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SAM Final > 24. Vascular liver diseases, portosystemic shunt in dogs and cats. Hepatic encephalopathy > Flashcards

24. Vascular liver diseases, portosystemic shunt in dogs and cats. Hepatic encephalopathy Flashcards

1
Q

Normal blood pressure in the portal system

A

5-10mmHg

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2
Q

Definition of portal hypertension

A

When the portal blood pressure is 5mmHg higher than the BP in the inferior vena cava

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3
Q

Composition of the portal system

A

Portal vein
superior mesenteric vein
inferior mesenteric vein
splenic vein
left gastric vein
umbilical vein

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4
Q

Aetiology of Portal Hypertension

A

when the blood flowing from portal system to inferior vena cava meets resistance

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5
Q

3 Causes of Portal Hypertension

A

Pre-hepatic
Intra- hepatic
Post - hepatic

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6
Q

Prehepatic Causes of Portal Hypertension

A

Occurs before blood arrives to liver
- Portal vein thrombosis
- Splenic vein thrombosis
- Arteriovenous malformation
- Splenomegaly

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7
Q

Intrahepatic Causes of Portal Hypertension

A

Occurs due to causes affecting the liver specifically
- Cirrhosis by viral hepatitis; metabolic disease; (alcohol)
- Primary sclerosing hepatitis
- Schistosomiasis
- Nodular regenerative hyperplasia

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8
Q

Post hepatic Causes of Portal Hypertension

A

due to problems involving the vena cava
- Inferior vena cava obstruction
- RS-HF
- Hepatic vein thrombosis

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9
Q

Clinical signs of Portal Hypertension

A

May be asymptomatic, usually related to underlying disease
- Hepatosplenomegaly
- Fatigue
- Nitric oxide release
- Pruritis
- Swollen capillaries
- Oedema
- Caput medusae
- Ascites
- Palmar erythema
- Jaundice

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10
Q

Portosystemic Shunt definition

A

Abnormal vascular communication between the portal and systemic venous system

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11
Q

Causes of PSS

A

acquired / congenital
Intrahepatic / extrahepatic

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12
Q

Consequences of PSS

A

Increased toxins in systemic circulation
decreased hepatic blood flow —> atrophy

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13
Q

Congenital PSS

A

75% of cases
can be intrahepatic or extra hepatic
young > old

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14
Q

cause of congenital PSS

A

abnormal embryonal blood vessels

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15
Q

Intra hepatic congenital PSS

A

solitary
persisten embryonal ductus venous
large > small dogs - wolfhound, settler, retriever, lab

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16
Q

extrahepatic congenital PSS

A

solitary
anatomically abnormal communication btw portal system and v. cava caudalis / azygous
small & toy dogs
cats, yorkies

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17
Q

Acquired PSS

A

multiplex, collateral vessels, narrowing and twisting
Protective compensatory response to portal hypertension
old > young

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18
Q

Hepatic Microvascular Dysplasia

A

congenital hypoplasia to portal vein
formation of intralobular microvascular shunts

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19
Q

Predisposition to Hepatic Microvascular Dysplasia

A

Small > large
cairn terrier, yorkie

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20
Q

Clinical signs of Hepatic Microvascular Dysplasia

A

mild / none

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21
Q

Diagnosis of Hepatic Microvascular Dysplasia

A

Increased ; BA
US
Biopsy

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22
Q

Treatment of Hepatic Microvascular Dysplasia

A

Diet
lactulose

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23
Q

Arterioportal fistula

A

connection forms between a. hepatica & v. portae

24
Q

what does Arterioportal fistula lead to

A

Portal hypertension
ascites
acquired pss
gi oedema

25
Q

clinical signs of Arterioportal fistula

A

continuous murmur
gi oedema
ascites

26
Q

diagnosis of Arterioportal fistula

A

hepatic AV fistula - distended, echo loose portal branch within liver lobe
hepatofungal blood flow above liver lobe

27
Q

Treatment of Arterioportal fistula

A

Lobectomy
treat hypertension

28
Q

Hepatic venous outflow obstruction

A

abnormal development of vessels before differentiation into veins & arteries

29
Q

diagnosis of Hepatic venous outflow obstruction

A

colour doppler
ex lap
celiac arteriogrphay

30
Q

Lab D of Hepatic venous outflow obstruction

A

mild anaemia
Leucocytosis
Hypoproteinaemia
Normal liver enzymes
increased ; BA

31
Q

Hepatic Encephalopathy definition

A

metabolic dysfunction of brain due to liver dysfunction

32
Q

Hepatic Encephalopathy in younger animals

A

caused mostly by shunts

33
Q

Hepatic Encephalopathy in older animals

A

caused mostly by neoplasia or cirrhosis

34
Q

Acute Hepatic Encephalopathy

A

Rare
<10% of cases

35
Q

Cause of Hepatic Encephalopathy

A

Liver necrosis

36
Q

Clinical signs of Hepatic Encephalopathy

A

Seizures
semi - coma, com
increased intracranial pressure

37
Q

Lab D of acute Hepatic Encephalopathy

A

increased ; NH3

38
Q

Chronic Hepatic Encephalopathy

A

More common
PSS and decreased liver function

39
Q

Pathophys of Chronic Hepatic Encephalopathy

A

PSE —> Chronic Hepatic Encephalopathy —> portosystemic vascular anastomosis —> HE

40
Q

Chronic Hepatic Encephalopathy in dogs

A

high reserve capacity

41
Q

Chronic Hepatic Encephalopathy in cats

A

lower reserve capacity
arginine isnt synthesized in liver –> inadequate NH3 detoxification

42
Q

Final consequence of Chronic Hepatic Encephalopathy

A

Deranged neurotransmitter systems

43
Q

Clinical signs of Hepatic Encephalopathy

A

graded 1- 4
cns signs due to deranged neurotransmitter systems , brain oedema, hypoglycaemia

44
Q

Grade 1 of Hepatic Encephalopathy

A

Lethargy
Apathy
Depression
Personality Changed
Anorexia
PU

45
Q

Grade 2 of Hepatic Encephalopathy

A

Ataxia
Disorientation
Compulsive pacing
Head pressing
Apparent blindness
Personality changes
Salivation
PU

46
Q

Grade 3 of Hepatic Encephalopathy

A

Stupor
Severe salivation
seizures

47
Q

Grade 4 of Hepatic Encephalopathy

A

Coma
Non responsive

48
Q

Other clinical signs of Hepatic Encephalopathy

A
  • Anorexia
  • Vomiting
    Weight loss
  • Ptyalism
  • Diarrhoea
  • PU/PD
  • Urolithiasis
  • Cystitis
  • Stranguria
  • Dysuria
  • Haematuria
  • Pollakiuria
  • Crystalluria
49
Q

Haematology of HE

A

Non regen microcytic anaemia
acanthocytes
poikilocytosis

50
Q

Biochem of HE

A

increased ; ALP, ALT, AST, GGT, Br, BA, NH3
Decreased ; BUN, Urea, Chol, Albumin, glucose
Coagulopathy

51
Q

Urinalysis of HE

A

Decreased ; USG
PU/PD
Ammonium biurate crystals
Urolithiasis
haematuria
proteinuria
pyuria

52
Q

Liver function tests of HE

A

Ammonia tolerance test
Post prandial ammonia tolerance test
Fasting BA, post prandial BA
Decreased protein C

53
Q

US of HE

A

Doppler
smaller liver
decreased size of intrahepatic veins
blood flow direction
enlarged kidneys

54
Q

Angiography of HE

A

used to locate anatomical location of PSS
surgical catheterisation

55
Q

Treatment of acute HE

A

treat seizures - propofol –> levetiracetam
Treat brain oedema - mannitol
fluids, electrolytes, acid - base control
to decrease NH3 and toxins - enema, lactulose
PO AB - metronidazole, amox
Gi protectants

56
Q

Treatment of chronic HE

A

AB
Lactulose
Dont alter dietary protein intake
regular small meals

SAM Final (48 decks)

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