic active hepatitis, or CAH, is a condition in which a pet is dealing with persistent and progressive inflammation of the liver. The word active in this context means the cells of the liver are continually becoming inflamed and dying. Over time, this inflammatory process replaces normal liver tissue with scar tissue, resulting in a condition known as cirrhosis (scarring) of the liver.
CAH is more common in dogs than cats, and is sometimes called chronic canine inflammatory hepatic disease. CAH is seen across all breeds of dogs, both genders, and at any age, though it is more common in middle-aged to older female pets.
Certain breeds are predisposed to the disease, including Bedlington Terriers, Doberman Pinschers, Skye Terriers, standard Poodles, Cocker Spaniels, and West Highland White Terriers.
What Causes Chronic Active Hepatitis?
Most cases of chronic active hepatitis have no known cause. However, certain diseases can lead to CAH, including leptospirosis, copper storage disease, autoimmune disease, and drug and chemical toxicities.
Another disease that can trigger CAH is infectious canine hepatitis, or ICH, which is caused by the canine adenovirus type 1 (CAV-1). The infection can cause damage to cells throughout a dog's body, including in the liver.
At one time, there was a vaccine available to protect dogs from type 1 adenovirus, but it was discontinued because it caused a condition called blue eye. Today we vaccinate against canine adenovirus type 2 (CAV-2), which is a kennel cough virus, and the same core vaccine provides cross-protection against canine adenovirus type 1 as well. Fortunately, outbreaks of infectious canine hepatitis are rare in the US.
Aflatoxins found in moldy grains are another cause of CAH, which is one of the reasons I don’t recommend feeding pets dry food containing grains such as corns, wheat, soy, or rice.
In addition, the way in which an animal’s immune system responds to liver inflammation may contribute to the progressive worsening of the disease.
Symptoms of CAH
Symptoms of chronic active hepatitis include:
Sluggishness Excessive urination Lack of appetite Jaundice (yellowish discoloration of gums and skin) Vomiting Fluid build-up in the abdomen (ascites) Weight loss Poor body condition Excessive thirst Neurological symptoms such as dullness or seizures caused by a build-up of ammonia in the body
Diagnostics your veterinarian will need to run: a variety of blood tests, including a blood-clotting profile; urinalysis; serum bile acids; ammonia levels; abdominal X-rays and/or ultrasound; liver biopsy; and culture and sensitivity tests to check for a liver infection.
Definitive diagnosis of CAH typically relies on blood chemistry test results indicating an increase in liver enzyme levels, as well as a liver biopsy.
Treatment of CAH focuses on dealing with any underlying causes, decreasing inflammation within the liver, supporting its recovery, and attempting to stop the progression of the disease.
Very ill pets must be hospitalized and treated aggressively. They will need to receive intravenous (IV) fluid therapy to treat dehydration from severe vomiting, diarrhea, and/or anorexia (refusal to eat).
Any drugs that must be cleared by the liver should be discontinued immediately.
Medications may be given to decrease fluid build-up in the abdomen, enhance bile flow, treat any infection that is present, address GI ulceration if present, alleviate brain swelling to control seizures, decrease ammonia production and absorption into the body, eliminate copper from the liver, and decrease liver scarring.
Holistic vets, including myself, may also treat CAH patients with supplemental zinc, vitamin K, S-adenosylmethionine (SAMe), milk thistle, n-acetyl cysteine (NAC), glutathione, and a variety of Chinese herbs.
Nutritional support and dietary management will also be necessary. I strongly recommend discontinuing all processed foods and transitioning to an organic, fresh food diet containing high-quality protein, fresh fruits and veggies loaded with detoxifying antioxidants, and balanced for patients with liver dysfunction, which usually means lower copper levels than are found in traditional pet foods.
Chronic active hepatitis can be a difficult disease to treat, and unfortunately, it’s rarely cured. If it goes undiagnosed or inadequately treated and monitored, CAH can progress to cirrhosis of the liver and ultimately, fatal liver disease.But with consistent care and monitoring, the progression of the disease can often be slowed, and the animal can enjoy a very good quality of life.