Canine And Feline Liver Disease

Question 1

What are the causes of acute hepatitis?

Answer 1

Toxins, infections, drugs, idiopathic

• causes focal or diffuse hepatocellular damage

Question 2

How do you diagnose hepatitis?

Answer 2

• Based on clinical findings, biopsy rarely indicated/useful
• marked incr in ALT
• ALP incr but much lower than ALT
• bilirubin may be incr

Question 3

How do you treat acute hepatitis?

Answer 3

• Supportive - fluids, glucose, anti-emetics, antioxidant therapy (N-acetylcysteine, silymarin)

Question 4

What are the causes of chronic hepatitis in the dog?

Answer 4

• drug-induced
• copper-associated
• familial (breed) related
• often idiopathic (may be immune mediated)

Question 5

What are the breed tendencies for chronic hepatitis in dogs?

Answer 5

Copper-associated:

• Beldlington
• Dobies
• Westies
• Dalmatian
• Labs

Question 6

How do you diagnose and manage chronic hepatitis?

Answer 6

• Dx: Biopsy
  
  • inflammation (typically mononuclear), necrosis (single cell), bile duct hyperplasia, +/- fibrosis —> bridging
  • use a rhodanine stain for Cu associated, look for centrilobular distribution
• Tx: immunosuppressive tx, UDCA, anti-oxidants, anti-fibrotics?

Question 7

What are the causes of extrahepatic biliary duct obstruction?

Answer 7

Impairment of bile flow in the biliary system b/t liver and duodenum

• Dog: pancreatitis (common), GB mucocele
• Cat: neoplasia (common), liver flukes (FL)

Question 8

What are the forms of cholangitis in the cat?

Answer 8

• Neutrophilic
  
  • anorexia, fever, vomiting, jaundice, +/- abd pain, chronic dz milder
• Lymphocytic
  
  • in Persians; jaundice, ascites, wt loss, hepatomegaly

Question 9

What are the causes of cholangitis in the cat?

Answer 9

• Neutrophilic is caused by ascending infections; e.g. E. coli
• Lymphocytic: immune-mediated, triaditis

Question 10

How do you treat cholangitis in the cat?

Answer 10

• general supportive tx, depends on biopsy result
• neutrophilic
  
  • fluoroquinolone and metronidazole
  • potentiated penicillin - clavamox

Question 11

What is the cause of feline hepatic lipidosis?

Answer 11

• obesity
• dz-induced wt change
  
  • FLUTD, pancreatitis, stress, boarding, wt reduction
• rapid wt loss in short time
• decr caloric intake
  
  • neg nitrogen balance

Question 12

How do you diagnose and treat feline hepatic lipidosis?

Answer 12

• Dx: hx of anorexia, fat cat with muscle wasting, incr SAP with normal GGT
• Tx: tx underlying cause, nutritional support - force feed, NE, E, G tubes, high protein diet, vitamins, appetite stimulants (oxazepram, cyproheptadine, mirtazapine), antiemetics and prokinetics (cisapride, maropitant), carnitine, taurine, Silymarin

Question 13

What are the forms and breed predispositions for portosystemic shunts?

Answer 13

• Congenital PSS: Dogs frequently young (<1yr), small for age, less active and ‘don’t do well’
• Breeds: Yorkies, min schnauzers, maltese, Irish wolfhound; also seen in cats

Question 14

What is the clinical presentation for PSS and hepatic encephalopathy?

Answer 14

• HE: Behavior changes, learning difficulties, head pressing, blindness, pacing, seizures
• CPSS: PU/PD, ammonium biurate stones, ptyalism, small stature, copper irises (cats)

Question 15

How do you diagnose and treat hepatic encephalopathy?

Answer 15

• Dx: presence of liver dysfunction: bile acids, ammonia, known liver dz
• Tx: lactulose, abx (neomycin, amoxicillin), restricted protein diet

Question 16

The most common cause of increased liver enzymes is what?

Answer 16

extrahepatic disease

Question 17

How do you treat PSS?

Answer 17

• Dx:
  
  • abd US (aortic to portal vein ratios, renomegaly, may visualize shunt), CT angiogram, transplenic scintigraphy
• Tx:
  
  • medical - restricted protein, high quality diet, lactulose, +/- neomycin, amoxicillin
  • sx ligation of shunt - ameroid constrictor, cellophane banding, interventional