Penny Watson [Penny Watson of the Cambridge Veterinary School and a European diplomate in internal medicine] Explores Liver Disease And Canine Pancreatitis, UK
Liver disease is one area where knowledge has advanced at a particularly rapid rate and has overturned many of the old certainties about the diagnosis and management of the condition.
Like all students of her 1980s generation, Dr Watson was told in her undergraduate course that steroids are a frontline treatment in the care of patients with chronic liver disease. But that was based on the assumption that most animals with the disease were just like human patients in suffering from an autoimmune condition. But now the finger of suspicion is pointing towards an infectious agent as the probable cause and in that case giving drugs that will weaken the patient’s immune response is likely to do more harm than good, she says.
Dr Watson will also point out that colleagues will need to buy a new text book if their current volume advises the attending clinician to put any patient with chronic liver problems on a low protein hepatic diet. Patients that are fighting liver disease will often need a higher than normal dietary intake of protein and it is particularly important that it is good quality material, she says. There is also increasing evidence that a diet rich in anti-oxidants can be helpful in managing the condition.
Chronic liver disease in dogs is a particularly frustrating condition to treat because the cause will often appear idiopathic and there is only a limited amount of published evidence to support the different treatment options. But there is anecdotal evidence that some of those options will help recovery and a proper diagnostic work up, including hepatic biopsies will help identify some patients with eminently treatable causes of liver problems.
In a second presentation, Dr Watson will be updating colleagues on another condition that presents difficult clinical challenges for a first opinion practitioner, canine pancreatitis. Again there is little convincing evidence to support any particular treatment option. She will be advising on ways to identify patients with severe disease at the earliest opportunity as the condition is very painful and with a high mortality and so the owners need to be warned of the poor prognosis.
“Dogs don’t drink alcohol, they don’t have gallstones and they don’t suffer from cystic fibrosis, which are the three main causes of acute pancreatitis in people. So we have got to be looking at some of the more unusual causes of this disease if we want to learn anything from our human medical colleagues,” Dr Watson points out.
But there are some strategies used in NHS hospitals that may help recovery in dogs with acute pancreatitis, such as aggressive use of fluid therapy and early attempts at assisted feeding in dogs who may be emetic and have little appetite for food. As in patients with liver disease, the received wisdom 20 years ago was to discourage feeding of patients with such a severely compromised digestive system – so once again the information told to veterinary surgeons-to-be as recently as the 1980s has again been found to be completely inaccurate, she says.
1. Session titles: Diagnosing and managing acute pancreatitis in the dog, 9am, Saturday 24 September Treatment of chronic liver disease, 10.30am, Saturday 24 September
2. BVA Congress, in association with BSAVA, will be held in London on 22-24 September 2011 under the theme ‘Vets in a Changing World’.
British Veterinary Association