ACVIM Required Literature - Liver Dz Flashcards
Cassia occidentalis (coffee senna) causes myonecrosis in cattle. Horses usually succumb to failure of another organ following Cassia occidentalis ingestion prior to development of myodegeneration. Which organ is this?
Liver.
Ref: Equine Vet. J. (2013); 45 (2) 240-244.
List clinical signs observed in horses following exposure to Cassia occidentalis seeds in their grain.
- Sudden death.
- Pica.
- Hyperactivity.
- Circling.
- Head pressing.
- Central blindness.
- Tongue protrusion.
- Loss of facial sensitivity.
- Proprioceptive deficits.
- Mild to severe depression.
- Inappetence.
Ref: Equine Vet. J. (2013); 45 (2) 240-244.
What is the prognosis for survival in horses following a natural outbreak of Cassia occidentalise poisoning?
- Mortality: 60%.
- Mares that survived recovered fully; pregnant mares did not abort.
Ref: Equine Vet. J. (2013); 45 (2) 240-244.
Describe the lesions found following post mortem of horses that have ingested Cassia occidentalis.
- Enhanced lobular pattern visible on capsular and cut surface of liver.
- Liver histology: centrolobular hepatocellular vacuolisation and necrosis with mild lymphocytic infiltration, hyperaemia and haemosiderosis.
- Brain histology: perivascular oedema; Alzheimer type II astrocytes.
Ref: Equine Vet. J. (2013); 45 (2) 240-244.
Hepatic encephalopathy is typified by clinical signs of forebrain disease. What alternate neurologic abnormalities have been reported as the presenting complaint in horses with HE?
- Ataxia, dysmetria, general proprioceptive deficits and UMN paresis with normal mentation/CN exam.
Ref: Equine Vet. Educ. (2011); 23 (1) 5-10.
What are the landmarks for ultrasound visualisation of the liver? What are the landmarks for percutaneous liver biopsy in the horse (for use when ultrasound is unavailable)?
- Ultrasound: 9th-16th R ICS, 9th-11th L ICS.
- Biopsy: 12th-14th R ICS ventral to a line drawn between the point of the elbow and the tuber coxae, directing the needle towards the opposite elbow joint and advancing the needle during expiration.
Ref: J. Am. Vet. Med. Assoc. (2014); 245 (8) 939-943.
What are potential complications of percutaneous liver biopsy in the horse?
- Biopsy of diaphragm, lung or intestines; enterocentesis; pneumothorax; haemorrhage into the peritoneal or thoracic cavity.
Ref: J. Am. Vet. Med. Assoc. (2014); 245 (8) 939-943.
In a study of 36 QH/QH cross horses, what percentage of horses:
- Had liver visible in all the 11th-14th R ICS?
- Had liver >3.5cm thickness in all the 11th-14th R ICS?
- Lung, intestines or both in the place of liver in an ICS of interest?
- 39%.
- 0%.
- 55%, 36%, 9%.
Ref: J. Am. Vet. Med. Assoc. (2014); 245 (8) 939-943.
Describe clinical signs and diagnostic test abnormalities in a case of hepatic abscess in a 4yo Arabian cross mare (Ref: J. Am. Vet. Med. Assoc. (2015) 247 (1) 98-105).
- PE: Intermittent colic and fever, tachycardia, tachynpnoea, icterus.
- U/S: irregularly marginated, hyperechoic walled region of heterogenous echogenicity in proximity to the L liver lobes.
- CBC: leukocytosis, mature neutrophilia, hyperfibrinogenaemia
- MBA: inc GLDH, TBili, SAA.
Ref: J. Am. Vet. Med. Assoc. (2015); 247 (1) 98-105.
If an encapsulated hepatic abscess does not respond to medical management what surgical procedures may be attempted under standing sedation to resolve the abscess?
- Percutaenous drainage and lavage of the abscess.
- Partial rib resection, abscess drainage, removal of necrotic hepatic tissue.
Ref: J. Am. Vet. Med. Assoc. (2015); 247 (1) 98-105.
Which spirochete was reported to cause suppurative cholangiohepatitis in a 3.5 month old foal in Pennsylvania presenting with lethargy and dermatitis and how was the diagnosis reached?
- Bartonella hensellae.
- CBC/Chem: mature neutrophilia, hyperfibrinogenaemia, inc GGT, SDH, TBili, BA concentrations.
- Liver u/s: enlarged, diffusely increased echogenicity.
- Histology: liver - neutrophils within hepatic zones forming micro abscesses; neut/lymph/plasma cells/spindle cells proliferation between hepatic cords; Warthog-starry stain –> pleomorphic, 3-7um long, curved, blunt spiral and beaded agyrophilic organisms; skin - photosensitisation.
- PCR on liver biopsy sample.
Ref: J. Vet. Intern. Med. (2014); 28 (4) 1341-1345.
Outline the treatment of Bartonella henselae cholangiohepatitis reported in a foal in a single case study.
- Antimicrobials: rifampin and TMPS for 4mo; GGT inc and PCR +ve on biopsy therefore swapped to minocycline for a further 3mo.
- SAMe.
- Pentoxyfylline.
Ref: J. Vet. Intern. Med. (2014); 28 (4) 1341-1345.
What modality can be used to identify a congenital port systemic shunt in a foal if liver ultrasound findings are WNL?
- Computed tomography angiography (pre and post-contrast scans).
- Ultrasound-guided percutaneous transplenic injection of agitated saline and simultaneous echo –> bubbles in RA/RV (bubbles should be absorbed by the liver parenchyma if no shunt is present).
- Biopsy: severe lobular atrophy characterised by dec distance b/w portal areas and central vv, marked arteriolar proliferation, dilated portal lymphatic and periportal sinusoids; findings consistent with portal v hypoperfusion.
Ref: J. Vet. Intern. Med. (2012;) 26 (1) 171-177.
What surgical techniques have been reported to successfully treat extra-hepatic congenital PSS in foals?
- Cellophane banding with titanium clips.
- Surgical ligation (risk of fatal portal hypertension or haemorrhage).
- Transvenous coil embolisation.
Ref: J. Vet. Intern. Med. (2012); 26 (1) 171-177.
In a review of horses with liver disease diagnosed by liver biopsy and serum biochemistry, what factors were associated with non-survival and what was their sensitivity and specificity (if available)?
- Serum bile acid concentrations > 20umol/L; Sp 78%, Se 63% for short-term survival; Sp 81%, Se 57% for long-term survival; NB serial testing may improve sensitivity.
- Histologic score >2; Sp 90%, Se 63% for short-term survival; Sp 96%, Se 64% for long-term survival.
- Hypoalbuminaemia, hyperglobulinaemia.
- Elevated fibrinogen and SAA concentrations.
Ref: J. Vet. Intern. Med. (2015); 29 (2) 644-650.
