• Liver cultures are not needed routinely as very few are positive. Samples could be frozen or held in transport medium for culture, pending histologic findings.
• In dogs with liver disease, cultures may be useful in patients with suppurative or granulomatous hepatitis, an inflammatory leukogram, or with fever.
• Liver cultures can be useful in cats as E. coli can sometimes be grown from liver biopsies of cats with suppurative hepatitis.

• Tissue in paraffin blocks can be de-paraffinized for elemental (Cu, Zu, and Fe) analysis. Sample size may be a problem here so wedge biopsies are preferred over the True-Cut method.
• Special stains can be substituted for elemental analysis to offer a rough estimate about presence of copper. Normal liver copper is < 400-450 µg/g dry weight. Special stains can readily detect copper at > 750 µg/g dry weight of liver.
• Other than in West Highland white terriers and Bedlington terriers, copper accumulation in dogs with chronic hepatitis is likely secondary to cholestasis rather than the cause of liver disease. Dalmatians can be presented with hepatitis and hepatic copper accumulation; many also have renal glycosuria.
• Many dogs with chronic hepatitis also have increased liver iron and decreased liver zinc concentrations. The significance of elevated liver iron is uncertain. Zinc is known to have antifibrotic and membrane protective properties.
• For Doberman pinschers with chronic hepatitis, treatment regimens include: anti-inflammatory drugs (steroids), actigall, copper chelator for 6 months or more depending upon results of repeat liver biopsy, and zinc supplementation for life (e.g. 100 mg elemental Zn q 12 h for 3–6 months; ½ dose for maintenance).

• SAMe (S-adenosyl-L-methionine). This is a product of body metabolism with several important functions: methylation reactions, maintenance of cell membrane fluidity, antioxidant effects (precursor of glutathione). When given orally, liver concentrations of SAMe and glutathione increase. Although efficacy is unproven, SAMe can be used as adjunctive therapy for patient with acute or chronic liver disease. There are no known side effects. Several products are available over-the-counter but have widely varying potency. One recommended product is Denosyl.™
• Milk Thistle (silymarin). This bioflavonoid has antioxidant properties. It is often used in management of liver disease in people and some benefit has been shown in refereed journal articles. A study in dogs fed hepatotoxic mushrooms showed a protective effect against clinical and pathologic changes when high doses of milk thistle were given at 5 and 12 hours post exposure. Veterinarians have used milk thistle for dogs with chronic liver disease and to ameliorate hepatic effects of anticonvulsants. Doses vary from 50-200 mg q 12-24 hr. Many products are available over-the-counter and potency varies.

References: From Antech consultants conference with Drs. David Twedt and Dennis Meyer; Meyer DJ, Twedt DC, Current Vet Therapy XIII, pp. 668-671, 2000; ACVIM Abstract III, 1999, J Vet Int. Med.