ISSN 2398-2969      

Liver: chronic hepatitis


Kyle Braund

Penny Watson

Synonym(s): Chronic active hepatitis


  • Cause: most cases idiopathic; copper associated chronic hepatitis common; some cases believed to be autoimmune; chronic infections (eg chronic leptospira) or toxicities possible causes. Lobular dissecting hepatitis in young dogs. 
  • Signs: lethargy, depression, anorexia, jaundice, ascites, polydipsia-polyuria, vomiting, diarrhea, melena, coagulopathy, hepatic encephalopathy.
  • Diagnosis: hepatic biopsy.
  • Treatment: supportive and symptomatic; use of copper chelators, low copper diet or immunosuppressives may be indicated.
  • Prognosis: reasonable in early stages particularly if cause can be treated. Poor in more advanced disease.



  • Chronic hepatitis is a heterogenous group of inflammatory-necrotizing diseases of the liver in which lymphocytes and plasma cells are the predominant inflammatory infiltrate.
  • Pathophysiologic mechanisms of chronic hepatitis in dogs are poorly understood; although immune mechanisms and copper accumulation play roles, chronic toxicity and chronic leptospirosis also implicated.
  • Chronic hepatitis can progress to hepatic cirrhosis (end-stage liver disease).
  • Copper accumulation in liver → significant hepatic injury → acute/chronic hepatitis → cirrhosis.
  • Immune mechanisms directed against cell nuclei, liver membranes, smooth muscle and mitochondria may → chronic active hepatitis.
  • Periportal and sinusoidal fibrosis → portal hypertension → ascites and gut wall edema → diarrhea +/- melena 
  • Decreased production of clotting factors → bleeding tendencies.
  • Hepatcyte swelling → intrahepatic cholestasis → icterus.
  • Inflammation of biliary system → partial obstruction to biliary flow → icterus.
  • Decreased production of albumin → hypoalbuminemia → ascites.
  • Failure to detoxify ammonia from intestine → hepatic encephalopathy.


  • Weeks to months to years.
Note: because of large functional reserve capacity of liver, onset of signs may appear recent in spite of marked chronic disease, suggesting an acute rather than chronic hepatic disorder.


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Further Reading


Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Webster C R L, Center S A, Cullen J M, Penninck D P, Richter K, Twedt D, Watson P J (2019) ACVIM consensus statement on the diagnosis and treatment of chronic hepatitis in dogs. J Vet Intern Med 33 1173-1200 PubMed doi:10.1111/jvim.15467
  • Bexfield N H, Buxton R J, Vicek T J, Day M J, Bailey S M, Haugland S P, Morrison L P, Else R W, Constantino-Casas F & Watson P J (2012) Breed, age and gender distribution of dogs with chronic hepatitis in the United Kingdom. Vet J 193,1 24-128 PubMed doi: 10.1016/j.tvjl.2011.11.024.
  • Poldervaart R P, Favier R P, Penning L C, Van den Ingh T S G A M & Rothuizen J (2009) Primary Hepatitis in Dogs: A Retrospective Review (2002 –2006). J Vet Intern Med 23, 72 PubMed.
  • Meyer D J et al (1997) Use of ursodeoxycholic acids in a dog with chronic hepatitis - effects on serum hepatic tests and endogenous bile acid composition. J Vet Intern Med 11 (3), 195-197 PubMed.
  • Andersson M, Sevelius E (1991) Breed, sex and age distribution in dogs with chronic liver disease: a demographic study. J Small Anim Pract 32, 1-5. 

Other sources of information

  • Lidbury J (2023) Chronic hepatitis. In: Textbook of Veterinary Internal Medicine. 9th edn. Ettinger S J , Feldman E C & Côté E (eds). W B Saunders, Philadelphia. 


American Cocker Spaniel

Bedlington Terrier

Bile acid deficiency

Biopsy: hepatic

Blood biochemistry: albumin

Blood biochemistry: alkaline phosphatase (ALP)

Blood biochemistry: ammonia

Blood biochemistry: bile acid stimulation test

Blood biochemistry: cholesterol

Blood biochemistry: glucose

Blood biochemistry: total bilirubin

Blood biochemistry: total globulin

Blood biochemistry: urea


Cocker Spaniel

Congenital portosystemic shunt (CPSS)

Copper toxicosis (Bedlington Terrier)


Dietetic diet: for liver insufficiency

Disseminated intravascular coagulation


English Springer Spaniel


Hematology: activated partial thromboplastin time (APTT)

Hematology: prothrombin time

Hepatic encephalopathy

Hepatocutaneous syndrome

Klebsiella pneumoniae


Liver function assessment

Liver: acute disease

Liver: amyloidosis

Liver: cholangiohepatitis

Liver: chronic disease - overview

Liver: chronic hepatitis (Doberman)

Liver: cirrhosis

Liver: copper accumulation - West Highland White and Skye Terriers

Liver: idiopathic fibrosis

Liver: lipidosis

Liver: lobular dissecting hepatitis (Standard Poodle)

Liver: neoplasia

Liver: steroid hepatopathy

Liver: toxic hepatitis





Polyuria/polydipsia (PU/PD)

Poodle: Standard


Radiology: liver


Retriever: Labrador


Skye Terrier


Stomach: acute gastritis

Stomach: chronic gastritis

Stomach: lymphocytic plasmacytic gastritis


Therapeutics: gastrointestinal system


Ultrasonography: liver

Ursodeoxycholic acid

Vitamin E

West Highland White Terrier

WSAVA Liver Diseases Guidelines

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