08 - liver and biliary tract disorders

Question 1

long term prog of acute hepatic failure may be favorable because of what?

chrhonic is usually irreversible

Answer 1

hepatic regeneration

Question 2

(clinical signs)

1. common nonspecific signs?
2. hematemesis suggests what?
3. wegith loss and stunted growth suggest what?

Answer 2

1. anorexia and vomiting

(small bowel diarrhea is less common)

2. ulcers
3. a chronic disorder

Question 3

(clinical signs)

1. polyuria and polydipsia may be present as a result of psychogenic polydipsia, hypercorticolism, and renal concentrating defects
2. signs of abnormal bilirubin include what?
3. coagulopathies occur due to what?

Answer 3

3. pigmented urine from bilirubinuria and jaundice
4. decreased clotting factor synth, vit K deficiency, and DIC

Question 4

(hepatic encephalopathy)

1. occurs due to what?
2. what may exacerbate symptoms?
3. Cx?

Answer 4

1. severe liver dz or PSS
2. high protein meals
3. depression, hypersalivation, behavioral changes, altered conciousness, seizures, coma

Question 5

why is ascites common in severe chronic liver dz?

Answer 5

hypoalbuminemia, portal hypertension, sodium and water retention

Question 6

(physical exam)

1. jaundice of the sclera, mucous membranes, and skin is clinically detectable with serum bilirubin concentrations over what?
2. abdominal palpation may reveal hepatomegaly, pain, or abdominal effusion
3. may have weird neuro
4. rectal exam may reveal the presence of what?

Answer 6

1. 2.5 mg/dL
2. melena or acholic feces

Question 7

(lab eval)

1. CBC may reveal mild to moderate anemia from blood loss or chornic dz
2. what is common with PSS?

Answer 7

2. microcytosis (from abnormal Fe metabolism)

Question 8

(lab eval)

(UA)

1. shows isosthenuria or hyposthenuria
2. bilirubinuria preceds hyperbilirubinemia and jaundice
3. is trace bilirubin normal in dogs or cats?
4. what crystals are common with PSS?

Answer 8

3. dogs
4. ammonium biurate

Question 9

(hemostasis eval)

1. coag tests freq abnormal, but clinical evidence of bleeding is uncommon
2. increased bleeding times can occur from what?
3. thrombocytopenia and platelet dysfx may be present

Answer 9

1. failure of hepatocytes to synth clotting factors

Question 10

(abdominal fluid analysis)

1. in liver dz and hypoalbuminemia, the ascitic fluid is usually a what?
2. how is fluid different in post-sinusoidal hepatic disorders?
3. in rupture of the biliary tract, the abdominal fluid looks how?

Answer 10

1. transudate
2. fluid is higher in protein (modified transudate greater than 2.5 g/dL)
3. yellow or green, bilirubin conc higher than serum, shows mixed inflammation on cyto

Question 11

(diagnostic imaging)

Question 12

(liver cytology)

1. FNA is easy and relatively safe to perform. However its diagnostic accuracy is controversial (lack of correlation with histopath in up to 50%)
2. cytology is most useful for what conditions?

Answer 12

2. diffuse hepatic pathologies (feline hepatic lipidosis, diffuse neoplasia, or infections)

Question 13

(liver biopsy)

Question 14

(tx for liver dz)

Question 15

(tx - hepatic encepalopathy)

1. give antibiotics (neomycin, amoxicillin, or metronidazole) to do what?
2. what acidifies the colon and thereby decreases ammonia absorption?
3. control GI bleeding - why?

Answer 15

1. decrease urease producing bacterial population in the colon
2. lactulose
3. may provide protein

Question 16

(tx - ascites and edema)

1. usually results from what?
2. tx how?

Answer 16

1. hypoalbuminemia, portal hypertension, renal retention of sodium and water
2. restrict dietary sodium, use diuretics

(avoid abdominocentesis if possible -> will just fill up again)

Question 17

(tx - coagulpathy and anemia)

1. administer what when deficiency present?

Answer 17

1. vitamin K1

Question 18

(tx - GI ulceration)

1. can be due to what two things?
2. manage with what?

Answer 18

1. gastric acid hypersecretion or portal hypertension
2. sucralfate and H2 blocker

Question 19

(tx - infection and endotoxemia)

1. penicillins, cephalosporins, or aminoglycosides are good choices - why?

Answer 19

1. excreted primarily by kidney

Question 20

(acute hepatic failure)

1. occurs when a sudden severe insult to the liver comporomises at least what % of the fxnal hepatic tissue?
2. in many cases, a specific cause cannot be identified

Answer 20

1. 70 to 80%

Question 21

(acute hepatic failure)

1. Cx of acute hepatic failure are often non-specific and reflect general hepatic dyxfx. cranial abdominal pain may be caused by swelling and stretching of the liver capsule

Question 22

(acute hepatic failure)

1. when jaundice occurs - consider what?
2. what is the most common cham abnormal?
3. does hypoalbuminemia suggest acute or chronic process?
4. liver biopsy shows what in most cases?

Answer 22

1. extrahepatic biliary tract disorders
2. increased ALT (^ ALP most also occur)
3. chronic
4. diffuse hepatic necrosis