Vacuolar Hepatopathy in Dogs: A Comprehensive Guide
Vacuolar hepatopathy in dogs is a common liver condition that causes liver cells to swell and become fragile. But what exactly is this disease, and how does it affect your four-legged friend?
In this comprehensive guide, we’ll dive into the details of this disease, including its causes, symptoms, diagnosis, and treatment. We’ll also answer some common questions about vacuolar hepatopathy, such as whether it’s contagious and whether a special diet can help.
OVERVIEW
What is vacuolar hepatopathy in dogs?
Vacuolar hepatopathy is a disease that affects the cells of a dog’s liver. Vacuoles are spaces within liver cells that are filled with one of three kinds of fluid: water, fat or glycogen. In vacuolar hepatopathy (VH), these spaces are filled with glycogen which is a storage form of carbohydrate.
Swelling and the formation of vacuoles are common liver cell responses to injury. Extensive vacuolization can damage individual cells and eventually affect significant portions of the liver.
What is the difference between hepatitis and vacuolar hepatopathy?
Hepatitis is a condition caused by inflammation of the liver. There are many causes of canine hepatitis from viruses to immune-mediated disease. Chronic hepatitis can cause secondary vacuolar hepatopathy.
Hepatopathy describes a disease condition of the liver that is not inflammatory in nature. Vacuolar hepatopathy causes liver disease by swelling liver cells so they are fragile and more easily damaged.
Which dogs does vacuolar hepatopathy affect?
Scottish Terriers have a higher risk of developing vacuolar hepatopathy. (1) The disease is found more in middle-aged to geriatric dogs. Female dogs are affected more often than males. (4)
How common is vacuolar hepatopathy?
This disease is common in dogs. In one study that looked at liver biopsies from 500 dogs, 19% of them had vacuolar hepatopathy. (4)
How does vacuolar hepatopathy affect my dog’s body?
Many dogs with VH have no symptoms that stem directly from their liver changes. Clinical findings may include liver enlargement found on physical exam, ultrasound imaging or radiographs. They often have elevated liver enzymes (ALT, ALP, AST, GGT) found on blood tests.
Dogs with steroid-induced VH often have symptoms related to steroid medication or excessive natural steroid production. The most common symptoms are increased thirst, increased urination and increased appetite.
Learn more about liver disease in dogs…
CAUSES & SYMPTOMS
Why do dogs get vacuolar hepatopathy?
The formation of vacuoles in liver cells is a normal biological response to injury. That injury can be placed in one of three categories
- Steroid-induced–taking steroid medication or excess steroid produced by Cushing’s disease causes vacuoles to form.
- Secondary–in addition to Cushing’s disease, at least 11 other diseases have been associated with VH in dogs including cancer, hepatitis, kidney disease, heart disease, diabetes and neurologic disease.
- Idiopathic–some dogs, especially Scottish Terriers, develop VH for no known reason.
What are the symptoms of vacuolar hepatopathy?
Many dogs have no symptoms of VH but do show symptoms of their primary disease. In the case of steroid-induced VH
- Increased thirst
- Increased urination
- Increased appetite
- Excessive panting
- Pendulous belly
- Enlarged liver
- Hair thinning on the trunk of the body
Dogs with advanced secondary VH may have fluid in their abdomen, diarrhea, lethargy and poor appetite.
Is vacuolar hepatopathy contagious?
VH is not contagious to humans, dogs or other animals. Some of the diseases that cause secondary VH are contagious including viruses and bacteria. You should talk to your veterinarian about how to keep yourself and other pets safe from infectious diseases that may be affecting your dog’s liver.
DIAGNOSIS
How is vacuolar hepatopathy diagnosed?
The most accurate way to diagnose VH is to have a liver biopsy examined microscopically by a pathologist. Liver cells with VH are enlarged, have glycogen-filled vacuoles and may be disintegrating.
Biopsy collection may be done under sedation with a large-bore biopsy needle through the dog’s skin. A surgical biopsy with the dog under anesthesia is more invasive but allows the surgeon to look for other abnormalities in the abdomen.
What tests will be done to diagnose vacuolar hepatopathy?
Other tests that can help diagnose VH include
- Blood chemistry test: expect elevated liver enzymes, especially ALP.
- Blood cortisol levels: checks for Cushing’s disease.
- Adrenal sex hormone levels: checks for excessive sex hormones that can cause VH.
- Ultrasound imaging: can identify tumors, enlarged adrenal glands and structural changes in the liver consistent with VH.
TREATMENT
How is vacuolar hepatopathy treated?
There is no specific treatment for VH. Instead, the focus is on finding underlying diseases such as Cushing’s disease and cancer and treating those.
Dogs who have steroid-induced VH due to medication may need to switch to alternative treatments if they’re available.
Dogs with no underlying disease and no symptoms are monitored periodically with blood tests and ultrasound imaging.
Will a special diet help vacuolar hepatopathy?
Although there are prescription diets for dogs with liver disease, they may or may not be right for your unique dog. Liver diets usually have a limited amount of high-quality protein and controlled copper content. Ask your vet if a prescription liver diet is right for your dog.
What medications can help reduce vacuoles in the liver?
Aside from medication to treat underlying diseases, there are no medications to treat liver vacuoles.
Ursodeoxycholic acid is a prescription medication that increases the flow of bile in the liver. It may be helpful for dogs with VH.
General liver support supplements such as SAM-e, vitamin E and silybin (Denamarin®) may help but, again, there isn’t much supporting evidence. Most dogs tolerate these supplements without side effects, so many dog owners use them.
PREVENTIVE CARE
How can I reduce my dog’s risk?
Avoidance of steroid medication is the only realistic step a dog owner can take to lower their pet’s risk of developing VH. Depending on the disease needing treatment, other medications may be available. Your vet may recommend periodic monitoring with blood tests and ultrasound imaging if your dog has to take steroid medication.
PROGNOSIS
What can I expect if my dog has vacuolar hepatopathy?
In most cases, VH itself does not shorten a dog’s quality of life or their normal lifespan. However, many of the underlying diseases that lead to VH can decrease a dog’s quality and length of life.
Some dogs, especially Scottish Terriers, with degenerative vacuolar hepatopathy may progress to liver insufficiency or even liver failure. (1)
Can vacuolar hepatopathy be cured?
Steroid-induced VH that occurs after a short course of prescribed steroid medication may be reversible. Treatment of other underlying diseases may improve or slow the progression of VH. (2)
HOME CARE & MAINTENANCE
When should my dog see their veterinarian?
If your dog has been diagnosed with VH, you should see your vet periodically for monitoring. Depending on the situation, you may need to visit the vet every 3-6 months.
You should contact your vet if your dog develops any unusual symptoms such as changes in appetite, thirst, urination, defecation, trouble breathing, weight loss, weakness or lethargy.
What questions should I ask the veterinarian?
- Should my dog see a specialist?
- When should I bring my dog in for a recheck?
- What symptoms will let me know my dog’s condition is getting worse?
- Should I give my dog liver-supporting supplements or medication?
- Should my dog eat a special diet?
KEY POINTS
- Vacuolar hepatopathy is a disease that affects the cells of a dog’s liver, where spaces within liver cells are filled with glycogen.
- VH can be steroid-induced, secondary to other diseases or occur for unknown reasons.
- While any breed of dog can get VH, Scottish Terriers have a higher risk.
- VH is best diagnosed through liver biopsy.
- VH doesn’t cause any symptoms in many dogs.
- There is no specific treatment for VH, with the focus being on identifying and treating underlying diseases, along with periodic monitoring.
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References
- Center, S .A. (2012). Breed specific hepatopathies: Scottish Terrier & Maltese dogs. In Proceedings of the Annual ACVIM Forum, New Orleans, Louisiana, USA (Vol. 30).
- Johnson S. E.: Vacuolar Hepatopathy. In: Richter KP (ed): Clinical Veterinary Advisor Dogs and Cats, 3rd ed. Elsevier Saunders 2015 pp. 1056-1057.
- Peyron, C., Lecoindre, P., Chevallier, M., Guerret, S., & Pagnon, A. (2015). Vacuolar hepatopathy in 43 French Scottish Terriers: a morphological study. Revue de médecine vétérinaire, 166(7-8), 176-184.
- Sepesy, L. M., Center, S. A., Randolph, J. F., Warner, K. L., & Erb, H. N. (2006). Vacuolar hepatopathy in dogs: 336 cases (1993–2005). Journal of the American Veterinary Medical Association, 229(2), 246-252.