Treatment of ascites in dogs

Hello

I have enjoyed your site and found the information useful.

We have a female bulldog turning 2 this month. We have always fed her Medi-Cal dog foods (we are in Canada). First growth formula, then to adult formula, then to urinary formula as she developed a tendency of bladder infection.

A few weeks ago we noticed her abdomen became distended and took her in immediately, fearing bloat. We were told it was ascites, and her bloodwork showed a possible liver issue. I have attached the bloodwork. The right side shows the inital test on April 1st, and the left side shows the results 11 days later on April 12th. X-rays were not successful at that time, so we were referred for ultrasound. I have attached two ultrasound stills and the ultrasound report, which found that her liver is undersized and of unusual shape. "Like a cluster of grapes". We decided against a needle biopsy of the liver, in cse of possible bleeding issues. We immediately started her on Zenonil (SAMe), an RX supplement with milk thistle and B vitamins, and the antibiotic Metronidazole.

Her ultrasound was on April 4th, and she began losing her appetite around that time as the ascites worsened. We tried to feed her high quality protein (egg) and rice, but she would not eat much, so we supplemented with a high calorie paste from the vet. On April 12th we felt her breathing was becoming compromised. so we took her in for abdominal tap. 7.5 litres of fluid was drained, and we had a new dog. She was very relieved, eating normally, and happy. The new bloodwork showed improvement in her liver function.

My questions for you:
1. Have you ever seen such a condition in a young dog? Any idea about the cause?
2. Do you feel there is a chance that there will be continued improvement of the liver
3. It seems that our problem now is the ascites. If she won't eat, the liver cannot improve. Is there some way to manage the ascites?
4. Is it possible that continued improvement of the liver will result in the ascites improving or disappearing altogether? Or will the ascites be permanent?

We want to give her every chance. After the abdominal tap her quality of life has been very good, but the fluid seems to be returning quickly, she is gaining about a pound of weight and an inch of girth each day. Today she is only 3.5 lbs below the weight at which she was when we took her in for the tap 5 days ago. As we can't do a tap once a week, should we be looking at letting her go?

Thank you for any advice and help.

Sincerely,
David Dutka

My Comment:

Hi David

And thanks for your mail and all the attachments (sent private to me and therefor not visible to the readers of this).

No, I haven't seen any thing like this in such a young dog before. It is very a young age to have such problems and not seen that often.

No idea about the cause.

I really would like to see a biopsy from the liver, but I also understand that it was decided not to perform this surgery. I agree in that decision and from what I can see your vet is doing a great job.

One thing you might discuss with your vet is a bile acid test to see how well/or how bad the liver is reusing the bile acids. This can tell you to which extent the liver functions is impaired.

I understand your problem about the ascites. It is hard to solve From the last blood results you can see the ALT/ALKP has improved but this is little comfort if other clinical symptoms are worsening.

If the diagnosis is most likely fibrosis/cirrhosis of the liver you might discuss to use some kind of cortisone. Sometimes I use this solution if nothing else seem to work. Talk to your vet about this solution.

You also have to discuss the antibiotics.

Metronidazol is a normal antibiotic to use in liver patients. But one patient of mine actually developed a side effect to the meternidazole medication and one symptom was ascites.

Other signs was weakness and difficulty walking and the symptoms just got worse and worse until I got suspicious about possible side effects.

Sometimes side effects can happen and I was very surprised to experienced this liver side effect in a much used liver medicine.

I took the dog of the medication and the dog improved gradually.

Now, I cant tell if this is the case here and it is important to discuss it with your vet!!

You can also ask your vet if he/she thinks any medication with prednisolone can be helpfull. Sometimes in liver fibrosis this can be beneficial, but this is a clinical judgement made by the "vet in clinical charge"

So - I am not trying to give "false hope"

The situation looks very serious to me as well. Use this mail as a help to think "outside the box" in this hard and difficult situation.

Sincerely

Per Schonbeck