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Liver Disease Standardization Group

WSAVA Standards for Histological and Clinical Diagnosis of Canine and Feline Liver Diseases – WSAVA’s first textbook is on the shelves!

In a publishing partnership with Elsevier, WSAVA is proud to announce the availability of its first scientific textbook, titled WSAVA Standards for Histological and Clinical Diagnosis of Canine and Feline Liver Diseases, representing a culmination of efforts begun in 2000 and prompted by discussions between then WSAVA president Hans-Klaus Dreier, president-elect Claudio Brovida, and Dr. Jan Rothuizen of Utrecht University. Born from a WSAVA strategic initiative to strengthen the relationship between veterinary academia and veterinary medical associations, this project is the first in a series of standardization initiatives begun by the WSAVA in an effort to provide clear direction in areas of academic research that have a direct impact on the practice of veterinary medicine.

The authors involved are a veritable “who’s who” of prominent, international researchers in veterinary hepatology and also includes one eminent human liver researcher (listed below). The textbook is designed to provide a world standard of guidelines for the diagnosis of liver diseases in dogs and cats using both histological and clinical criteria. Chapters include:
• Sampling and handling of liver tissue
• Ultrasonographic identification and characterization of congenital portosystemic shunts and portal hypertensive disorders
• Morphological classification of biliary disorders
• Morphological classification of parenchymal disorders, including
o Normal histology, reversible hepatocyte injury, and hepatic amyloidosis
o Hepatocellular death, hepatitis, and cirrhosis
o Hepatic abscesses and granulomas, hepatic metabolic storage diseases, and miscellaneous conditions
• Morphological classification of neoplastic disorders

This consolidation of international science and opinion regarding the diagnosis and staging of canine and feline liver disorders represents a critical step in elevating both the level of care provided by the veterinary profession for pet’s suffering from liver disorders as well as ensuring that the common language proposed facilitates a greater degree of communication between researchers and ultimately, our understanding of these ailments.

For additional information and to order the book, visit the Elsevier website.

The WSAVA would like to recognize and thank Hill’s Pet Nutrition for their generous sponsorship which made this work possible.

AIMS OF LIVER HISTOLOGY STANDARDIZATION

The aim is to obtain worldwide standardization for histological evaluation of liver tissues for liver diseases of dogs and cats: unified nomenclature, well-defined histological diagnostic criteria, and precise definition of chronicity stages and grades of diseases. Also, requirements for tissue staining techniques and size of tissue specimens are being recommended for the different diseases. Descriptions and typical slides of all relevant liver diseases of dogs and cats become available as a reference for all veterinarians. Of course liver diagnostics is not only a matter of histopathology. Therefore the relation with clinical and laboratory findings will be indicated when necessary. All this information will be published in a book, which will be available at an affordable price to make it widely available for all interested veterinarians and other potential users.

This work was made possible by the generous sponsorship of Hills Pet Nutrition.

THE LIVER STUDY GROUP

The Group is made up of internationally recognized scientists in hepato-gastroenterology. In addition we have invited one of the top human liver pathologists. Members are:
Dr. S. Bunch (USA), clinical hepatologist
Dr. J. Charles (Australia), liver pathologist
Dr. J. Cullen (USA), liver pathologist
Dr. V.J. Desmet (Europe, Belgium), human liver pathologist
Dr. T. van den Ingh (Europe, Netherlands), liver pathologist
Dr. T. VanWinkle (USA), liver pathologist
Dr. D. Twedt (USA), clinical hepatologist
Dr. R. Washabau (USA), gastroenterologist/hepatologist/ACVIM
Dr. J. Rothuizen (Europe, Netherlands), clinical hepatologist, coordinator of the Group.

In 2001, 2002, and 2003 the group has had five meetings in total. The diseases of the liver were grouped into vascular diseases, diseases of the biliary system (intra- and/or extrahepatic), cystic diseases, tumors of the liver and biliary system, and parenchymal hepatic diseases. Agreement has been reached about all these diseases. First, the concept was always presented at the ACVIM or ECVIM specialist congresses, and taking the comments into account, the final consensus was formulated the meeting thereafter.

The summary of the groups of diseases dealt with does not immediately show the enormous list of individual diseases and conditions that had to be discussed. For many diseases there were different names in use in the literature, which was very confusing. A unified name for all these diseases has been formulated so that readers in this field will be more comfortable. With the previous absence of standardised diagnostic criteria there has been much literature on a certain disease, which was in fact dealing with different diseases or at least a different spectrum of the same disease. It was therefore often impossible to compare results of research from different centres. A special field for which comparison of results from different centres will become of paramount interest is the multi-centre evaluation of treatments. In veterinary medicine there have been very few double blind, placebo-controlled and randomised studies on the effect of treatments, and the only way to include enough patients in such studies is by multi-centre studies. The availability of standards for liver diseases now makes this field of veterinary medicine ready for the start of such studies to build a science-based strategy for effective treatments.

Jan Rothuizen, March 2004

Liver Study Group status as of 2005

The work of the WSAVA Liver Standardization working group to develop a morphological liver disease classification scheme was completed during the ECVIM Meeting of September 2003, in Uppsala, Sweden. Subsequently, efforts have focused on the generation and eventual publication of this work. During this process, a decision was made to publish the work as a single entity, rather than multiple smaller articles. To this end, the group’s collective work will be published in book format by Elsevier with an anticipated publication date of year end 2005. A summary of the text is provided below.

MORPHOLOGICAL CLASSIFICATION OF PARENCHYMAL DISORDERS OF THE CANINE AND FELINE LIVER
Susan E. Bunch1, John M. Cullen2, Jenny A. Charles3, Valeer J. Desmet4, Jan Rothuizen* 5, David C. Twedt6, Ted S.G.A.M. van den Ingh7, Tom van Winkle8, and Robert J.Washabau9.

Address: 1Department of Companion Animal and Special Species, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA, 2 Department of Pathology, College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina, USA, 3Veterinary Clinic and Hospital, University of Melbourne, Melbourne, Australia, 4Academic Hospital St. Raphaël, Pathologic Anatomy II, Leuven, Belgium, 5Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine
University Utrecht, Utrecht, The Netherlands, 6CVMBS-Veterinary Teaching Hospital, Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA, 7 Department of Pathobiology, Faculty Veterinary Medicine, Utrecht, The Netherlands, 8Laboratory of Pathology and Toxicology, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA, and 9Department of Clinical Studies, School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Email: Susan E. Bunch - susan_bunch@ncsu.edu ; John M. Cullen - john_cullen@mcsu.edu ; Jenny A. Charles - charlesj@unimelb.edu.au ; Valeer J. Desmet (Tania.roskams@uz.kuleuven.ac.be ; Jan Rothuizen* - j.rothuizen@vet.uu.nl ; David C. Twedt – dtwedt@vthcolostate.edu ; Ted S.G.A.M. van den Ingh - thi@vet.uu.nl ; Tom van Winkle – tomvw@vet.upenn.edu ; Robert J.Washabau – washabau@vet.upenn.edu

ABSTRACT
This paper presents the consensus report of the World Small Animal Veterinary Association (WSAVA) working group “Liver Diseases and Pathology Standardisation Research Group” on parenchymal disorders in the dog and cat. It describes the normal liver lobule / acinus and the constituent elements, the hepatocytes, sinusoids, Kupffer cells and hepatic stellate cells. Moreover, it describes the various parenchymal disorders which can be classified as 1) reversible cellular injury: hepatocellular swelling, feathery degeneration, steroid induced hepatopathy and steatosis, 2) hepatic amyloidosis, 3) hepatocellular death: apoptosis, coagulation necrosis and lytic necrosis and the morphological patterns of necrosis in the liver, 4) the definition and characteristics of acute and chronic hepatitis and cirrhosis, non-specific reactive hepatitis, and hepatic abscesses and granulomas and includes examples on specific causes 5) hepatic metabolic storage diseases, and 6) miscellaneous conditions including cytoplasmic and nuclear alterations in hepatocytes, Kupffer cells and hepatic stellate cells.