• Vet Pet Factsheets | Cave Veterinary Specialists

If your pet has been diagnosed with a condition we know this can be a worrying time.  That’s why we’ve produced fact sheets on some of the most common conditions we see, to help explain the causes and treatment options available.

What is chronic hepatopathy?

Chronic hepatopathy means there is long term damage to the liver which affects the liver’s ability to function normally. The liver is very complex and is involved in many functions including:

  • Detoxification including the breakdown of drugs.
  • Production of clotting factors which help your body stop bleeding.
  • Absorption and digestion of nutrients.
  • Production of bile which helps with absorption of fats and vitamins.
  • Storing glucose in the form of glycogen so it can be released when required.

Altered function can result in accumulation of ‘toxic’ substances in the blood stream, increased tendency to bleed, reduced blood protein levels, reduced ability to absorb nutrients and other problems.

Liver failure usually occurs when 75% or more of the liver is affected. There are many different causes including chronic bacterial infections, long term exposure to toxins, chronic inflammation, cancer, autoimmune disease, increased storage of heavy metals such as copper and others.

Signs and symptoms

Some of the most common symptoms include increased thirst and urination, a distended abdomen (due to fluid accumulation called ascites), vomiting, diarrhoea, reduced appetite, jaundice (yellow skin or gums), altered behaviour (neurological signs), muscle wastage and weight loss.

Diagnosis

Liver failure is diagnosed with blood tests, but further investigations are required to determine the cause and confirm this finding. These may include diagnostic imaging (ultrasound or computed tomography), urine samples and liver biopsy.

Liver biopsies can be obtained surgically, sometimes through keyhole surgery or ultrasound guided ‘trucut’ biopsy (where a large wide bore needle is inserted into the liver).

Treatment for chronic hepatopathy

Some treatments will depend on the underlying cause but a lot of the treatments for managing liver failure are similar, including:

  • Dietary modification to reduce protein and some minerals as well as providing adequate calorie intake.
  • Management of abdominal fluid. This may include diuretic medication to reduce fluid in the abdomen or draining of the fluid.
  • Management of neurological signs, if toxins build up (known as hepatic encephalopathy) with medication such as lactulose.
  • Supportive treatment for the gut.
  • Liver support such as antioxidants.
  • Anti-inflammatories such as steroids.

Some medication may be more specific such as copper binding drugs, where copper accumulation causes liver damage.

The prognosis

The prognosis can vary depending on the underlying cause and often, the disease is already severe when symptoms develop. A cure is rarely achieved, and management is often difficult but if caught and treated early, longer survival times and more importantly a good quality of life may be achieved.

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What is CSM?

Cervical spondylomyelopathy (CSM) may also be referred to as “wobbler syndrome” is an uncommon disease of the cervical vertebral column (neck). We typically see this disease in large and giant breed dogs. It is a complex disease characterised by narrowing of the vertebral canal leading to compression of the spinal cord. There are two main forms of CSM identified – osseous associated CSM (OA-CSM) and disc associated CSM (DA-CSM).

OA-CSM is more commonly seen in young giant breeds (such as Great Danes or Bull Mastiffs). Changes to the bones in the neck during development lead to compression of the spinal cord.

DA-CSM is more commonly seen in older large breed dogs such as Dobermans. We generally see a combination of changes to the bones in the neck and protrusion of one or more intervertebral discs leading to compression of the spinal cord.

What signs are associated with CSM?

Spinal cord compression can lead to ataxia (wobbliness) and paresis (weakness). We may see dogs that tend to scuff their paws and drag the nails. The front legs can have a short choppy gait. We may also see neck pain (including spasms of the neck) and a reluctance to move in dogs with CSM. Some dogs with CSM may have an inability to walk and have incontinence.

How do we diagnose CSM?

CSM is typically diagnosed by a combination of history, neurological and advanced imaging.
Advanced imaging typically may be either an MRI, CT or a combination of these imaging modalities. MRI provides better soft tissue detail (such as the spinal cord), whilst the CT provides better information about the bones of the spine (vertebrae).

What is the treatment for CSM?

Treatment is depended on the cause and the severity of the patient’s clinical signs. The neurologist will be able to discuss different options with you once they have made a diagnosis.

Treatment options are divided into medical and surgical options. Medical management is generally recommended for dogs with mild pathology and often included exercise modification, anti-inflammatory medication, physiotherapy and hydrotherapy. There are a number of different surgical options available and the suitability of these is depended on the exact diagnosis.

What is the treatment for CSM?

The prognosis is highly variable depending on the severity of the disease and clinical signs, and response to treatment.

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What are brain tumours and what causes them?

A tumour (or cancer) is a growth of abnormal cells within a body tissue. Brain tumours can develop from brain cells (primary brain tumour) or the tumour may be the result of spread of a tumour elsewhere in the body such as the lungs, liver or skin (secondary or metastatic tumours). Common primary brain tumours include those arising from cells forming the lining of the surface of the brain (meningioma), the lining of the fluid filled cavities of the brain (ependymoma), the choroid plexus (choroid plexus tumour) or the brain tissue itself (glioma).
There is no single definitive cause for primary brain tumours. Some risk factors have been identified but these will depend on the patient and their environment. Mutations in the DNA of a cell leads to abnormal growth (uncontrolled division), and as further mutations accumulate the tumour cells can invade surrounding brain. What causes these mutations is likely to vary between different species and individuals.

Which pets typically get brain tumours?

Dogs of any age and breed can develop brain tumours, however we typically consider older and larger breeds as more likely to get this condition. The Boxer, Boston Terrier, Golden Retriever and French Bulldog are known to be at a higher risk of primary intracranial neoplasms. In cats, patients are also often older, tend to be male and domestic short haired breeds.

What are the signs of brain tumours?

Brain tumours in dogs and cats can cause a wide variety of clinical signs that are dependent on the part of the brain affected. In many cases the first sign to develop is seizures (fits). Other signs commonly seen are blindness, changes in the animal’s personality and understanding of the world, profound lethargy, circling and disorientation. Some pets can also appear to have a ‘headache’. Some of these signs, such as seizures, may be permanent whatever the treatment course.

How are brain tumours diagnosed?

The diagnosis of a brain tumour cannot be based solely on the clinical and neurological signs as other neurological conditions such as inflammations and infections can potentially cause similar signs. Diagnosis is usually based on a combination of history, neurological examination and advanced imaging such as MRI. MRI will only allow an approximate diagnosis to be made based on the imaging characteristics. As in humans, a precise diagnosis will require a biopsy of the tumour and investigation of the cells involved, but this is rarely carried out in veterinary patients.

What treatment options are available?

Treatments are available for brain tumours in dogs and cats, but they are rarely curative. Treatment is usually aimed at providing your pet with the best possible quality of life for as long as possible. The treatment and prognosis for brain tumours in dogs and cats varies with the type and location of the tumour. The most appropriate treatment for your pet depends on a number of factors, including the type and location of the tumour, the general health of the patient and the wishes of the owner. The three basic options for tumour treatments are:

1: Medication alone

There are limited chemotherapy options for brain tumours in dogs and cats because the brain is a very protected site and many drugs cannot penetrate it. Some drugs can help to reduce the neurological signs seen in brain tumour patients. These include corticosteroids which can reduce the swelling and pressure caused by the tumour, and anti-seizure medications to reduce the severity and frequency of seizures. These drugs can cause side effects such as drinking, eating and urinating more. Some pets can seem a little more wobbly or sleepy in the early days of treatment. Treating with medication can often have good initial results, however, there may only be relief from symptoms for a weeks to months.

2: Medication and radiation therapy

Some tumours can be treated with surgery (see below); however, others are deep within the brain and cannot be approached surgically. Radiation therapy targeted at the tumour can result in dramatic and rapid improvement of signs in some cases. Cancer cells generally multiply and grow very rapidly. Ionising radiation works primarily by disrupting the process of cell division causing cancerous cells to die. Radiotherapy is a focused treatment and the goal is to provide local or regional control of cancer. Radiation treatments are individualised for each patient and are sometimes incorporated into a treatment plan involving other types of cancer therapy, such as surgery or chemotherapy.

3: Medication, radiation therapy and surgery

The ultimate goal of cancer surgery is to try and remove the tumour completely. Unfortunately, this is rarely possible with brain tumours and there are nearly always tumour cells left behind which can cause the tumour to regrow. However, by removing as much of the tumour as possible during surgery, the remaining cells may become more ‘sensitive’ to radiation and the tumour will be smaller giving other therapies (medication, radiotherapy) a better chance of success. Surgery also allows vets to take a sample of the tumour which will provide a precise diagnosis and allow us to provide more information on treatment and prognosis. The feasibility of surgery to remove the tumour is dependent on tumour location and type. Tumours that are on the brain surface are more likely to be amenable to surgery. Although most dogs recover well and without complication, brain surgery can occasionally cause irreversible damage to the brain.

What is the prognosis?

The prognosis for brain tumours in dogs and cats is highly variable and dependent on tumour type and location. Many dogs can have a good quality of life following diagnosis and during treatment. As a rough guide, average remission time ranges from 1 to 6 months with corticosteroids alone, from 8 to 14 months with radiotherapy alone, and 12 to 20 months with surgery followed by radiotherapy. It must be noted that these figures are guidelines, and every pet is different.

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What is canine degenerative myelopathy and what is the cause?

Canine degenerative myelopathy (DM) is a progressive disease of the spinal cord. It is generally a slowly progressive condition where over many months the nerves within the spinal cord stop functioning and are therefore unable to transmit impulses normally. The nerves in the middle of the back (thoracolumbar spinal cord) are affected first and then the disease progresses down and eventually up the spinal cord.

The exact cause is incompletely understood. It appears to be the result of a genetic mutation in the gene coding for superoxide dismutase (SOD).

Which pets typically get canine degenerative myelopathy?

Dogs of any breed can be affected but DM is particularly common in German Shepherds, Pembroke Welsh Corgi’s, Boxer dogs and Soft Coated Wheaten Terriers. Clinical signs typically start between 8 and 14 years of age.

What are the signs of degenerative myelopathy?

Clinical signs are initially mild. Typically, only one leg is affected at the outset and there may be subtle signs of weakness e.g., scuffing the nails intermittently. This may gradually progress to affect both pelvic limbs and patients may have more obvious weakness and may appear wobbly (ataxic). As the disease progresses dogs may struggle to stand in their back legs and may have urinary and faecal incontinence. The condition is not painful.

How is degenerative myelopathy diagnosed?

DM can be suspected on the basis of the history and examination findings. However, it is a diagnosis of exclusion, meaning that other diseases that can look very similar need to be excluded by the neurologist first.

It is possible to perform a DNA test to look for a mutation in the SOD gene. In dogs that carry two defective copies of the gene they would be considered to be at risk of developing DM. This test does not definitively confirm the diagnosis.

In most cases we would recommend advanced imaging of the spinal cord and vertebral column with an MRI scan and sometimes a cerebrospinal fluid (CSF) analysis.

What treatment options are available?

There are no specific treatments available for DM, and sadly with time the clinical signs will continue to progress. However, many dogs can have an acceptable quality of life for months or even years. We would advise preventing affected dogs from becoming overweight, regular exercise on non-slip surfaces and regular physiotherapy and in some patient's hydrotherapy can be beneficial. There are also a number of mobility devices which can be useful.

What is the prognosis?

Unfortunately, DM is a progressive condition and with time patients will become paralyzed in their back legs. The disease will then start to progress up the length of the spinal cord to include the forelimbs and is ultimately a fatal condition. The rate of progression can be quite variable between patients. Once patients are unable to use their back legs and have lost urinary and faecal continence, we would recommend humane euthanasia.

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What is chronic enteropathy?

Chronic enteropathy is often characterised by diarrhoea that has occurred for a period of three weeks or more.  Diarrhoea occurs when the small or large intestine does not function normally, so fluid is either secreted excessively or not re-absorbed properly. This causes faeces to appear soft or runny and sometimes they can contain fresh blood, black digested blood, or mucus.

Signs and symptoms

There are many different causes of diarrhoea such as foreign bodies, dietary indiscretion, chronic enteropathy, systemic diseases such as liver disease or kidney failure and others.  These diseases need to be ruled out before chronic enteropathy can diagnosed.

Other potential symptoms of chronic enteropathy include weight loss, inappetence, vomiting, regurgitation, and reflux. Chronic enteropathy can have different causes including dietary intolerance, immune system dysregulation or gut bacteria imbalance.

How is chronic enteropathy diagnosed?

As there are many causes of diarrhoea, initially bloods to assess organ function (including pancreatic function), vitamin levels specific to the intestine, faecal analysis (assessing for infectious diseases such as worms or bacterial infections like salmonella) and imaging are necessary. Your local vet may have done some of these tests before referral. Ultrasound imaging can be useful to assess the intestine and organ structure as well as being able to identify blockages such as foreign bodies or tumours.

If chronic enteropathy is suspected, endoscopy (video imaging of inside the gut) may be discussed. Endoscopy of the stomach and guts allows for visualisation of the wall and for small ‘grab’ biopsies to be obtained with forceps passed inside the endoscope. This can be of the upper gastro-intestinal tract (stomach and first part of the small intestine) and/or lower gastro-intestinal tract (large intestine).  Your pet will need to be fasted overnight for endoscopy and will require to take gut cleansing solutions and enema for lower gut endoscopy. Grab biopsies carry a small risk of bleeding but are non-invasive and only obtain the inner layer of the intestine.  It may be that surgical abdominal exploration to access areas that cannot be reached via the scope and/or full thickness gut biopsies are recommended.  A rare complication of this is   wound breakdown which could cause leakage of gut content from the intestine into the abdomen and cause peritonitis. However, this is rare if certain safety measures are respected.

Biopsies will characterise the type of inflammation but may not confirm which treatment will work best and treatment trials may be recommended.

Treatment options

Chronic enteropathy is often treated with or a combination of dietary management, antibiotics or drugs which ‘dampen’ the immune response such as steroids.  Exclusion diets where a novel (never fed before) protein and carbohydrate source or hydrolysed protein diet may be recommended to be fed for a minimum of four weeks (although improvement is usually seen within two weeks) while no other treats or other foods are given.

What is the prognosis for chronic enteropathy?

Chronic enteropathy is an ongoing disease that usually cannot be cured but we aim to control. In most cases clinical signs can be managed with treatment (which may be lifelong) providing a good quality of life.  It may take weeks to months for treatments trials to be completed so that a final treatment plan can be decided on and adjustments might need to be made over time. Some severe cases may not respond to treatment and may carry a poor prognosis.

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