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Although I’m writing this between Christmas and New Year, by the time these few words are in print, it will be the latter half of February. So a bit late to dwell on the effects of over-indulgence during the festive period. Right now though, it’s still a topic of conversation. This brings me round to the organ system in the body that, along with the lungs, takes the brunt of the attack the outside world makes on us. I’m talking about the liver.
While the lungs suck in countless viruses, bacteria, fungal spores and particulates every day, the liver is subjected to a similar attack. Just about everything in our intestines, food, toxins, bacteria, and fungi affects it. The reason? All the blood from the digestive system, loaded up with the contents of our last meal and its byproducts, goes straight to the liver. It bypasses the general circulation. So after digestion, all the proteins, carbohydrates, medicines and….alcohol (if you’re human) are sent straight to the chemical factory of the liver.
The pathway fat takes is more complicated. Some digested forms go to the liver but the majority heads off to lymphatics in the form of lipoproteins, a mixture of fat and protein. The liver takes it all in, breaks it down and then builds up new molecules used around the body. I’ll just mention the bile system. This is a branched system of tiny canals (ducts) that join up like branches to the trunk of a tree, all buried within the liver structure. Bile flows in the ducts to the gall bladder where it’s stored until needed to help digest fat. So, the liver is at the centre, anatomically and metabolically, of all vertebrate bodies. Not surprising then that it’s complicated in structure and function. This results in a wide range of symptoms when it goes wrong.
Liver disease is common in all species. Unfortunately, making a diagnosis is often tricky as symptoms are non-specific; weight loss, vomiting, diarrhoea, ain’t doing right. Many people have come across liver enzyme blood tests, either for their pets or for themselves. These enzymes are responsible for all the chemical reactions that go on in the liver. They leak out into the blood when the liver is “unhappy”. We measure the levels of some of these enzymes. The problem is, that these levels do not correlate well with the degree of “unhappiness” and they give little information about the cause of the problem. What’s more, liver enzyme levels can vary due to non-liver factors, such as medication (especially steroids in dogs), high blood pressure and inflammation in the gut or pancreas.
Doctors and vets have to navigate a bewildering range of symptoms and diagnostic tests to pin down a problem in the liver. They then define what that problem might be. The ultrasound scan has moved our diagnostics up a notch or two as it sees into the structure of the liver and the bile system, including the gall bladder. But it doesn’t tell us about function nor can it definitively diagnose an infection or tumour without tissue culture or biopsy. Oh, it’s a can of worms, this liver lark.
A few weeks ago, an unhappy little Cavalier spaniel called Bertie came into the surgery with diarrhoea. The owner was pretty unhappy as well, having cleared up quite a mess that morning. Antonia, one of our vets who saw Bertie, was a little concerned. He was just a bit too miserable and had uncharacteristically refused his poached chicken the night before.
So in Bertie came to the hospital where the sight of a needle galvanised him into vigorous action. This made the job of taking a blood sample unusually difficult. But as ever, our nurses cajoled him with kisses and cuddles and after that “little scratch”, blood was successfully taken. Hmm, liver enzymes were elevated so out with the ultrasound machine and sure enough, changes were seen in the structure of the liver. Deciding to take a cautious approach, Antonia prescribed extract of milk thistle (wow! You might think…they’ve gone alternative on us) and a medicine to help the flow of bile. All sounds a bit mediaeval but in fact the active ingredient of milk thistle is known to support liver function and sluggish bile flow is a well-known complication of liver disorders.
Bertie made a complete recovery but a month later he came back, this time with persistent vomiting. No diarrhoea this time, thank goodness. I wasted no time in ordering a repeat of the blood tests, more useful now as we had a comparison with the previous results. The news was not good, suggestive of almost complete liver failure. Bertie’s owner and I started conversing in hushed tones, including the “c” word and agreeing what a good life he’d had. Meanwhile, Bertie and the nurses were having a party in the dog ward. Scoffing back his poached (well, microwaved this time) chicken and wagging his tail, Bertie seemed quite pleased with how things were going. He was oblivious to the dark discussions going on behind the scenes.
The repeat ultrasound scan just added to our worries. The numerous unexplained shadows on the previous scan had enlarged, never a good sign in any diagnostic imagery. However, over-interpretation is even worse….and sure enough, Kate pronounced the shadows benign mineralisation (apparently common in Cavaliers). Bertie spiked a fever, suggesting an infection of the bile system and liver, a condition we call cholangio-hepatitis. A course of antibiotics, along with milk thistle and bile thinners and Bertie was back, in no small part thanks to the liver’s unique capacity to regenerate, a fact for which I have given thanks since the indulgences of Christmas.
Now, when’s Easter?
