11 - Hepatobiliary Disease Flashcards by Maggie Malone

Early signs of liver disease

Hyporexia, vomiting, lethargy, weight loss, diarrhea, PU/PD

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More specific signs of liver disease fo not develop until

Late stages of disease

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Icterus

Yellow discoloration of tissues and body fluids secondary to hyperbilirubinemia and bile pigment deposition

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The most sensitive places to look for icterus on PE

Sclera and conjunctiva

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Typical clinical signs of acute hepatopathy in dogs and cats

Anorexia, fever, cranial bdominal pain, acute kidney injury

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Typical clinical signs of chronic liver disease in dogs and cats

Inappetence and weight loss

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If your patient is icterus and has a moderate or marked decrease HCT

Pre hepatic

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If your patient is icterus and has a normal or mild decrease HCT

Hepatic or post hepatic

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Most common cause of icterus in dogs

Immune mediated

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Ascites

Accumulation of free fluid within the abdominal cavity

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Causes of ascites related to Hepatobiliary system

Portal hypertension, hypoalbuinemia, gallbladder rupture

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Portal hypertension is secondary to

Increased resistance, increased blood flow or combo in portal circulation

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Hepatic encephalopathy

Neurological dysfunction in patients with liver disease

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Etiology of hepatic encephalopathy

Dysmetabolism of toxins due to liver dysfunction, Porto systemic bypass

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Most common etiology in dogs

Congenital portosystemic shunts, and aquired portosystemic shunts

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Most common etiology of cats

Argine deficiency secondary to feline hepatic libidos is

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Most common etiology of dogs and cats

Acute liver failure without PSS

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Early clinical signs of HE

Mild confusion, inappetence, dullness, irritability

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Advanced clinical signs of HE

Ataxia, head pressing, salivation in cats, seizures, supor, coma

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How to diagnose HE

Evidence of liver dysfunion with neurological signs, exclusion of other known brain disease, episodic signs of encephalopathy, hyperammonemia

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Precipitating factors for HE

GI hemorrhage, excessive protein intake, hypocalcemia, constipation, diarrhea

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Clinical signs of acute hepatopathy

Anorexia, fever, cranial abdominal pain , acute kidney injury

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Clinical signs of chronic liver disease

Inappetence and weight loss

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The most sensitive place to look for icterus

Sclera and conjunctiva

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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

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