For example, your vet may prescribe antibiotics to kill bacteria in your dogs blood stream. Sign up to receive the latest and greatest articles from our site automatically each week (give or take)right to your inbox. What's your suggestion. Dr. Mercola Liver and Kidney Support for Dogs & Cats: Barks & Whiskers Detox Support, ThorneVet CurcuVET-SA150 - Curcumin (turmeric) for Pets - Powder, ThorneVet Hepagen - Liver Support - Powder Formula, ThorneVet Hepagen - Liver Support for Dogs & Cats - 90 chews, Animal Essentials Liver Defense - 2 oz. All herbs mentioned can be obtained from In dogs with increased liver enzymes, I always obtain a complete blood count (CBC) and biochemistry profile, and urinalysis. At the histopathological level, it is characterized by apoptosis or necrosis associated with an inflammatory infiltrate (mixed or lymphoplasmacytic) which tends to progress to fibrosis and cirrhosis with liver failure. There are numerous holistic options to treat canine liver disease, ranging from the herb milk thistle, to flavanoids including green tea. Also she has some dock weed, chickweed, dandy lion and rapeseed leaves and cabbage and lots of green veg. To prevent accidents in the house, be ready to take your dog outside more frequently so it can urinate. Patients with primary liver disease are more likely to have more serious clinical signs, such as hepatomegaly, microhepatica, jaundice, or hepatic encephalopathy. However, sensitivity is low when compared with histopathology, but since the process is fast, minimally invasive, and safe, I recommend it in many cases as a first step for taking liver samples. Enlarged liver in dogs, on the other hand, is an indication of liver disease. Nodular hyperplasia is characterized by multiple nodules in the liver parenchyma and is a benign condition in older dogs. Liver disease can cause nausea or vomiting. Most liver tumors in dogs are malignant, while in cats, most are benign. References. In the early stages there are often no symptoms, and the first signs can be very non specific. ThorneVet CurcuVET-SA50 - Curcumin for cats & small dogs - 90 chews, ThorneVet CurcuVET-SA150 - Curcumin for Dogs - 90 chews, VetriScience Vetri-Liver Canine Chews - 60 ct. - Liver Support for Dogs, Jaundice - yellow discoloration of gums, eyes and skin. In older animals the liver isoenzyme predominates. The minimum, excluding if an emergency clinic is required, is $425, while the maximum, excluding specialty treatments such as cancer, is $2,777. Get a free pet insurance quote in less than 60 seconds! Elevated liver enzymes on routine biochemistry screens are a daily occurrence in small animal practice; Jordi Puig discusses how he decides if such findings are significant or not. The largest increases are seen with necrosis and inflammation. Stewart JE, Haslam AK, Puig J. i cannot do that she is eating in fact she wants to eat all the time the only thing is that she has this distended tummy. The information, by no means, intends to supplant the diagnosis and advice imparted by the veterinarian. To learn how to treat doggy stomach ulcers caused by liver disease, read more from out Veterinary co-author. Pancreatitis As noted above, the most common causes of increased AP in asymptomatic older dogs are vacuolar hepatopathy, nodular hyperplasia, or neoplasia. Brad. It is important to remember that to quantify the amount of hepatic copper, a large sample (1-2 grams) of liver biopsy tissue is required. This article was co-authored by Pippa Elliott, MRCVS. In cases where a tumor is found or a severe liver disease is suspected, the veterinarian may require a liver biopsy in order to obtain a sample and determine if the tumor is benign or malignant. As many different diseases may cause an enlarged liver in dogs, the treatment varies widely. Low-copper diet to prevent copper buildup in the liver, Low-protein diet if your dog has a shunt in its liver, High-fiber diet to prevent nitrogen buildup. Weve been back to the vets for blood tests, whos very impressed at the recovery of Dreama considering 3 months a go she was at deaths door. The most typical clinicopathological findings are an increase in liver enzymes, hyperbilirubinemia, and neutrophilia. It therefore measures the ability of the test to ascertain a healthy animal does not have the condition being tested for). It performs critical processes like the regulation of blood sugar, the production of bile for digestion and the regulation of blood clotting. Surgery is the treatment of choice for most primary liver tumors. Following coagulation tests, it is essential to always obtain multiple samples of the liver lobes, and various methods (Tru-Cut, laparotomy, or laparoscopy) may be employed. Hepatomegaly is clinical state of abnormal liver enlargement. AST has a lower specificity than ALT and can also be found in muscle and red blood cells. - Dandelion & Milk Thistle for Dogs & Cats, Dr. Mercola Organic Curcumin Extract for Dogs and Cats - 2.64 oz. Enlarged liver, in itself, is a premiere symptom of different liver diseases; such as, liver cancer, or liver injury. There is a DogCancerSupport site where you can get information from all the people who post. We also add powdered ginger and garlic which is an anti- inflammatory. We are hopeful after thinking we would be losing her, shes only 3 & 1/2. Treatments for Enlarged. Ultrasound helps to determine the extent of hepatic injury (focal, multifocal, or diffuse), as well as evaluation of vascularization, and can aid sampling (for cytology, culture, and biopsy) (Figure3). Enlarged liver in dogs is caused due to various reasons. The changes found in patients with secondary liver disease are typically due to a non-specific reactive hepatitis. Aspiration or biopsy procedures can be used to obtain samples for bacterial culture, cell and tissue analysis, and, when appropriate, toxicologic analysis. thank you for the information and a greater understanding of the problem,I enjoy reading all Dr. Jones material and have learned a great deal. My 14 year old Chihuahua/Terrier has very elevated liver enzymes: ALT 1754 and ALP 790 on her last test. It can also be given as a tincture of 2 drops per 10lbs twice daily, My dog is about nine years old and she was diagnosed with a slow growing tumor on her liver my vet just gave her a human liver tablet when i ask another vet if the liver regenerates and her said no. % of people told us that this article helped them. Because an enlarged liver may be caused by various diseases, the symptoms may vary as well. Mentioned herein, is a detailed account, enunciating the symptoms, causes, various methods of diagnosis, and treatment techniques used, if your canine is identified with an enlarged liver. Corticosteroid-induced AP is produced in the liver. A laboratory diagnostic approach to hepatobiliary disease in small animals. Published 12/03/2020. Young dogs can have liver disease as a result of a liver shunt, or certain breeds can aquire liver disease due to a copper storage deficiency ( Bedlington Terriers, Westies, Keeshounds, Dalmations). The isoenzymes catalyze the same chemical reaction but have a different sequence of amino acids. The vets assistant could not believe it as he stated the Denamarin would not of done that on its own. Chemotherapy drugs commonly used include doxorubicin, vincristine, cyclophosphamide, prednisone, and L-Aspariginase. The release of the enzyme is typically associated with alterations in the permeability of the hepatocellular membrane, and is most commonly caused by toxins, inflammatory processes, hypoxia, tissue trauma, or neoplasia (Table2). In some dogs, it can be a genetic defect; as in, Skye terriers, Doberman, Bedlington terriers, etc. There are a number of diseases that can affect the functioning of a dogs liver and lead to enlargement. Many holistic veterinarians advise a natural, moderate protein, moderate carbohydrate diet; your veterinarian may advise a specific veterinary diet. Posted by Holistic Pet Info on 7/1/2019 to. The most important test called the biochemistry test provides an account of the cholesterol content, and the degree of liver enzymes found in the test. Jaundice. Treatment Prevention The liver is an important organ for your dog. The veterinarian may suggest an antibiotic to treat (or avoid) infection. Intrahepatic cholestasis: My first step in this situation is to confirm the results (by repetition of the tests or by obtaining a second sample, avoiding hemolysis or lipemia) to exclude laboratory error. I will discuss the more steps in diagnosis of liver disease, and the large number of holistic options available if your dog is to be diagnosed with canine liver disease. In response to Josephine Testa wanting a holistic vet in Florida, we use Dr. Tiffany Rimar I St. PETE BEACH,FLORIDA. Incidence, timing, and risk factors of azathioprine hepatotoxicosis in dogs. Liver neoplasia, hepatitis, storage of excess fat in the liver tissues, or an accumulation of blood at the peripheries of the liver, are causes as well, deemed responsible for an enlarged liver. And dosage, There is a typo/missing portion on Dr. Jones article on natural treatment of liver disease. Necrosis (tissue death) sets in, with . It is also well recognized that some dog breeds are predisposed to certain liver problems. 1. Methionine - An amino acid needed for proper detoxification of the liver. , Portugus Copyright Pet Ponder & Buzzle.com, Inc. Try to keep him away from harmful substances and gases, and make sure that he takes the required amount of rest. Secondary/reactive to systemic inflammatory illness By signing up you are agreeing to receive emails according to our privacy policy. If, in the recent past, the dog has had an abdominal injury, then your canine could be prone to suffering from an enlarged liver. If it's not working right, it can make. Lipidosis My 14 yr old, 20lb miniature eskimo was diagnosed with elevated liver enzymes. It has a number of functions, such as in digestion, detoxification, sugar storage, breaking down red blood cells, and hormone production. Checking the blood proteins may indicate a reduction in albumin and globulin which may have caused ascites. Other common conditions of the gallbladder and bile ducts are mucocele, cholelithiasis, and neoplasia. Fortunately the liver can do a wonderful job of regenerating liver cells, and can heal itself with supportive care and supplements. The liver is one of the most important organs for your pet's overall health. Hepatology, Written by The first step requires integration of the history, clinical signs, and physical examination. The total cost with what has been mentioned here would be between $2,237 and $4,425. Vitamin B12 - An important vitamin needed for proper digestion and absorption of food. From this excerpt, it is clear, that liver forms an important part in the dogs body; hence, it should be administered with utmost care. . In some cases, an increase in dosage or change of diuretic (which works with a different mechanism of action) may help with the fluid accumulation. Not all forms of liver cancer in older dogs can be treated with surgery. Many thanks. 1. Signs you may see include: Seizures Wandering Disorientation Aggression Restlessness Levels tends to be increased with hyperadrenocorticism, but the isoenzyme can also be elevated with other conditions such as diabetes mellitus, primary liver disease, or other chronic processes; this limits its use in the diagnosis of hyperadrenocorticism. To treat liver disease in your older dog, talk to your vet about which treatment option will work best for your pup. It can also be given as a tincture of 2 drops per 10lbs twice daily. Published 26/03/2020. AST (which was previously known as serum glutamic oxaloacetic transaminase (SGOT)), is found in the hepatocyte mitochondria at higher concentrations than ALT, and is more predominant in zone 3 of the hepatic acinus (Box1) 2. I have had great success using this herb. Because of this,, the specificity of the enzyme is around 51% for hepatobiliary diseases, but its sensitivity is 80% (Table3) (Box2). Bile sampling is important to check for potential antibiotic resistance, and the preferred treatment for the condition is usually cholecystectomy, which also allows for biopsies/cultures to be obtained. Inflammation of the tissues closely associated with the bile duct can cause obstruction and lead to the backflow and eventual build-up of bile in the gallbladder. Microcytosis is frequently seen with portosystemic shunts. Its amazin how your garden is abundant in natural food stuffs provided you dont administer weed killers. With these diagnostic tools, the veterinarian is in the position to prescribe appropriate medication, and treatment management techniques. The outer layer produces the mineralocorticoids, which help to control the body's balance of sodium and potassium . I trust your suggestions and believe you are a man whom actually cares about on furry kids. Diabetes mellitus can have far-reaching effects on the By Her primary diet for that last 14 years has been Solid Gold kibble. When the system endures dehydration, replenishing of the lost fluids is a must. A visit to an Internist may be required. An increase in AP detected during an annual check-up or a pre-anesthetic analysis is a common finding. As a result, the total cost will vary greatly. , Espaol Severe ascites can enlarge a dogs abdomen so much that breathing becomes difficult. Diagnosing the stage of the condition, and the possible ailments that may have gathered the premises for the enlargement of the liver to occur is also conducted. Easily compare quotes from the most trusted pet insurance companies in the United States. If anemia is present, this is usually non-regenerative, although intestinal bleeding secondary to a coagulopathy can also occur. Homeopathic remedies are used to supplement veterinary care and additional remedies. Liver enzymes are generally classified into two groups, those that indicate cell damage (alanine aminotransferase and aspartate aminotransferase) and those that indicate enzyme synthesis (alkaline phosphatase and gamma-glutamyl transferase) 3. Liver disease is the most probable cause, blood tests and an ultrasound can be beneficial in reaching a diagnosis. Antioxidant vitamins work in conjunction with SAMe to decrease liver cell damage and help the liver regenerate; Vitamin E and Vitamin C are the two most commonly used. Milk Thistle from the vet was really expensive so i sourced my local horse supplier who sells it loose leaf in 500G tubs. Antibiotics usually cost between $15 and $53. Chronic hepatitis often presents in dogs with vague clinical signs and increased liver enzymes. Conditions in which blood pooling around the liver takes place, could be treated with surgery as well. Many different things can cause liver problems in dogs, (toxins, infectious diseases (viruses and bacteria), and cancer to name a few). Dogs commonly eat compost in which there is often a toxin that can cause acute liver disease. Determine if there is a hepatobiliary disease. There are a number of supplements which can be helpful in normalizing the immune system, but there are particular ones that may be beneficial for the liver. Surgical intervention becomes mandatory if tumor-like growths exist. Excellent article and advice. The dog urinating rarely, is also a symptom of enlarged liver. I think you will get some help. Presence of poisonous substances in the environment can also give rise to an enlarged liver. Also wondering about zinc for a dog with Copper Storage Disease? Fernandez NJ, Kidney BA. It is extremely important that the pathologist follows the World Small Animal Veterinary Association (WSAVA) guidelines for liver histopathology1 when interpreting the samples. It is a powerful antioxidant and helps maintain . Metabolic: lipidosis, diabetes, glucocorticoids, hyperthyroidism This website has been very informative and beneficial. These pets are often very weak, so I begin with lower potency remedies. Tumeric upsets my stomach so not sure how my dog would do with it. Compare top pet insurance plans. Biopsy will demonstrate an inflammatory infiltrate in the portal areas and parenchyma, without signs of liver necrosis. Hepatitis This article gave me a better understanding and information on treating is liver. A thorough diagnosis needs to be conducted, with regards to your dogs overall health, and the ailments that your canine might have encountered in the past. I just want to thank you so very much for sharing this information! Determine if the origin is primary or secondary. Wants her to see internal medicine specialist to see what's wrong. Liver-derived AP is located in the hepatocyte membrane of the bile canaliculi and sinusoids. Vacuolar hepatopathy may be linked to endogenous or exogenous corticosteroids, and this can sometimes be severe, with cholestasis and cell damage leading to an increase in ALT 18. Center SA. The causes are varied, with many dogs having acute damage by ingesting some type of toxin, or reacting to a prescribed veterinary medication. Liver enzymes do not inform us about the functional capacity of the liver. Copyright 2023 Four Paws Online Ltd. All rights reserved. Corticosteroids are predominantly prescribed in case of your dog suffering from Hepatitis disease. Liver enzyme levels do not indicate hepatic functionality; this requires evaluating parameters which reflect the livers capacity for synthesis and/or excretion of compounds, such as bile acids. Treatment The course of treatment will depend on the underlying cause of the disease. It can also be given as a tincture of 2 drops per 10lbs twice daily. For chronic issues like diabetes or other K-9 diseases you may be able to control the symptoms and help heal the liver with a special diet and supplements. An enlarged liver in dogs can often be accompanied by ascites, or fluid accumulation in the abdomen. Hope this helps Extrahepatic cholestasis: Table 2. There are numerous things that can cause liver disease ranging from tumors to infections. Table 3. The signs of liver disease are many and varied; they are similar to many other canine diseases. Therefore the dog can positively recover with the right and timely treatment without any permanent damage to the body. Cirrhosis Some of the treatments are: Your vet may refer you to a veterinary surgeon if you want your dog to undergo the procedure. An enlarged liver is most commonly found in older dogs. A single measurement does not provide enough information in most cases, and serial monitoring is much more helpful. We provide informative articles about caring for pets that you can come back to again and again when you have questions or want to learn more! There are 8 references cited in this article, which can be found at the bottom of the page. Franais Lead II electrocardiogram demonstrating sinus tachycardia with a regular rhythm and heart rate of 175 beats/min in a dog with CHF (25 mm/s; 10 mm/mV). Some breeds are predisposed to chronic hepatitis; the most studied ones are those prone to copper storage hepatopathy. I told him about you and how you are so amazing, the knowledge you have is a gift that I feel fortunate to have. There are a number of reasons that may result in an enlarged liver in dogs. Worried about the cost of treating your pet's symptoms? Of all the alternative options, milk thistle is the most important solution in helping any ailing liver. The adrenal glands are located just in front of the kidneys. Causes Liver disease can have a number of different causes such as: Viral or bacterial infection Cancer of the liver (hepatocellular carcinoma) Cysts or gallstones, which can obstruct the bile duct Endocrine diseases including diabetes, Cushing's Disease, or hyperthyroidism Trauma to the liver due to an accident or heatstroke Mara-Dolores Tabar Rodrguez, Issue number 29.3 Most cases show increased enzyme levels compatible with cell damage (ALT and AST) and enzyme induction (AP and GGT). Were fresh blood tests taken after the ascites presented? Boarding In Caregiver's home. Where enzymes are elevated due to cell damage, the leaking of enzymes depends on their concentration and location within the cell. The veterinarian will then conduct a comprehensive round of tests in order to identify the cause of the enlarged liver. These cookies do not store any personal information. These cookies will be stored in your browser only with your consent. This website uses cookies to improve your experience while you navigate through the website. Drop-Ins Brief home visit Sitting In your home. The etiology is unknown, but the WSAVA categorization of liver disease classifies it as a neoplastic process. Increases in osteosarcoma cases tend to be slight. They are a kind of dog worms, that not only affect the heart of the dog, but also affect its liver, and cause its enlargement. Turmeric gives curry its flavor and yellow color, and has been used as an anti-inflammatory, to treat digestive and liver problems, skin diseases, and wounds while also being a powerful ANTIOXIDANT..Antioxidants can fight free radicals The dose of the dried herb is 100 mg per 10 lbs of body weight daily. The underlying cause of the enlarged liver can mean any number of tests which can add substantial cost to the total. The dose of the dried herb is 100 mg per 10 lbs of body weight daily. Depending upon the severity, your dog may require a period of hospitalization, in the case of heart complications or advanced liver disease, or even surgery, in the case of cysts, abscesses, or tumors. In order to detox, the liver needs critical antioxidant nutrients and enzymes such as glutathione (an important antioxidant molecule that helps prevent aging and chronic disease). Corticosteroid-induced AP contributes 10-30% of the total AP level, with the higher percentage in older dogs. i am devastated they didnt say anything about her diet . Treatment. This category only includes cookies that ensures basic functionalities and security features of the website. There are many diseases that cause high liver enzymes in dogs, this means there are many different treatments for elevated liver enzymes in dogs. If you notice that your dog is suffering from liver disease, it is important that you take him to the veterinarian as soon as possible, in order to avoid further damage. Elevated hepatic enzymes are a common finding in small animal practice but such results do not tell us about the functional capacity of the patients liver. Cost Check your pet's symptoms Print this page Overview The liver is a very important organ with a range of different functions. Diagnosis and resolution of the primary cause will often result in normalization of the enzymes; for example, 50% of dogs with tracheal collapse have increased liver enzymes and bile acids, possibly due to hepatic hypoxia. A benign familial hyperphosphatasemia (with a rise in mainly bone-specific AP) has been described in Siberian Huskies 5. Different dog illnesses, like, diabetes, and encephalopathy can also cause this condition. In patients with liver failure or portosystemic shunts, it is common to find ammonium biurate crystals in the urine sediment. The half-life of AST in the dog is 5 to 12 hours. We'll assume you're ok with this, but you can opt-out if you wish. I have had success with a product called Marin and a home cooked diet. In this article you will learn the more common causes of canine liver disease, along with the common symptoms to recognize in your dog. These loyal creatures are the best friends of human beings and if you have them as pets, make sure that you take proper care of your dog. Weingarten MA, Sande AA. Due to its anatomo-functional situation and its ability to metabolize foreign compounds (xenobiotics), the liver may be exposed to high concentrations of substances which can have toxic effects 6. I also have your ultimate canine health formula on auto ship for Chauncy which is giving me amazing results. Induction: Substances, like, arsenic, insecticides, tetrachloride, ragwort, arsenic, etc. The surgery itself can cost between $2,000 and $4,000 depending on the cause of the enlargement. This article has been viewed 16,805 times. GGT is an enzyme found in epithelial cells of the biliary system and hepatocytes. Methionine helps metabolize fats, preventing their build-up in the liver. An increase in liver enzymes is a common finding in all veterinary practices, and we must comprehend its meaning in order to establish a suitable diagnosis and treatment. The dose of the dried herb is 100 mg per 10 lbs of body weight daily. Urine changes often show bilirubin, and brownish/yellowish urine. Jaundice causes liver malfunction. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Veterinarian, author, advocate for alternative, natural solutions for dog and cat health, Dr. Andrew Jones, DVM The liver is divided histologically into hexagonal lobules. Veerle Vandendriessche, Issue number 29.3 If pituitary masses are present, radiation therapy is used to destroy these masses within pituitary glands. In some dogs with localized disease, surgery or radiation therapy can also play a role in treatment. It is also found in other organs (heart muscle, skeletal muscle, kidneys and red blood cells), but ALT levels in the liver are 4 times higher than in heart muscle and 10 times higher than in the kidney. A classic symptom is jaundice; the white area around her eyes and the gums may be yellowish. The assessment of liver function is based on evaluating parameters which reflect its capacity for synthesis and/or excretion, such as bilirubin, glucose, cholesterol, urea, albumin, or the bile acid stimulation test (Table1). I am sending you smiles and hugs as in just TWO weeks his ALT went from 508 to 108, the lowest it has every been. Log in, Worldwide medical and scientific journal for animal health professionals, Royal Canin, Health Nutrition for Cats and Dogs. More-than-likely, the veterinarian will then conduct a urinalysis, which will be analyzed to determine kidney function. clover leaves are excellent. Enlarged liver in dogs is caused due to various reasons. Ultrasound-guided cholecystocentesis is another useful minimally invasive test, with few associated complications 14. If that does not provide a clear reason for the elevated enzymes she will do an ultrasound. An S 3 gallop can be heard in dogs with DCM associated with rapid ventricular filling into an enlarged, poorly contracting and relaxing ventricle. If it consists of one large vessel outside of the liver, as is more common with congenital shunts in small breed dogs, surgery can be very successful. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. Offer him his favorite food. Causes of Liver Failure in Dogs. A number of diseases can cause the liver to stop functioning properly. and . I now prepare Dreamas food every couple of days which consists of wholemeal pasta, wholemeal rice, potato, porridge, lots of fresh veg, fish chicken and lots of white meat as opposed to red meat which is harder to digest. Surgery may be used to remove the affected mass. Lethargy Vomiting and nausea Diarrhea Weight loss Decreased or absent appetite Increased thirst Increased urination Yellow discoloration to skin and/or the white of their eyes Distended abdomen Sometimes dogs can slowly develop liver failure and not show any indication anything is wrong until it gets really bad. PetAlive Immunity and Liver Support for Dogs and Cats - 60 ct. PetAlive LiverAid - Liver Support for Dogs and Cats - 1 oz. Furthermore, the liver plays a major role in detoxifying both endogenous and exogenous toxins, and there are many extrahepatic processes which affect it on a secondary level. In addition to milk thistle, there are several other nutrients which are beneficial to the liver: Copyright var date = new Date(); document.write(date.getFullYear()) Holistic Pet Info. , Romn This article has been viewed 16,805 times. Hepatomegaly is clinical state of abnormal liver enlargement. It is common to detect elevated liver enzymes in an asymptomatic patient; one study in a group of healthy dogs of differing ages revealed significant numbers of animals had increased levels of ALT, AST, AP, and/or GGT, at 17%, 11%, 39%, and 19% respectively 16. She is currently on Denamarin and Metronidazole. Your dogs prognosis depends upon the cause of the enlarged liver; however, in any case, keep in mind that the liver is the site of drug metabolism in dogs, and do not give your dog any new medication without consulting your veterinarian first. It is important to distinguish hyperplasia from tumor-related processes or cirrhosis. This is due to the high levels of toxins in the body that would normally have been removed by a healthy liver. Required fields are marked *. The overall cost could even be greater than the total mentioned here, if the underlying issue requires ongoing treatment. Alternatively, if your dog has a build-up of fluid in its abdomen, it may need a prescription diuretic. Most methods used to measure enzyme levels are based on the calculation of their activity. Published 09/04/2020. Inflammation: this can be infectious (e.g., leptospirosis, cholangiohepatitis/cholangitis, sepsis) or non-infectious (e.g., chronic hepatitis, copper accumulation, reactive liver disease)
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