24. chronic hepatitis, familial liver diseases

Question 1

what to mention

Answer 1

chronic hepatitis: what, patho, background
familial CH: types, breeds
treatment

Question 2

what is chronic hepatitis

Answer 2

a group of inflammatory-necrotizing liver diseases
mononuclear or mixed infiltration, periportal necrosis, fibrosis, clinical/ biochemical hepatocellular dysfunction
no improvement for 4-6 weeks
end stage = liver chirrosis

Question 3

chronic hepatitis pathophysiology

Answer 3

poorly understood
immune mediated?
copper - cause or consequence
virus - infective cause?

Question 4

chronic hepatitis background

Answer 4

1. familiar: Bedlington, Dalmatian, labrador, doberman, WHWT
   2: infective: infectious canine hepatitis, leptospirosis, helicobacter
   3- drug: anti epileptic, carprofen

Question 5

clinical signs of chronic hepatitis

lab

Answer 5

apper if >75% of liver is damaged
uterus, ascites, wavy GI signs, PUPD
ALT! BA, albumin

Question 6

familial chronic hepatitis types

Answer 6

primary: increased cu through life, bedlington, Labrador, Dalmatian
secondary: increased cu but not throughout life

Question 7

cu storage disease in bedlington terrier what is it

Answer 7

progressive cu accumulation due to failed normal hepatobiliary excretion - low bile cu level
homoxygote and heterozygote types

Question 8

cu storage disease in bedlington terrier heterozygote

Answer 8

transient, normalizes at around 1 year

Question 9

cu storage disease in bedlington terrier homozygote

Answer 9

1-2 years - clinically normal but affected
young adult: acute fulminant hepatic necrosis
young middle aged: very high ALT
old middle aged: chronic hepatitis, increased ALT

Question 10

cu storage disease in Dalmatian

Answer 10

primary cu disease 
acute onset, rapid progression 
fibrosis, necrosis 
icterus, PU/PD, dehydration
highly increased ALT
AST, ALP increased

Question 11

cu storage disease in Labrador

Answer 11

primary disease - female

hepatocellular apoptosis, necrosis

Question 12

cu storage disease in Doberman pincher

Answer 12

not primary
chronic hepatitis and chirrosis
doberman get it from less cu than bedlington
progressive anorexia, weight loss, vomit, ascites, icterus, PUPD
increased ALT, ALP, BR
decreased albumin

Question 13

cu storage disease in WHWTerrier

Answer 13

early: focal no signs
later: ictreus, vomit, anorexia
increased ALT, Br,
decreased albumin

Question 14

treatment of cobber increase

Answer 14

normal level is below 400 ppm 
cu-chelator: penicillamine
Zn-salt: decrease cu absorption from intestines 
NEVER MIX CHELATOR AND ZN
antioxidant: SAMe, Evit, silimaryne
low cu diet

Question 15

treatment of chronic hepatitis

Answer 15

prednisolone <3
+ cyclosporine or azathioprine if not enough
UDCA: hepatoprotect, antiinflam, antifibrotic
antifibrotic drugs: d penicillamine, vit E, colchicine