CCM: 112, 113, hepatitis, cholangiohepatitis, liver failure

Question 1

What are the most common bacterial isolates in neutrophilic cholangitis?

Answer 1

E coli, Enterococcus spp. staphyloccous, clostridium

Question 2

Why do many dogs with chronic hepatitis have increased hepatic copper levels?

Answer 2

biliary excretion is the major mechanism for copper clearance and homeostasis

Question 3

What are the complications from excessive hepatic copper?

Answer 3

• oxidative stress
• cellular degeneration
• inflammation

Question 4

What is the treatment for chronic hepatitis with increased hepatic copper concentrations?

Answer 4

copper chelation with D-penicillamine
decreased copper in diet

Question 5

What are the clinical manifestations of leptospirosis infection?

Answer 5

AKI
hepatitis
Uveitis
pulmonary hemorrhage
acute fever

Question 6

How do the histopathologic lesions differ between acute liver disease and chronic liver disease?

Answer 6

acute - necrosis
chronic - fibrosis, inflammation, hyperplasia of ductular structures

Question 7

How much of the liver must typically lose function before signs of HE occur?

Answer 7

70%

Question 8

List compounds that exist in excess when liver function is impaired and that have been implicated in the pathogenesis of HE

Answer 8

• ammonia
• GABA
• aromatic amino acids
• glutamate
• endogenous benzos
• short-chain fatty acids
• tryptophan

Question 9

Euglycemia can be maintained with a functional liver mass loss of up to _____

Answer 9

75%

Question 10

Portal hypertension usually only occurs in chronic liver disease. What is the assumed pathogenesis of PH in acute liver failure?

Answer 10

sinusoidal collapse
thromboembolic disease

Question 11

Do dogs or cats with PSS develop jaundice?

Answer 11

not if congenital

Question 12

What are common hematologic abnormalities in dogs with acute liver failure?

Answer 12

anisocytosis, acanthocytes, target cells
anemia (nonreg. from chronic disease, reg. from blood loss)
thrombocytopenia
leukopenia/leukocytosis

Question 13

What organs besides the liver may release ALT?

Answer 13

muscle, red blood cells

Question 14

What organs besides the liver may release ALP?

Answer 14

bone, steroid-induced, leukocytes

Question 15

How do the specificity and sensitivity for cholestatic disease of ALP and GGT compare?

Answer 15

GGT is more specific but less sensitive

Question 16

What is the half-life of albumin?

Answer 16

8 days

Question 17

Why do dogs normally have small amouts of bilirubin in their urine?

Answer 17

renal tubular cells can produce, conjugate, and excrete bilirubin

Question 18

What are causes for hypokalemia in acute liver failure?

Answer 18

• anorexia, vomiting
• respiratory alkalosis - increases renal K excretion

Question 19

What is the presumed cause for hypophosphatemia in acute liver failure?

Answer 19

hypocapnea alkalosis - more P moves IC and is used for glucose phosphorylation - P used up

Question 20

What is Silymarin’s mechanism of action/effect?

Answer 20

anti-inflammatory
anti-oxidant
free radical scavenger
inhibits lipid peroxidation
increases hepatic glutathione content

Question 21

What is Ursodiol’s mechanism of action?

Answer 21

anti-inflammatory
increases choleresis
anti-fibrotic properties