u/Empty_Alternative_94

I lost my 12 year old Jack Russell Terrier about 6 weeks ago and I keep trying to understand what may have originally caused her hepatitis/liver disease process. I know nobody online can diagnose her, but I would really appreciate veterinary insight because I keep replaying everything wondering if I missed something earlier.

One thing that has been especially hard for me emotionally is that she passed away less than a month after I first brought her to the vet for this issue, and before that there were almost no obvious signs. Looking back, the ONLY thing that really prompted me to bring her in initially was occasional vomiting and slightly decreased appetite. Otherwise she was still acting mostly like herself.

Some background/timeline:

• She had completely normal bloodwork about 6 months before becoming sick. At that time, ALT was 56 and ALP was 36.
• Ironically, that bloodwork was drawn during an ER visit after she got into a fight with a groundhog and sustained a puncture wound to her lip.
• She was treated with Clavamox, carprofen, and gabapentin afterward.
• Around 1 to 2 months before getting sick, she also got into and passed some cooked chicken bones without obvious complications.
• Prior to diagnosis, she was still functioning pretty normally overall aside from intermittent vomiting and reduced appetite.

What initially brought me to the vet:

• occasional vomiting/nausea
• decreased appetite
• mild lethargy/tiredness

Only later did jaundice/yellow gums and eyes become noticeable.

Her liver values became extremely elevated very quickly:

• ALT initially around 3629
• ALT later 2967 and then 2646 despite treatment
• ALP around 2012 initially, then 1569 and 1371
• GGT 72 initially, later 96 and 90
• Bilirubin rose from 1.7 to eventually almost 6 later in the disease course. It was almost 10 the day she passed.

Ultrasound was surprisingly fairly unremarkable structurally:

• normal appearing liver architecture
• no masses
• no biliary obstruction
• no free fluid

We did pursue a liver biopsy. The pathology reportedly showed:

• no cirrhosis
• some fibrosis/scarring
• copper score around 3/5, but not severe copper accumulation
• severe inflammatory/hepatitis changes

The liver culture from the biopsy grew Enterococcus species and meth resistant Staph pseudintermedius from broth culture.

Internal medicine suspected severe hepatitis/inflammatory liver disease, possibly immune mediated. She was treated with prednisone, ursodiol, Denamarin, antibiotics, anti nausea meds, etc. Interestingly, she actually seemed to begin clinically improving shortly before everything went wrong. She was eating better, brighter, and her values had started trending somewhat in the right direction.

Then later she unfortunately developed a femoral artery clot and seizures and we lost her.

But what I am really trying to understand now is the BEGINNING:
Could a dog truly go from normal bloodwork 6 months earlier to severe hepatitis this quickly? Could the groundhog bite/fight theoretically trigger an infection, inflammatory response, immune mediated process, or toxin exposure that could later affect the liver? Could medications like carprofen have contributed months later, or would that timeline make no sense? Could the chicken bone incident have introduced bacteria or caused something occult?

Or is it more likely there was already something brewing that simply was not detectable yet on routine bloodwork?

I think I am also struggling with wondering if there were subtle signs I should have caught sooner. I miss her so much and I would do anything to go back and catch this before it started.

Thank you for any insight.

I lost my 12 year old Jack Russell Terrier about 6 weeks ago and I keep trying to understand what may have originally caused her hepatitis/liver disease process. I know nobody online can diagnose her, but I would really appreciate veterinary insight because I keep replaying everything wondering if I missed something earlier.

One thing that has been especially hard for me emotionally is that she passed away less than a month after I first brought her to the vet for this issue, and before that there were almost no obvious signs. Looking back, the ONLY thing that really prompted me to bring her in initially was occasional vomiting and slightly decreased appetite. Otherwise she was still acting mostly like herself.

Some background/timeline:

• She had completely normal bloodwork about 6 months before becoming sick. At that time, ALT was 56 and ALP was 36.
• Ironically, that bloodwork was drawn during an ER visit after she got into a fight with a groundhog and sustained a puncture wound to her lip.
• She was treated with Clavamox, carprofen, and gabapentin afterward.
• Around 1 to 2 months before getting sick, she also got into and passed some cooked chicken bones without obvious complications.
• Prior to diagnosis, she was still functioning pretty normally overall aside from intermittent vomiting and reduced appetite.

What initially brought me to the vet:

• occasional vomiting/nausea
• decreased appetite
• mild lethargy/tiredness

Only later did jaundice/yellow gums and eyes become noticeable.

Her liver values became extremely elevated very quickly:

• ALT initially around 3629
• ALT later 2967 and then 2646 despite treatment
• ALP around 2012 initially, then 1569 and 1371
• GGT 72 initially, later 96 and 90
• Bilirubin rose from 1.7 to eventually almost 6 later in the disease course. It was almost 10 the day she passed.

Ultrasound was surprisingly fairly unremarkable structurally:

• normal appearing liver architecture
• no masses
• no biliary obstruction
• no free fluid

We did pursue a liver biopsy. The pathology reportedly showed:

• no cirrhosis
• some fibrosis/scarring
• copper score around 3/5, but not severe copper accumulation
• severe inflammatory/hepatitis changes

The liver culture from the biopsy grew Enterococcus species and meth resistant Staph pseudintermedius from broth culture.

Internal medicine suspected severe hepatitis/inflammatory liver disease, possibly immune mediated. She was treated with prednisone, ursodiol, Denamarin, antibiotics, anti nausea meds, etc. Interestingly, she actually seemed to begin clinically improving shortly before everything went wrong. She was eating better, brighter, and her values had started trending somewhat in the right direction.

Then later she unfortunately developed a femoral artery clot and seizures and we lost her.

But what I am really trying to understand now is the BEGINNING:
Could a dog truly go from normal bloodwork 6 months earlier to severe hepatitis this quickly? Could the groundhog bite/fight theoretically trigger an infection, inflammatory response, immune mediated process, or toxin exposure that could later affect the liver? Could medications like carprofen have contributed months later, or would that timeline make no sense? Could the chicken bone incident have introduced bacteria or caused something occult?

Or is it more likely there was already something brewing that simply was not detectable yet on routine bloodwork?

I think I am also struggling with wondering if there were subtle signs I should have caught sooner. I miss her so much and I would do anything to go back and catch this before it started.

Thank you for any insight.