Hepatic encephalopathy in dogs and cats

Area of Science:

• Comparative veterinary medicine
• Gastroenterology
• Neurology

Background:

• Hepatic encephalopathy (HE) is a complex neurological disorder.
• It is characterized by a spectrum of neuropsychiatric abnormalities.
• HE is caused by liver dysfunction and the resulting accumulation of toxins in the blood.

Purpose of the Study:

• To review and compare the pathogenesis, clinical presentation, diagnosis, and management of HE in dogs and cats.
• To highlight the current understanding and treatment strategies for HE in companion animals.

Main Methods:

• A comprehensive literature search of the Medline database was conducted.
• Articles related to HE in humans, dogs, and cats were included.
• Emphasis was placed on studies published within the last five years.

Main Results:

• Ammonia is a central factor in HE pathogenesis, leading to astrocyte swelling and neurological dysfunction.
• In humans, lactulose and rifaximin are approved treatments, and severe protein restriction is not recommended.
• In dogs and cats, HE is linked to portosystemic shunting, with ammonia, manganese, and benzodiazepines as potential contributors. A soy-based diet showed promise for canine HE, and lactulose and antimicrobials are common treatments.

Conclusions:

• HE is a serious, potentially underdiagnosed condition in companion animals.
• There is a lack of robust evidence for optimal HE management strategies in veterinary medicine.
• Further research into HE pathogenesis may lead to new diagnostic and therapeutic advancements for dogs and cats.