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Sem 6: SAM 2 > Biliary Diseases > Flashcards

Biliary Diseases Flashcards

1
Q

How does the gallbladder in cats differ from dogs?

A

Cats have 1 entry into duodenum, CBD joins pancreatic duct prior to the major duodenal papilla

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2
Q

What enzymes on biochemistry are most indicative of cholestasis?

A

- Increased ALKP > ALT
- Increased GGT in cats

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3
Q

What are causes of intrahepatic cholestasis?

A
  • Hepatocellular swelling (Ex: Hepatic lipidosis, corticosteroid hepatopathy in dogs)
  • Inflammation or neoplasia around portal area and biliary tree
  • Solid tumors
  • Fibrosis around biliary tree
  • Bile sludge
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4
Q

What are causes of extrahepatic cholestasis?

A
  • Tumors in pancreas, duodenum, biliary tract
  • Pancreatitis
  • Choleliths
  • Parasites
  • Mucocoeles
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5
Q

How does cholestasis affect absorption from the GI tract?

A
  • Causes malabsorption of fat-soluble vitamins (A,D,E,K)
  • Malabsorption of Vitamin K leads to decreased Factor II, VII, IX, X, Protein C and S)
  • Risk of prolonged PT and coagulopathies
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6
Q

List clinical signs of extra hepatic cholestasis

A
  • Jaundice
  • Anorexia
  • Vomiting
  • Abdominal pain
  • White acholic feces or lack of urine pigment
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7
Q

What diseases have an increased incidence in patients with gall bladder mucocoele?

A
  • Hyperadrenocorticism
  • HypoT
  • Hyperlipidemia
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8
Q

What is the treatment of choice for gall bladder mucoceles?

A
  • Cholecystectomy has best long term results
  • Medical management is a reasonable alternative
  • Emergency sx if gall bladder rupture!
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9
Q

How can a gall bladder mucocele be medically managed?

A
  • Low fat diet
  • Ursodiol
  • Antibiotics ONLY IF evidence of infection
  • Treat underlying cause
  • Monitor ultrasounds
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10
Q

What is the doctor term for a bacterial infection of bile?

A

Cholecystitis

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11
Q

What bloodwork changes can be seen with cholecystitis?

A
  • Increased ALP, GGT, ALT, and Bilirubin + inflammatory leukogram with or without left shift

(bacterial infection of bile)

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12
Q

How is cholecystitis diagnosed?

A

Cholecystocentesis (bile sample)

Contraindicated if gall bladder mucocele!!

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13
Q

When is a Cholecystocentesis (bile FNA sample) contraindicated?

A

Contraindicated if gall bladder mucocele!!

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14
Q

What is the most common cause of cholecystitis?

A
  • Haematogenous > ascending bacterial infection
  • E. coli, Enterococcus, Bacteroides, Clostridium
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15
Q

What is the treatment protocol for cholecystitis?

A

Antibiotics for 4-6 weeks based on C&S from FNA

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16
Q

How do patients with cholecystitis typically present?

A
  • Sometimes asymptomatic or intermittent signs, difficult to diagnose
  • V/D, anorexia, ABD discomfort, jaundice, pyrexic if severe
17
Q

List risk factors for cholecystitis

A
  • Choleliths
  • Extra hepatic biliary obstructions
  • Hepatic neoplasia
  • Congenital abnormalities
  • Pancreatitis and IBD esp in cats
  • Pre existing hepatitis
18
Q

What are secondary consequences to cholecystoliths?

A
  • Bile obstruction
  • Rupture
  • Inflammation
  • Infection
19
Q

What is the recommended treatment protocol for patients with cholecystoliths?

A
  • Most require surgical removal
  • Ursodiol if non-obstructive small stones
  • Antibiotics
20
Q

What is cholangitis vs cholecystits?

A
  • Cholangitis is inflammation of the bile ducts
  • Cholecystitis is inflammation of the gallbladder
21
Q

What are the different forms of cholangitis seen in cats?

A

- Neutrophilic (most common)
- Lymphocytic
- Sclerosing, associated with liver flukes

22
Q

What is the most common cause of neutrophilic cholangitis in cats?

A
  • Ascending bacT infection within bile ducts (e. coli, enterococcus, clostridium, etc)
  • Rarely protozoal infections (toxoplasma, coccidiosis)
23
Q

How do cats with neutrophilic cholangitis typically present?

A
  • Acute CS most commonly
  • Only 30-40% are pyrexic
  • V/D
  • Jaundice
  • ABD pain
  • Hepatomegaly
  • Ptyalism
  • Often concurrent pancreatitis and/or IBD (triaditis)

(Presents like acute extrahepatic cholestasis)

24
Q

How is feline neutrophilic cholangitis diagnosed?

A
  • Cholecystocentesis (FNA gall bladder) to ID bacteria
  • Biopsy for definitive diagnosis, but only recommended if FNA culture comes back negative

(Can see false negatives with FNA)

25
Q

What is the treatment protocol for feline neutrophilic cholangitis?

A
  • Amoxi Clav +/- metronidazole pending C&S
  • Ursodiol
  • Denamarin
  • Cholecystectomy if refractory to tx
26
Q

What causes feline lymphocytic cholangitis?

A

Immune mediated bile duct inflammation, bacteria postulated as a trigger to IR

27
Q

What CS can be seen with lymphocytic cholangitis in cats?

A
  • BAR unlike neutrophilic cholangitis
  • Anorexia, weight loss
  • Vomiting
  • PU/PD
  • Ascites
    Pyrexia is uncommon

(make sure to differentiate between neutrophilic and lymphocytic)

28
Q

How is lymphocytic cholangitis in cats diagnosed?

A
  • Increased BA and liver enzymes
  • Hypergammaglobinemia (most consistent finding)
  • High protein and globulins from Ab tap, non degen neuts + small lymphocytes (mimics FIP)
  • Lymphocytic inflammation on biopsy (Ddx: lymphoma)
29
Q

What is the recommended treatment protocol for feline lymphocytic cholangitis?

A
  • Immunosuppressives: Pred, Chlorambucil, Cyclosporine
  • Ursodiol

(Abx not recommended unless bile culture is positive)

30
Q

What is the treatment protocol for feline sclerosing cholangitis?

A
  • Praziquantel
  • Ursodiol
  • Abxs if concurrent neutrophilic cholangitis
  • Poor px if surgery required
31
Q

What causes feline sclerosing cholangitis?

A
  • Liver flukes
32
Q

How can cats with sclerosing cholangitis present?

A
  • Asymp to liver failure
  • V/D
  • Acute disease may present like extrahepatic bile duct obstruction
  • Poor BCS
  • Jaundice
  • Hepatomegaly
  • ABD pain
  • Ascites

Female, free roaming, > 2 years

33
Q

How is feline sclerosing cholangitis diagnosed?

A
  • Fecal float > sediment
  • Bile cytology

Sem 6: SAM 2 (34 decks)

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