21. Acute liver diseases in dogs and cats. Acute hepatic failure, feline hepatic lipidosis Flashcards
are liver diseases more likely to be acute or chronic
acute because chronic conditions allow for regeneration time and functional adaptation.
chronic only show if 70% of hepatic functional mass has been lost
general non specific clinical signs
anorexia
weight loss
poor coat
vomiting
diarrhoea
apathy
lethargy
depression
dehydration
general specific clinical signs
icterus
bilirubinaemia
CNS signs
enlarged abdomen
pu/pd
DIC
coagulopathy
causes of liver associated ascites
pre hepatic
intra hepatic
post hepatic
prehepatic mechanism
ateriovenous fistula
portal vein obstruction
portal vein hypoplasia
intrahepatic mechanism
portal venule hypoplasia
sinusoidal cellular infiltration
fibrosis ; periportal region
post hepatic mechanism
aka passive congestion
hepatic vein obstruction
cauda vena cava obstruction
RS HF
pericardial disease
differential of ascites
HF
peritonitis
protein loss due to AKI/ GI
liver disorders
predispositions to liver disease in cats
liver has less storage & regenerative capacity than dog
more likely to suffer a biliary disease or hepatic lipidosis
rarely develop fibrosis, cirrhosis, portal hypertension, APSS
hepatomegaly
predispositions to liver disease in dogs
more likely to suffer a parenchymal disease
smaller liver
What % of liver is affected in Acute Hepatic Failure - AHF of dogs
70%
histo of AHF
Necrosis
what are the 3 outcomes of AHF
recovery
chronic liver disease
death
Clinical signs of AHF
Mild - slow progression
Severe - acute AHF
depression
dehydration
abdo pain
coagulopathy
CNS signs
polydipsia
icterus
fever
vomiting
anorexia
Lab D of AHF
Increased; ALT, AST, ALP. GGP. Br, FBA- PPBA, NH3
Decreased ; glucose. bun, albumin
US of AHF
decreased echogenicity
toxic effect of AHF
intrinsic - reproducilbe, dose dependant, toxic dose limit, direct toxic effect
extrinsic - non reproductible, unique, not dose- dependant
Hepatotoxins
Parcetamol
Phenobarbital
Phenytoin
Potentiated sulphonamide
xylitol
Primidone (cats)
Diazepam (cats)
paracetamol toxic effect
in cats
rapidly depletes the body’s stores of glutathione
oxidative effects
causing erythrocyte methamoglobinaemia and necrosis
clinical signs of paracetamol toxicosis
cyanosis
dyspnoea
facial oedema
tachycardia
tachypnoea
brown blood
lab d of paracetamol toxicosis
haemolytic anaemia
methemoglobinaemia
abnormal rbcs
increased; ALT, Br, haemoglobinaemia
treatment of paracetamol toxicosis
fluish stomach
activated charcoal
IVFT, oxygen, mannitol
antioxidants
N- acetylcycteine
Phenobarbital toxicosis
rarely causes hepatotoxicity
treat by decreasing dose
Lab d of Phenobarbital toxicosis
decreased; albumin
Increased; Br, enlarged liver
Phenytoin toxicosis
very hepatotoxicosis
causes hepatitis, fatal intrahepatic cholestasis
short half life in dogs
types of potentiated sulphonamide toxicosis
sulphonamide hypersensitivity - thrombocytopaenia, fever, polyarthropathy
acute hepatopathy - liver necrosis& cholestasis
destructive cholangitis - idiosyncratic hypersensitivity, acholic faeces
other drugs causing hepatotoxxicity
phenytoin - hepatitis, fatal intrahepatic cholestasis
primidone - liver necrosis, lipidosis & cholestasis
xylitol toxicosis
quickly absorbed into liver
causes very pronounced dose- dependant insulin production in dogs
leads to hypoglycaemia, liver necrosis, acute liver failure
Lab D of xylitol toxicosis
hypoglycaemia
hypokalaemia
increased ; liver enzymes, Br
hypophosphataemia –> hyper
Clinical signs of xylitol toxicosis
vomiting
weakness
tremor
AHF
lethargy
ataxia
seizure
treatment of xylitol toxicosis
emesis
not activated charcoal
monitor and maintain blood glucose
palliative therapy
AHF caused by pathogens in dogs
Canine Adenovirus
Canine Herpesvirus
Leptospirosis
Clostridium Piliformis
Helicobacter Canis
Abscess
Mycosis
Toxoplasmosis
Dirofilaria immitis
another name for Canine Adenovirus
Rubarth’s disease
consequence of Canine Adenovirus
hepatic necrosis
gall bladder oedema
Clinical signs of Canine Adenovirus
None (low chance)
Chronic Hepatitis & cirrhosis
Centrilobular to bridging hepatic necrosis
Pathology of Canine Adenovirus
dark and mottled liver
complications of Canine Adenovirus
HE
DIC
hypoglycaemia
CN
GI vasculitis
tonsillitis
jaundice
Diagnosis of Canine Adenovirus
inclusion bodies
IF antibody test
biopsy
treatment of Canine Adenovirus
vaccine
symptomatic - atropine, IVFT, blood transfusion, topical corticosteroids
Canine Herpesvirus
acute, afebrile, fatal in neonates
Older dogs = mild upper resp signs
Multiorgan failure - liver, kidney, lung
Pathology of Canine Herpesvirus
acute, systemic necrosis & haemorrhage
necrotising vasculitis
petechiae
vessicles
subcutaneous oedema
Lab d of Canine Herpesvirus
eosinophilic intranuclear inclusion bodies
Leptospirosis
Zoonotic, acute disease
Toxin causes of Leptospirosis
lysis of tight junction
intrahepatic cholestasis
vascular damage - - bleeding tendencies
Lab D of Leptospirosis
increased; ALPL, ALT, BA, Br
Clinical Signs of Leptospirosis
Fever
DIC
Myalgia
Oedema
Jaundice
Haematemesis
Haematochezia
Vomiting
Vascular injury
Melena
Renal dysfunction
Epistaxis
Oliguria/anuria
Uveitis
Diagnosis of Leptospirosis
US - thickened gallbladder
serology
PCR
isolation from fresh urine
clinical signs Clostridium Piliformis
acute onset, rapidly fatal
anorexia
lethargy
abdo discomfort
Diagnosis of Clostridium Piliformis
Biopsy - multifocal periportal hepatic necrosis
Treatment of Clostridium Piliformis
No treatmend
Pathology of Clostridium Piliformis
multifocal hepatic necrosis
necrotising ileus
Helicobacter canis
mostly young dogs
lesions of bile canalculi
2 different types of Hepatic abscess
Focal - ischaemia, hepatobiliary infection
Multifocal - systemic infection
Clinical signs of hepatic abcess
Anorexia
Ascites
Depression
Weight loss
Vomitus
Hepatomegaly
Fever
Lab d of hepatic abcess
neutrophilia (left shift)
increased ; liver enzymes, Br
Treatment of hepatic abcess
surgery - drainage - AB
Clinical signs of Mycotic infection
Hepatomegaly
ascites
icterus
cough/ dyspnoea
lab d of mycotic infection
increased liver enzymes
+/- SBA
Increased ; Br, Albumin
Decreased ; DIC
Pathology of Mycotic infection
Granulomatous / pyogranulomatous inflammation
2 mycosis
Histoplasmosis
Coccidiosis
histoplasmosis
affecting - bone marrow, lymph nodes, GIT
coccidiosis
affecting - bone marrow, ln, joints, abdo organs
toxoplasmosis infection affects
lungs, eye, lymphoid tissue, spleen, cns, heart
toxoplasmosis clinical signs
icterus
abdo pain
fever
uveitis
pathology of toxoplasmosis
widespread multifocal necrosis
ahf
Treatment of toxoplasmosis
clindamycin
dirofilaria immitis
post caval syndrome
affects RA of heart
Clinical signs of dirofilaria immitis
anorexia
weakness
dyspnoea
haemoglobinuria
anaemia
icterus
Lab d of dirofilaria immitis
intravascular haemolysis
pathology of dirofilaria immitis
acute, passive congestion of the liver.
AHF causing pathogens in cats
Herpes
FIP
Lepto
Clostridium Piliformis
Hepatic abcess
mycotic infection
toxoplasmosis
dirofilaria immitis
Feline hepatic lipidosis
increased hepatocellular accumulation of lipids & cholestasis leading to hepatic failure
indoor DSH, obese cats that then undergo prolonged anorexia
Clinical signs of Feline hepatic lipidosis
Anorexia
Hepatomegaly
Depression
Depression (HE)
Dehydration
Salivation (HE)
Icterus
GI signs (D & V)
Coagulopathy
Ventroflexion of head & neck
2 types of FHL
idiopathic hepatic lipidosis
secondary hepatic lipidosis
Idiopathic Hepatic lipidosis
high resistance protein catabolism in cats
amino acids can be constantly lost
- fasting during illness or anorexia or stress can increase fat mobilisation from fat stores –> decreased lipoprotein synthesis leading to lipid accumulation
main 2 consequences of Idiopathic Hepatic lipidosis
lipid accumulation and increased ammonia
Secondary Hepatic lipidosis
most common
cause of Secondary Hepatic lipidosis
metabolic / infective disease
Cholangiohepatitis
DM
Cardiomyopathy
IBD
Pancreatitis
FORL
CKF
FIP
Neural diseases
Neoplasia
Toxins
Drugs (tetracycline)
Lab D of FHL
increased ; ggt, SBA, ALT, ALP, TBr, glucose, NH3
decreased ; K, P, Mg
Diagnosis of FHL
Liver biopsy
early biopsy may lead to death
Vit K depletion - coagulopathy (dangerous)
US - hepatomegaly
FNA & cytology
Treatment of FHL
gcc are contraindicated
NG tube
avoid re feeding syndrome
treat HE, coagulopathy
FIP cause
corornavirus
which organs are affected in FIP
peritoneum
pleura
brain
eyes
parenchymal organs
Clinical signs of fip
non
mild resp, mild diarrhoes
Diagnosis of FIP
no definitive test
diazepam in cats
acute hepatic failure and high mortality