1. Treating Liver Disease
(in 30 minutes!)
Craig B Webb, PhD, DVM, DACVIM
Professor & Head Small Animal Medicine Section
Colorado State University
Veterinary Teaching Hospital

2. Disclosure #2:
I think Nutramax Labs is a Great Company!

3. Medical Management of
Congenital Portosystemic Shunts
“Sophie”
1 yo FS Chihuahua
“Jack”
8 mo MC Domestic short hair

4. Emergent Treatment of Seizures
IV Fluids with Dextrose
Warm Water Enema with Lactulose
Diazepam
(Phenobarbitol or KBromide if necessary)
Levetiracetam to reduce post-op seizures
(20 mg/kg TID at least 24 hrs pre-op)

5. PSS Medical Treatment
•Lactulose
•Acidify the colon, cathartic
•Drives Ammonia to Ammonium (not absorbed)
•0.25-0.5 ml/kg, 3-4x/day, to effect
Lactic Acid

6. PSS Medical Treatment
•Lactulose
•Acidify the colon, cathartic
•Reduces Ammonia production & absorption
•0.25-0.5 ml/kg, 3-4x/day, to effect
Lactic Acid

7. PSS Medical Treatment
•Diet
•Protein Restriction IF Hepatic Encephalopathy
• 11% Dry Matter basis
•Hepatic Diets for Non-HE Liver dogs
17.8% DM
[Cu] 4.6 ppm
14% DM
[Cu] 7 ppm
19% DM
[Cu] 4.9 ppm

8. PSS Medical Treatment
•Diet
•Protein for a Growing Puppy (20-25% DM)
•Add cottage cheese or vegetable-based protein
17.8% DM
[Cu] 4.6 ppm
14% DM
[Cu] 7 ppm
19% DM
[Cu] 4.9 ppm

9. PSS Medical Treatment
•Diet
•Vitamin Supplementation
•Water soluble: B1 (thiamine – cats!)
•Fat soluble: K (clotting) &
vitamin E (oxidative stress)
•Fiber
•SCFA = acidification = NH3 to NH4+
•Antioxidants
•More to come

10. PSS Medical Treatment
•Microbiota
•Lactic acid producing bacteria
•Metabolism of fiber to SCFA
•Decrease pH, Decrease [Ammonia]

11. Treating Feline Cholangitis
Neutrophilic Acute or Chronic
“Grumpy”
8 yo MC Domestic short hair
Anorexia, vomiting, ptyalism
Febrile, jaundice

12. Treating Feline Cholangitis
Neutrophilic Acute (or Chronic)
Non-Specific & Supportive
Fluids, Electrolytes, Nutrition, Pain
Vit K1 {0.5-1.5 mg SQ, q 12 h (2-3 doses)}

13. Ideally
Gallbladder Aspirate
Culture
Antibiotic

14. Empirically
Cover the Enterics
Ampicillin
or
Clavimox
Metronidzole
or
Pradofloxacin
2 months
+/-

15. Empirically
IF Chronic or IF antibiotic failure
add Prednisolone
1 mg/kg BID for 2 weeks;
1 mg/kg SID for 2 weeks;
0.5 mg/kg SID for 2 weeks;
0.5 mg/kg q48hr

16. Treating K9 Hepatopathies
[Cu] - associated Hepatitis
“Bella”
8 yo FS Labrador Ret
Anorexia, lethargy, vomiting
Weight-loss, jaundice

17. Avoid Copper in Diet, Treats, Supplements
Do not restrict protein unless HE
BalanceIT.com

20. Cuisine-a-crocs.com/en/

21. Chelate the Copper
•[Cu] > 600 µg/g - 1000 µg/g dry weight
•Penicillamine on an empty stomach
•2-6 months
•Problem: Penicillamine on an empty stomach
•Hyporexia, nausea, vomiting

22. How to Help
Stop the Vomiting Decrease Nausea Increase Appetite

23. Treating K9 Hepatopathies
K9 (Immune) Chronic Hepatitis
1-2 mg/kg day
Taper
Steroid hepatopathy
Hard to monitor
5 mg/kg BID
Without steroids
Vomiting
Monitor Enzymes

24. Treating Any Liver Disease
Support the Liver
“Drain the Swamp”
Ursodiol
Choleretic
Hepatoprotective
Biliary cirrhosis
Denamarin
Antioxidant
SAMe + Silybin

26. Dr. Twedt – Before Vit E

27. Dr. Twedt – After Vit E

28. Treating Feline Hepatic Lipidosis
Center S. Vet Clin NA Sm Anim Pract 2005
Vit K (for Procedures)
Vit E
B-soluble vitamins
Thiamine
Vit B12
L-Carnitine
SAMe

29. RedRubber&CurvedCarmalts Empower the Owner with Easy Access
VIDEO #1 will be here

30. www.milainternational.com
Video #2 will be here

31. www.kittykollar.com

32. THANK YOU!
Serge Martinod
Directeur Scientifique,
Dr. Vétérinaire, Arcanatura SAS