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Cirrhosis; Chronic Active Hepatitis; Cholangiohepatitis In A Dog

by valariedvm - January 7, 2015 View Case Report

Ge Xia Zhu Yu Tang vs. (Jia Wei) Xiao Yao San ... Quick summary:

Confirmed cirrhosis via biopsy in March 2014. I consulted on case in June 2014, weaned off mycophenolate and metronidazole and started on Xiao Yao San (elevated liver enzymes, anxiety). Modified to Jia Wei Xiao Yao San in August (otitis; improving but persisting anxiety) and treated otitis (enrofloxacin, Momentamax). Seems to have ~q4-6 week bout of mildly increased body temp, slightly decreased appetite and feeling "dumpy" - resolves with acupuncture. In September, noticed significant peripheral lympadenopathy (aspirate - inflammation). Recheck liver enzymes in November - elevations to ALP, AST and ALT. Had participated in your on-line Hepatic Disease webinar, so changed her to Ge Xia Zhu Yu Tang. About 2 weeks later, O notices her a little "off" - decreasing appetite, increasing water consumption, feeling more dumpy (less energy, less interest). Recheck blood work and, yikes, big jump in GGT/ALP but AST elevated but steady and ALT decreased 20%. Changed back to Jia Wei Xiao Yao San; added Chu Shi Wei Ling Tang; started amoxicillin 5 days ago and she is clinically much better.
Question: possible that jump in biliary numbers related to change in protocol (from JWXYS to GXZYT) or is it more likely that could be dealing with obstruction pathology (O willing to do AUS). Suggestions for next course of action?
(Sorry for the long summary)
Valarie

by naturevet

January 8, 2015

Hi Valarie,

GXZYT decongests the liver and reduces hepatic blood flow. XYS and CSWLT increase hepatic blood flow. So the results suggest that she has a need for increased liver blood flow. Liver blood flow deficiencies are aggravated in the winter months.

How is the lymphadenopathy now? If it is still present, consider adding Xiao Chai Hu Tang. It decongests as well, but you could pair it with Si Wu Tang for its blood flow augmenting effects. That might even take her to the next level so far as liver function is concerned.

The cyclical 'heat' with increased thirst and drop in appetite (or Qi) could signal a Shao Yang disharmony, for which the previous formula combination should be helpful. Use a 2:1 ratio of XCHT to SWT

Hope that helps!

Steve

by valariedvm

January 10, 2015

Maybe I'm putting too fine a point on it, trying to differentiate between the liver values and the biliary values?
Her ALT/AST went up when I started her on (Jia Wei) Xiao Yao San but her ALP/GGT stayed within the normal range. I'd attended your webinar on Hepatic Disease so I switched her to the Ge Xia Zhu Yu Tang. Her ALT stayed the same, the AST dropped 20%, but her ALP/GGT went up. I would have expected the ALT/AST to increase when I switched to the GXZYT so that is the part that made me post the question!

Oh, and yes, she still has peripheral lympadenopathy.

Valarie

by naturevet

January 20, 2015

The increase in biliary enzymes in response to a drop in blood flow suggests chronic inflammation around the bile ducts themselves. Less common.

Using XCHT and SWT together might give you a nice mixed effect of reducing episodes of acute inflammation and resolving chronic inflammation. Keep it in mind if you hit another plateau in progress.

Steve

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