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Diabetic Hepatopathy in Dogs

Diabetic hepatopathy is a disease of the liver which causes lesions to develop on the liver. It is associated with diabetes mellitus, and for unknown reasons, this type of liver disease is also associated with lesions on the skin. One of the possibilities may be a link to metabolic system and a change in the organ systems.

This is a relatively uncommon disease and there is no breed that is more disposed than others, but it does tend to affect predominantly male dogs that are middle-aged to older.

Symptoms and Types

• Sudden onset
• Weight loss
• Lethargy
• Frequent urination and drinking
• Yellowish skin and/or yellow whites of eyes
• No appetite
• Diarrhea
• Vomiting
• Sometimes lameness
• May be few signs
• No energy, poor body condition, painful feet and elbows making it difficult for your dog to stand and lie down
• Skin abnormalities

Causes

• A deficiency of amino acids (the building blocks of proteins) helps play a role in your pet’s skin disease
• Zinc deficiency
• Fatty acid deficiency
• Niacin deficiency
• Possibly too much glucagon secreted by the pancreas (a hormone causing break-down of stored energy in the liver)
• High blood sugar — insulin resistance
• Swallowing of anticonvulsant drugs
• Swallowing fungal toxins

Diagnosis

You will need to give a thorough history of your dog's health and onset of symptoms. Standard tests will include a chemical blood profile, complete blood count, urinalysis and electrolyte panel. A skin biopsy will be taken for laboratory analysis.

Using the results from the bloodwork, your veterinarian will be able to determine how advanced the disease is. The complete blood count (CBC) may show a mild regenerative anemia, and the biochemistry profile may show high liver enzymes and low amino acids.

If the liver is severely compromised, characteristic crystals will be seen in the urine (crystalluria). Abdominal X-rays can be used to look for enlargement of the liver, and in some cases, may show effusion (an escape of fluid from the organ). An abdominal ultrasound is ideal for visualizing the liver in more detail and for searching for a possible pancreatic mass. Ultrasound may show nodular lesions, a swiss cheese appearance, or an uneven shape along the edge of the liver. Your doctor may decide to take a liver biopsy, but this procedure may further complicate the diagnosis or condition, as affected dogs do not heal well from the procedure.

Treatment

Your veterinarian will recommend switching your dog to a high-quality high protein diet. Supplementing the affected dog's diet with egg yolks (three to six yolks per day) or anabolic protein supplements is usually recommended. Your dog will also be given medical prescriptions to improve liver function.

For treating the associated skin disorder, your dog will be treated with supplements of essential fatty acids (omega-3 fatty acids) at double the normal dose. Zinc and antioxidants might also need to be supplemented in your dog's diet under the supervision of your veterinarian.

It is possible in some cases for a condition of sepsis to result from the skin lesions. Your veterinarian will prescribe topical medications to be applied to your dog's skin to prevent or alleviate microbial and fungal infections, to help the skin heal and to provide pain relief for your dog as the skin recovers.

Medications may also be prescribed to treat the diabetes mellitus, but this condition is treated mainly by managing it with diet, to prevent complications or worsening of the diabetes. Be sure to regularly monitor your dog's eating and behavior so as to keep tabs on its diabetes mellitus symptoms. If you suspect this disease is not controlled, call your veterinarian as soon as possible and discuss the signs you are seeing.

Living and Management

You will need to return to your veterinarian every month to assess your dog's need for amino acid supplements and treatment for secondary infections. Every three months a chemical blood profile, complete blood count, urinalysis and electrolyte panel should be performed by your veterinarian. Your dog's diabetes mellitus will be assessed and treatment will be adjusted as necessary during these visits.

With consistent treatment, some dogs will enjoy a long remission from the symptoms of skin disease. Some dogs, however, will be unresponsive to the therapy and will continue to suffer from progressive symptoms. For these dogs, euthanasia may be the only answer.