Chronic hepatitis — histological diagnosis

WSAVA guideline

Key findings

• Grading (Table 2, 0–5): 0 absent; 1 slight (very mild interface hepatitis, ≤1 focus/10× field); 2 mild (2–4 foci); 3 moderate (5–10 foci); 4 marked (>10 foci ± confluent/bridging necrosis); 5 very marked (>10 foci AND bridging or panacinar/multiacinar necrosis) (Ch7 p39).
• Staging (fibrosis 0–4): 0 absent; 1 mild focal periportal/central expansion; 2 moderate expansion + some bridging (PP/CC/PC); 3 marked expansion + marked bridging; 4 marked bridging WITH nodules = cirrhosis (Ch7 p39).
• Copper score (Table 3, 0–5+): 1+ solitary centrolobular hepatocytes; 2+ small centrolobular groups; 3+ centrolobular hepatocytes + some macrophages; 4+ centrolobular + midzonal + macrophages; 5+ panlobular/diffuse; 0–2+ normal, 3+–5+ pathological (Ch7 p40).
• Copper thresholds (dry weight): healthy ≤400 µg/g; Bedlington, WHWT, Dalmatian, Doberman, Labrador with copper damage >2,000 µg/g; Skye 800–2,200; cocker spaniels elevated (primary vs secondary undetermined); feline copper hepatitis via ATP7B variants (Ch7 pp26–27).
• Breed genetics as printed: Bedlington (COMMD1, ABCA12); Labrador and Doberman (ATP7A/ATP7B); familial in WHWT, Skye, Dalmatian; copper starts centrolobular → necrosis → copper-laden macrophages → hepatitis/cirrhosis (Ch7 pp26–27).
• Aetiology: mostly undetermined; no infectious cause in molecular studies; anticonvulsants (primidone, phenytoin, phenobarbital) and aflatoxicosis reported; no validated criteria for immune-mediated hepatitis (Ch7 pp25–26).
• Sampling prerequisites: 12 h fast; PTT/APTT/platelets ≤24 h pre-biopsy; fibrinogen <50% of lower 95% reference (<1 g/L) contraindicates (Utrecht, 1000 dogs); 14G medium/large dogs, 16G small dogs/cats; cores ≥1 cm (2 cm much better), ≥2 pref. 3 samples; quantitative copper → metal-free plastic, no saline (sodium disturbs neutron-activation analysis) (Ch2 pp2–10).
• Add-on: steroid-hepatopathy score 0–3 (ballooning: solitary → multiple/moderate → extensive/diffuse); corticosteroids often precede first biopsy (Ch7 p43).

Drugs named in WSAVA’s own guideline text

As printed in WSAVA’s document, not this app’s own extracted data — see “Related drugs in this reference” below for that.

• Ammonium chloride (NH4Cl) 5% (🐕)

  Ammonia tolerance test (cirrhosis/portal hypertension); skip if fasting ammonia >100 µmol/L (Ch4 p30)

• Vitamin K1 (🐈)

  Pre-biopsy vitamin-K-deficiency coagulopathy (Ch2 p3)

• Prednisolone (🐕)

  Raises fibrinogen above <1 g/L contraindication in >90% (Ch2 p3)

• Fresh frozen plasma (🐕🐈)

  Borderline coagulation; ultrasound 30–60 min after (Ch2 p3)

Recommendations

• Full definition + report aetiology, activity, stage (Ch7 pp24–25)

  Expert consensus (WSAVA Liver Standardization Group)

• "Interface hepatitis", not piecemeal necrosis (Ch7 p5)

  Expert consensus (WSAVA Liver Standardization Group)

• Grade 0–5, stage 0–4; stage 4 = bridging + nodules (Ch7 pp38–39)

  Expert consensus (WSAVA Liver Standardization Group; Ishak-type basis)

• Copper score 0–5+ in ALL canine hepatitis; ≤400/>2,000 µg/g thresholds (Ch7 pp26–27, 38)

  Expert consensus (WSAVA Liver Standardization Group)

• Biopsy: 14–16G/laparoscopic, ≥1 cm (pref. 2 cm), 10–11 portal tracts (Ch7 p38)

  Expert consensus (WSAVA Liver Standardization Group)

• Stains H&E + reticulin/Sirius red + rubeanic acid/rhodanine; ≥3 fields/10× (Ch7 p38)

  Expert consensus (WSAVA Liver Standardization Group)

• Pre-biopsy: 12 h fast, coagulation ≤24 h, fibrinogen <1 g/L contraindication; steroid score 0–3 (Ch2 pp2–3)

  Expert consensus + empirical Utrecht criterion (1000 dogs)

Related drugs in this reference (2)

The quoted line under each drug is its own already-extracted indication text that matched this condition — the reason it’s listed, not a paraphrase. Open a drug for its full species/route breakdown, calculator, and complete adverse-effect list.

Showing 2 of 2 linked drug records. Open a record for species, route and source details.

• SAM E

  “Adjunct for liver disease: chronic hepatitis, feline hepatic lipidosis, cholangiohepatitis/triad disease, vacuolar hepatopathy”

  Source dose preview: 20 mg/kg (≈18 mg/kg per Denosyl dosing), q24h **on empty stomach (≥1 h before food)**, PO (Dog)

  Adverse-effect notes: Well tolerated — Main experience · Occasional GI upset / vomiting — Possible, reduced by empty-stomach dosing with water

• URSODIOL

  “Adjunctive therapy of chronic hepatobiliary disease — cholestasis, cholangitis/cholangiohepatitis, chronic (active) hepatitis, copper-associated hepatopathy, fi…”

  Source dose preview: 10–15 mg/kg (range 5–15), q24h or divided q12h, PO (Dog)

  Adverse-effect notes: Taurine depletion — Theoretical concern with chronic feline use · Generally well tolerated — Limited use but no hepatotoxicity signal