Chapter 115- Hepatitis and cholangiohepatitis

Question 1

Any inflammatory infiltrate within the hepatic parenchyma

Answer 1

Hepatitis

Question 2

Extension of inflammation from the hepatic parenchyma to include the intrahepatic bile ducts

Answer 2

Cholangiohepatitis

Question 3

Acute hepatitis is characterized by what?

Answer 3

Inflammation, hepatocellular apoptosis, necrosis, +/- regeneration, LACK OF FIBROSIS

Question 4

Chronic hepatitis is characterized by what?

Answer 4

Presence of fibrosis, proliferation of ductular structures, regenerative nodules, PLUS inflammation, apoptosis +/- necrosis

Question 5

T/F: A short duration of clinical signs indicates acute disease

Answer 5

F- the liver has a large reserve capacity

Question 6

More likely acute or chronic hepatitis?

1. Abdominal pain-
2. Ascites-
3. Fever-
4. Hepatomegaly-

Answer 6

1. Abdominal pain- Acute
2. Ascites- Chronic
3. Fever- Acute
4. Hepatomegaly- Acute

Question 7

Why are hepatocytes especially susceptible to anoxia?

Answer 7

The liver receives a mixture of venous and arterial blood

Question 8

Experimental work in mice suggests that what plays a role in the initiation and perpetuation of hepatitis?

Answer 8

TNF-a

Question 9

TNF-a is produced secondary to what two co-stimulatory molecules on what types of cells?

Answer 9

CD154 on T-cells and CD40 on hepatocytes and Kupffer cells

Question 10

What does TNF-a do to the hepatocytes and how does it do it?

Answer 10

Stimulates apoptosis via the Fas-Fas ligand pathway

Question 11

What is the difference between acute and chronic neutrophilic cholangitis?

Answer 11

Edema and neutrophilic inflammation extend to the portal regions, mixed inflammatory infiltrate may be noted in the portal areas along with varying degrees of fibrosis and bile duct hyperplasia

Question 12

What are some common bacterial species found in cats with cholangitis?

Answer 12

E. coli, Enterococcus, Clostridium, Staph

Question 13

What are some sequelae of neutrophilic cholangitis?

Answer 13

Bile duct obstruction, acute necrotizing pancreatitis, sepsis, MODs

Question 14

Name some causes of bacterial cholangitis in dogs and cats (11-2, depending on your count).

Answer 14

1. Lepto
2. Bartonella
3. Tyzzers (C. piliforme)
4. Salmonella
5. Tularemia
6. Brucella
7. Yersina
8. Helicobacter
9. Mycobacteria
10. Septicemia
11. “Feline cholangitis complex”

Question 15

T/F: Lymphocytic cholangitis in cats is most likely an immune mediated disease.

Answer 15

T

Question 16

T/F: Canine chronic hepatitis is perpetuated by an immune mediated process.

Answer 16

T

Question 17

Name some breeds predisposed to chronic hepatitis (bonus points if you know if suspected/ proven copper associated hepatopathy) (10):

Answer 17

1. American cocker
2. Bedlington*
3. Dalmation*
4. Doberman*
5. English cocker
6. Springer
7. Lab*
8. Skye terrier*
9. Standard poodle
10. Westie *
    * Denotes copper associated hepatopathy

Question 18

What drug may delay progression of hepatic fibrosis.

Answer 18

Colchicine

Question 19

Name 2 drugs that may helped with elevated copper levels noted in a liver biopsy

Answer 19

D-penicillamine, trientine

Question 20

In what percentage of cases does Lepto cause liver involvement?

Answer 20

20-35%

Question 21

What 2 serovars of Lepto are more likely to cause hepatic involvement?

Answer 21

Icterohaemorrhagiae, Pomona

Question 22

What drug is used to specifically eliminate the leptospiremic stage?

Answer 22

Penicillin

Question 23

What drug is the antibiotic of choice for treatment of Bartonellosis?

Answer 23

Azithromycin

Question 24

How does SAMe work to support the liver?

Answer 24

It increases glutathione levels which may increase antioxidant and repair abilities