(https://www.ed.ac.uk/vet/services/small-animals/services/internal-medicine/news/research-liver-disease-complication)

Research by the Dick Vet’s Medicine Team, along with colleagues at Dick White Referrals and Davies Veterinary Specialists, has offered insight into why dogs may suffer from neurological abnormalities as a common complication of liver disease. One of the most common complications of liver disease is neurological abnormalities like lethargy, altered gait, confusion and stupor. This syndrome is often termed hepatic encephalopathy (HE). This syndrome is a particular problem in dogs with a congenital portosystemic shunt (cPSS), presence of an abnormal blood vessel, which diverts blood from the intestines away from the liver. High manganese concentrations in the blood of dogs and humans with liver diseases is considered to be clinically relevant But in dogs, it is seen that resolution of hepatic encephalopathy can occur without the correction of hypermanganesemia, indicating that increased manganese concentrations alone do not play a causative role in HE. One more study highlights the key role of ammonia and inflammation play in the development of HE.