Clinical Manifestation and Screening of Liver Disease (Rudinsky In Class Feb 3rd) Flashcards
Definition:
A nervous system disorder brought on by severe liver disease
Hepatic Encephalopathy
Physical Examination:
- Ascites
- Jaundice
- Skin and mucous membranes
- bilirubinuria
- acholic feces
- Encephalopathy
- Hepatomegaly
- Dehydration
- Poor body condition
- Evidence of bleeding
This is …
Hepatobiliary Disease
What are the initial screening diagnostics for hepatobiliary disease?
- CBC
- Hemogram
- Leukogram
- Thrombogram - Biochemical Profile
- Urinalysis
Which of the initial screening diagnostics for hepatobiliary disease is the least specific?
CBC
- However, Anemia can develop (Blood loss or Chronic disease)
- And may give clues
From which of the initial screening diagnostics for hepatobiliary disease do we get the most utility?
Biochemical Profile
- Liver enzymes
When does an increase in liver enzymes get clinically significant?
> 2-3x normal
(T/F) Looking at liver enzymes activity tests for liver function
False, NOT liver function tests
Increased Liver Enzymes:
- Inflammation
- Necrosis
- Lipidosis
- Vacuolar hepatopathy
- Congestion
- Neoplasia
- Biliary Obstruction
These are …
1 degree liver Disease
Increased Liver Enzymes:
- Pancreatic disease
- Intestinal disease
- Endocrine disease
- Hyperthyroidism in cats
- Diabetes Mellitus
- Cushing’s disease
- Heart failure
- Sepsis & endotoxemia
- Others
These make …
Liver disease a secondary disease
List disorders with Increased ALT:
- Hepatic disease
- Hepatic necrosis
- hepatic inflammation (hepatitis)
- Hepatic hypoxia
- 2 to cholestasis
- Hepatocyte regeneration
- Enzyme induction (some drugs) - Skeletal muscle disorders (infrequent)
- Aspartate aminotransferase
- Hepatocyte cytoplasm and Mitochondria (leakage)
- Not liver-specific
- Muscle**, heart, brain, kidney
This is describing …
- Muscle**, heart, brain, kidney
Serum AST Activity
(T/F) If AST > ALT, consider muscle, severe necrosis (mitochondrial)
True
Mechanisms of Increased Activity: Liver enzymes
- It can be intrahepatic (in liver) or extrahepatic (out liver)
Cholestasis
- Alkaline phosphatase
- Many tissue sources/isoenzymes
- Cholestasis or drugs
ALP
- Dog serum ALP»_space;> cats (short t1/2)
- Corticosteroid-induced ALP
- Dogs (not cats)
- Hypercortisolism (endogenous or exogenous)
- Individual variation in severity
- “Steroid hepatopathy” in dogs
ALPCAP
Liver Enzymes
- Corticosteroids (dogs)
- Increased ALPCAP/Increased Total ALP
- Phenobarbital (dogs)
- Increased ALP (+/- ALPCAP; +/- ALT)
Drug Induction
How much (%) would you have to lose of your liver function for hypoglycemia to develop?
70% of liver function
Liver Disease:
- Liver failure
- Severity
- Mechanisms
- Impaired gluconeogenesis
- Dec glycogen stores
- Dec insulin degradation
- Poor prognosis
- Hepatic neoplasia
- Secrete insulin-like factors
This is describing …
Hypoglycemia
What is considered a. failure marker for liver disease?
Hypoglycemia
Altered Fat Metabolism
Increase serum cholesterol –>
Increased synthesis secondary to cholestasis
Altered Fat Metabolism
Decreased serum cholesterol –>
Decreased hepatic synthesis
(T/F) Albumin synthesized only in liver
True
List Bleeding disorders that can develop in liver patients:
- Decreased synthesis of clotting factors
- Marked inflammatory disease
- Vit K deficiency
- Fat-soluble vitamin
- If bile salts aren’t excreted, it can’t absorb fats
Liver Disease
What may you see in a urinalysis?
- Bilirubinuria
- Crystals
- NH4 biurate
- associated w/ shunts & liver failure
- Bilirubin
- marked cholestatic disease
Liver Function Tests:
What are the two primary methods?
- Serum bile acids
- Blood ammonia levels
- Liver function test
- Sensitive and specific
- Increase w/ all types of liver disease
- Hepatocellular dysfunction
- Cholestasis
- Portosystemic shunting
- No additional info gained when bilirubin already increased
- Fasting vs post-prandial SBA
Serum Bile Acids
- manipulating to see how well the liver is doing its job
When does the gallbladder contract?
After eating
Definition:
during or relating to the eating of food
Prandial
- Liver-specific function test
- Portosystemic shunting
- Severe hepatocellular dysfunction
- Urea cycle abnormality - Primarily an indicator of portosystemic shunting***
- Not as helpful as SBA for most hepatobiliary disorders
Blood Ammonia test
Drug definition:
An anticonvulsant that can prevent seizures in dogs
Phenobarbital
(T/F) The liver plays the single most important role in detoxification/clearance of many different substances: Drugs, toxins, hormones, metabolites
True
