10 - more liver disorders (PSS)

Question 1

(congenital PSS)

1. vascular communications between what?
2. communcations allows what to reach systemic circulation?
3. intrahepatic shunts most common in what?
4. extrahepatic shunts most common in what?

Answer 1

1. portal and systemic venous systems
2. toxins
3. large dogs
4. small dogs and cats

Question 2

(congential PSS)

1. Cx?
2. get what kinds of urintary stones?

Answer 2

1. CNS signs (hepatic encephalopathy), anorexia, vomiting, diarrhea, stunted growth
2. urate sontes from ^ urinary excretion of ammonia and uric acid

Question 3

(congenital PSS)

1. sex predilection?
2. many cats with what colored irises?

Answer 3

1 . no

2. copper

Question 4

(congenital PSS)

1. hematological findings?
2. lab eval looks how?

Answer 4

1. microcytosis, target cells, poikilocytosis
2. consistent iwth hepatic dysfunction without significant necrosis and cholestasis

Question 5

(congenital PSS)

1. what is the procedure of choice to characterize?

Answer 5

1. positive contrast portography

Question 6

(congenital PSS)

1. tx of choice?

Answer 6

1. surgical attenutation/ligation of shunt

(gradual progressive closure - ameroid constrictors or cellophane bands - is preferable)

Question 7

(congenital PSS)

(medical therapy)

1. need to address what?

Answer 7

1. hepatic encephalopathy (restirct protein, lactulose, neomycin)
2. mgmt of urate urolithiasis
3. manage seizures with anticonvulsant therapy

Question 8

(congenital PSS)

1. prog with sx?
2. with med?

Answer 8

1. great
2. good short-term, poor long-term

Question 9

(multiple extrahepatic PSSs)

1. develop as a compensatory response to what?
2. tx?

Answer 9

1. portal hypertension
2. treat underlying disorder -> DO NOT ligate the shunting vessels

Question 10

(hepatic microvascular dysplasia (HMD))

1. congential microscopic hepatic vascular abnormalities that result in increased what?
2. inherited in what?
3. Cx similar to congenital PSS

(see signs of hepatic encephalopathy with failure to identify shunting)

4. provide dietary mgmt as for PSS once Cx appear

Answer 10

1. serum bile acid concentrations
2. Cairn terriers

Question 11

(primary portal vein hypoplasia (PPVH))

1. congenital abnormality of portal vascular development, mostly small intrahepatic portal venules, but hypoplasia of the extrahepatic portal vein may occur in 30% of dogs

Question 12

(cholecystitis)

1. what is this?
2. predisposing factors: chlolelithiasis (gallstones), anatomic malformation of gallbladder, biliary obstruction/surgery
3. Cx: fever, abdominal pain, jaundice, vomiting, diarrhea
4. dx based on radiography or ultrasound

Answer 12

1. inflammation of the gall bladder

Question 13

(gallbladder mucocele)

1. abnormal accumulation of mucus in the gallbladder lumen accompanied by cystic mucosal hyperplasia of the gallbladder mucosa
2. what are two risk factors?
3. Cx signs occur with what?

Answer 13

2. hyperadrenocorticism or corticosteroid therapy
3. secondary bacterial infection, obstruction or rupture, ischemic necrosis

Question 14

(cholelithiasis)

1. what is this?
2. 2 predisposing factors?
3. what dogs are at increased risk?
4. what calls for surgical removal?

Answer 14

1. presence of gallstones
2. bile stasis, inflammation of bile ducts and gallbladder
3. older, small breed females
4. infection, obstruction, or perforation

Question 15

(extrahepatic biliary obstruction)

1. caused by a complication of a primary biliary disorder, or an extrahepatic disorder
2. surgical treatment is necessary

Question 16

(biliary rupture)

1. usually caused by trauma, can be primary though
2. how does abdominal fluid bilirubin content compare to serum?
3. tx?

Answer 16

2. bilirubin conc higher than serum

(also find free green-brown material)

3. sx required, treat with abx and vitamin K