27. Hepatobillary Disease Flashcards
Common diseases affecting the hepatobillary system?
Jaundice
Acute hepatopathy/hepatitis:
Canine chronic hepatitis:
Feline hepatic lipidosis:
Feline Inflammatory liver disease:
Hepatic encephalopathy
Jaundice Pathophysiology?
Jaundice;
Pathophysiology:
-Divided Into three types:
- Pre-hepatic:
> incr Production of haemoglobin due to haemolysis
- Hepatic:
> incr Uptake and conjugation due to hepatic failure
>Hepatic excretion
- Post-hepatic:
> Removal due to billary obstruction
Causes of Jaundice?
Causes:
- Pre-hepatic:
> Immune-mediated haemolytic anaemia
- Toxic: Snake, onions/garlic, paracetamol
> Bacterial: Mycoplasma haemofelis
“’ Hepatic:
» Hepatitis: Severe acute
• Toxic: Plants, mycotoxin
Inflammatory: Hepatitis, cholanglohepatitis, neoplasia
Infectious: Bacterial (leptospirosis), parasitic {migrating larvae, toxoplasma)
“’ Post-hepatic:
» BIiiary tract obstruction: Biliary stones or mucocele
> Duodenal foreign body: Blocking duodenal papillae)
-Pancreatitis
Clinical signs of Jaundice?
Clinical signs:”’ Icteric mucous membranes and sclera
“’ Clinical signs associated with underlying cause
Jaundice diagnostics?
Diagnostics:
“’ Pre-hepatic:
PCV/TP, lcteric serum
- Spherocytes
- Autoagglutination
“’ Hepatic:
Bilirubin, incr ALP, GGT, +/- incr ALT, AST
» Ultrasound: +/- Liver pathology
“’ Post-hepatic:
>Incr Bilirubin, Incr ALP, GGT
» Ultrasound: Biliary tract congestion, biliary stones, mucocele, pancreatitis
Jaundice treatment?
Treatment:
As per the underlying condition
Consider antibiotics for post-hepatic obstruction as biliary stasis is a high risk of infection
Acute hepatitis clinical signs?
Acute hepatopathy/hepatitis;
Clinical signs:
Acute onset,
- anorexia,
- vomiting,
- cranial abdominal pain,
- Jaundice,
- bleeding,
- hepatic encephalopathy,
seizures
Acute hepatitis Diagnostics?
Diagnostics:
Biochemistry:
Elevated liver enzymes especially ALT and AST, ALP, bilirubin, bile acids, hypoproteinaemia,
hypoglycaemia
Haematology:
Anaemia, thrombocytopenia
Ultrasound: May not see any specific changes
Biopsy: May show non-specific changes
Acute hepatitis causes?
Causes:
Infectious (bacterial, viral, protozoal, parasitic, algae),
toxicity (paracetamol, cycad Ingestion),
neoplastic, pancreatitis, IBD etc.
Acute hepatitis treatment?
Treatment:
- Supportive therapy.
- IV fluids and electrolytes
- Antiemetic: Metoclopramide 0.5mg/kg TID, maropitant 1mg/kg SC SID for <5 days
- Gastric protectants: Proton pump Inhibitors, H2 antagonist (famotidine), sucralfate
- Antibiotics:
- Depending on cause
> Metronidazole 7 .5mg/kg Coagulopathy:
> Plasma for coagulopathy
> Vitamin K1 injection, single dose 5mg/kg SC, +/- continue with 2.5mg/kg PO BID
Adjunctive therapy:
> Antioxidants:
Vitamin E 400 IU PO SID and Vitamin C
• S-Adenosy·L·methlonlne (SAMe): Potent antioxidant 20mg/kg PO SID
)> Choleretic:
• Ursodeoxycholic acid (Actigall ®): 10-15mg/kg PO SID, only if no biliary tract obstruction ·
) Paracetamol toxicity:
• N-Acetylcystelrie: 140mg/kg IV initially (diluted In saline), then 70mg/kg IV or PO QID for 5 doses
Neurological signs:
avoid benzodiazepines, use propofol to stop seizures and begin
phenobarbitone or levetiracetam
Canine chronic hepatitis pathophysiology?
Canine chronic hepatitis:
Pathophysiology:
- Syndrome characterised by hepatic degeneration and necrosis leading to fibrosis, causes can Include:
Idiopathic: Most common
> Recurrent pancreatitis/lBD, biliary tract disease (obstruction, inflammation)
-Toxicity/drug: Chronic exposure
- Inflammation (lmmune mediated, fungal, bacterial, viral (adenovirus))
> Breed-specific copper accumulation disorders (Bedlington terriers, West Highland Terriers,
Dalmatians, Dobermans)
Canine chronic hepatitis clinical signs?
Clinical signs:
Anorexia, lethargy, vomiting, weight loss, jaundice, PU/PD, ascites (portal hypertension or
hypoalbuminaemia)
- Behaviour changes: Disorientation, head pressing, ataxia, pacing, seizures, circling
Diagnostics of chronic canine hepatitis?
Diagnostics:
- Haematology and biochemistry:
- Variable changes in haematology
- Usually elevated ALT, bilirubin and paired serum bile acids
- But signs of liver dysfunction: Low albumin, urea, glucose, coagulopathy
- +/- Coagulopathy
- Ultrasound
- Biopsy: Definitive diagnosis, histopathology and culture and sensitivity
Treatment of canine chronic hepatitis?
Treatment:
- Treatment for specific disease according to diagnosis based on biopsy
- Supportive therapy:
» IV fluids and electrolytes
> Antiemetic: Metoclopramide O.5mg/kg TID, maropitant 1 mg/l<:g SC SID for <5 days
- Gastric protectants: Proton pump Inhibitors, H2 antagonist (famotidine), sucralfate
- Coagulopathies: Plasma and Vitamin K
- Adjunctive: Based on definitive diagnosis
- Diet as for “Hepatic encephalopathy”· protein restriction to minimise hepatic workload or protein
Intolerance
> lmmunosuppressive therapy:
• Prednisolone O.5mg/kg PO BID
• +/- Azathloprine 2mglkg PO SID until remission then O.5mg/kg PO EOD, monitor for bone
marrow suppression and hepatoxicity, also very toxic In cats
-Anti-fibrotic:
• Colchicine 0.03mg/kg PO BID
> Copper chelation:
D-penicillamine 10-15mg/kg PO 810
Zinc acetate 5mg/kg PO BID (max dose 100mg BID)
Anti-oxidants:
• Vitamin E 400 IU PO SID
S-Adenosy-L-methionine (SAMe): Potent anti-oxidant 20mg/kg PO SID
Milk thistle
> Choleretic:
Ursodeoxycholic acid (Acligall ®): 10· 1 5mg/kg PO SID
Only if there is no biliary tract obstruction
> Ascites:
SpIrolactone +/- FurosemIde
Abdominocentesis
Feline hepatic lipidosis Pathophysiology?
Feline hepatic lipidosis;
Pathophysiology:
-Increased hepatocellular accumulation of lipids and cholestasis leading to hepatic failure
- Typically seen In middle age obese cats that have experienced a period of prolonged anorexia resulting in rapid weight loss.
- Most commonly secondary to pancreatitis, inflammatory bowel disease, cholangiohepatitis and diabetes mellitus -
;. Other causes include hepatotoxins, other systemic Illnesses, surgery, severe prolonged stress
