11 - Hepatobiliary Disease Flashcards
Early signs of liver disease
Hyporexia, vomiting, lethargy, weight loss, diarrhea, PU/PD
More specific signs of liver disease fo not develop until
Late stages of disease
Icterus
Yellow discoloration of tissues and body fluids secondary to hyperbilirubinemia and bile pigment deposition
The most sensitive places to look for icterus on PE
Sclera and conjunctiva
Typical clinical signs of acute hepatopathy in dogs and cats
Anorexia, fever, cranial bdominal pain, acute kidney injury
Typical clinical signs of chronic liver disease in dogs and cats
Inappetence and weight loss
If your patient is icterus and has a moderate or marked decrease HCT
Pre hepatic
If your patient is icterus and has a normal or mild decrease HCT
Hepatic or post hepatic
Most common cause of icterus in dogs
Immune mediated
Ascites
Accumulation of free fluid within the abdominal cavity
Causes of ascites related to Hepatobiliary system
Portal hypertension, hypoalbuinemia, gallbladder rupture
Portal hypertension is secondary to
Increased resistance, increased blood flow or combo in portal circulation
Hepatic encephalopathy
Neurological dysfunction in patients with liver disease
Etiology of hepatic encephalopathy
Dysmetabolism of toxins due to liver dysfunction, Porto systemic bypass
Most common etiology in dogs
Congenital portosystemic shunts, and aquired portosystemic shunts
Most common etiology of cats
Argine deficiency secondary to feline hepatic libidos is
Most common etiology of dogs and cats
Acute liver failure without PSS
Early clinical signs of HE
Mild confusion, inappetence, dullness, irritability
Advanced clinical signs of HE
Ataxia, head pressing, salivation in cats, seizures, supor, coma
How to diagnose HE
Evidence of liver dysfunion with neurological signs, exclusion of other known brain disease, episodic signs of encephalopathy, hyperammonemia
Precipitating factors for HE
GI hemorrhage, excessive protein intake, hypocalcemia, constipation, diarrhea
Clinical signs of acute hepatopathy
Anorexia, fever, cranial abdominal pain , acute kidney injury
Clinical signs of chronic liver disease
Inappetence and weight loss
The most sensitive place to look for icterus
Sclera and conjunctiva
What is the most common cause of icterus in dogs and cats
Prehepatic immune mediated hemolysis
Severe abdominal ascites detection
Abdominal dispensation and positive ballottement on PE
Causes of ascites related to hepatobiliary system
Portal hypertension, hypoalbuminemia, gallbladder rupture
Portal hypertension of ascites
Secondary to increased resistance, increased blood flow or combo in portal circulation
Hepatic encephalopathy
Neurological dysfunction in patients with liver disease
General etiology of HE
Dysmetabolism of toxins due to liver dysfunction, Porto systemic bypass, combo
Most common etiology of HE in dogs
Congenital portosystemic shunt and acquired portosystemic shunt due to portal hypertension
Most common etiology of HE in cats
CPSS - Arline deficieny secondary to feline hepatic lipidosis
Most common etiology HE of dog and cat
Acute liver failure without PSS - severe dysmetabolism of ammonia
What is the most common etiology for dogs with HE
Congenital portosystemic shunt and acquired portosystemic shunt due to portal hypertension
What is the most common etiology for cats with HE
Arginine deficieny secondary to feline hepatic lipidosis
Most common etiology for dog and cat with HE
Acute liver failure without PSS - severe dysmetabolism of ammonia n
What is the Pathogenesis of HE
PSS / liver dysfunction - NH3 rich blood from the portal circulation bypasses the liver and flows directly into the systemic circulation
68% of dogs with single CPSS have
Neurological abnormalities
What are brain neurotoxins implicated in the Pathogenesis of HE
Ammonia, glutamate, benzodiazepines, opioids
Early clinical signs of HE
Mild confusion, inappetence, dullness, irritability
Advanced clinical signs of HE
Ataxia, circling, head pressing, salivation, seizures, stupor, coma
Diagnosis of HE
Evidence of liver dysfunction in patient with neuro signs, exclusion of other known brain disease, episodic signs of encephalopathy, hyperammonemia
What are precipitating factors for HE
GI hemorrhage, excessive protein intake, hypokalemia, constipation, diarrhea
What is the only way to tell different between primary and secondary hepathopathies
Biopsy
What are expections of not using biopsy to confirm
Gallbladder mucocele - imaging, congenital vascular anomalies - imaging, biliary tract infections - bile cytology
ALT, AST, ALP and GGT, Bilirubin test for
Liver involvement
Urea, glucose, cholesterol, test for
Liver function
Reactive hepatopathy
Secondary LE increase caused by factors coming from injured organs with portal venous drainage
ALT is more
Sensitive
Which is most specific to liver injury
ALT
AST is less sensitive than
ALT
If AST increase + normal ALT
Extrahepatic source likely
If AST increased great than ALT and CK elevated
Muscle origin
If AST increased greater than ALT CK normal
RBC origin
What has the lowest specificity for hepatibiliary disease in dogs
ALP increase
Steroids may stimulate what production
GGT
With feline cholangitis, usually the increase of GGT greater than increas of
ALP
Delta bilirubin
Conjugated bilirubin in plasma bound irreversibly covalently with albumin
Bile acid increase indicates
PSS, parenchyma hepatic disease, cholestasis
What causes hyperammonemia
Congenital or acquired PSS or acute hepatocellular inability to detoxify NH3 to urea, detection of HE
For increase in NH3 how much reduction must occur to urea cycle
Greater than 70%
Marked coagulopathy correlated with
Functional failure
What increase is most common caogulopathy in cats with liver disease
PT
Protein C
Anticoagulant protein synthesize in the liver
Protein C can help distinguish between
Macroscopic shunting and micro vascular dysplasia
Radiographs of liver size is based on
Position of gastric axis
Radiograph normal gastric axis
Perpendicular to the spine to parallel with the last rib
Hepatomegaly on radiograph
Rounded caudoventral margins, extension of liver margins beyond costal arc, displacement of gastric axis
Microhepatica on radiograph
Cranial displacement of gastric axis and shorter distance between diaphragm and gastric lumen
Ascites radiograph
Loss of aerosol detail
pros of FNA of liver
Less invasive, fewer risk, faster results, less expensive
Cons of FNA of the liver
Low cellularity, artifacts, no assessment of tissue architecture
Definitive diagnosis of primary liver disease requires
Histology
Most common techniques of hepatic biopsy
Core needs biopsy, laparoscopic biopsy, surgical biopsy
Most common techniques of hepatic biopsy
Core needs biopsy, laparoscopic biopsy, surgical biopsy
