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Hepatic Nodular Hyperplasia in Old Dogs

Hepatic Nodular Hyperplasia in Old Dogs

Hepatic nodular hyperplasia in old dogs is a common finding in dogs that are over a certain age. If your dog was diagnosed with this condition, you may want to learn more about it and what kind of impact it may have on your senior dog. Hepatic nodular hyperplasia may affect dogs of any breed, affecting male and female dogs without any particular predilection. This condition is often not detected until the vet runs a blood test that assesses the function of internal organs. Following is some information pertaining hepatic nodular hyperplasia in old dogs.

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Hepatic Nodular Hyperplasia is a common finding in old dogs.

Hepatic Nodular Hyperplasia in Old Dogs

As your dog ages, his body will undergo several physiological changes. Cellular changes associated with age often instigate the growth of certain cells that may cause abnormalities. A distinctive change to the liver that is age-related, is seen in a condition known as hepatic nodular hyperplasia. 

Still as of today, the exact mechanisms that cause this condition remain for the most part unknown. Hepatic nodular hyperplasia is known to affect mostly dogs over the age of 10 but can appear in dogs as early as between the ages of 6 and 8 years.

According to a clinical study, this condition was present in all dogs over the age of 14. This liver condition is therefore simply an age-related change just as it happens with old dogs who develop haziness in their eyes (lenticular sclerosis).

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Hepatic nodular hyperplasia in old dogs is fortunately a benign liver condition. Since it is benign, it is not related to the average cancerous growths that have a tendency to cause illness and spread to distant organs, a process known as metastasis.

The term hepatic simply means "pertaining the liver," the term nodular refers to a "growth of abnormal tissue," and the term hyperplasia is used to depict the "increase in the number of cells in an organ or tissue."

Clinical Findings in Dogs

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The condition is often suspected based on bloodwork results.

When a dog develops hepatic nodular hyperplasia, the first signs of abnormalities may be detected when the dog undergoes exploratory surgery due to other medical conditions, or more commonly, when a dog's bloodwork results come in, more specifically when running a biochemistry profile test.

In particular, the test would reveal an increase in the dog's ALP(alkaline phospatase) values, but there may also be some mild increases in transaminaseenzymes such as serum ALT (alanine transaminase) and AST (aspartate transaminase) concentrations, explains board-certified veterinarian Dr. Johnny D. Hoskins.

Some changes may be detected on an ultrasound which can demonstrate the architecture of the liver. The ultrasound may reveal the presence of nodules, but sometimes these may be too microscopic to be detected. Generally, the nodules are pink-tan in color and may be anywhere between 2 mm to several centimeters. Even when detected, the nodules cannot be classified as benign or malignant by looks of it alone.

The most reliable diagnostic tests is a wedge-section biopsy. A needle biopsy may not be too accurate in revealing the presence of nodules and results may be confused for the changes seen in other conditions such as in chronic hepatitis or in certain liver tumors such as the benign hepatocellular adenomas or the malignant variant, hepatocellular carcinomas. An exploratory surgery is needed in order to obtain a larger biopsy sample.

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Did you know? According to a study it was found thatScottish Terriers have higher serum ALP activities compared to dogs of other breeds.


"It is not unusual for the ALP to creep up in older dogs and it often is not a sign of liver disease if the other liver enzymes, the albumin and the bilirubin are all in the normal range. Benign nodular hyperplasia of older dogs can cause one enzyme to go up while the other liver values remain normal."~Dr. Rebecca, veterinarian

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At the Vet's Office

Hepatic nodular hyperplasia does not typically cause dogs to manifest any particular symptoms. No treatment is therefore generally needed for this benign condition. The only complication, though rare, is a rupturing of the nodules. In a rupture of a large nodule, the affected dog may require a blood transfusion followed by a surgery.

If your vet suspects nodular hyperplasia based on increased liver enzymes on a chemistry profile, he may take a different approach based on how high those numbers are, what enzymes are showing to be elevated and whether the dog is showing clinical signs.

Typically, if only the levels of alkaline phosphatase are mildly elevated and the dog is not showing symptoms, the vet may suggest to do nothing. As mentioned, hepatic nodular hyperplasia in old dogs is a benign condition and pretty much a normal part of aging.

If other factors though are at play or the vet suspects something else going on, he or she vet may decide to recheck the dog's alkaline phosphate levels in four to six weeks so to see if the levels normalize or conduct a few a tests just to exclude other possible conditions.

A bile acids tests may be a good starting point as it reveals how well the dog's liver is functioning. If bile acid tests results show impaired liver function, the vet may want to pursue further work-up.

The vet may suggest an ultrasound. This non-invasive test can detect changes within the dog's liver; however, a lack of findings does not rule out the possibility of disease. Needle aspirates taken during the ultrasound may be inconclusive. A liver biopsy may be therefore suggested, but only if there are valid reasons to do so (dog showing symptoms, preliminary tests revealing impaired liver function).

"You could spend hundreds of dollars to get an ultrasound guided liver biopsy, only to get a diagnosis of benign nodular hyperplasia, and for that we usually just recommend the Denamarin."~Dr. Rebecca

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  • Nodular Hyperplasia in the Liver of the Dog: An Association with Changes in the Ito Cell Population, J. R. Bergman First PublishedSeptember 1, 1985 
  • J Am Vet Med Assoc. 2006 Jan 15;228(2):222-4. Serum alkaline phosphatase activity in Scottish Terriers versus dogs of other breeds. Nestor DD1, Holan KM, Johnson CA, Schall W, Kaneene JB

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