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SA gastro > concepts of liver dz + canine and feline liver dz > Flashcards

concepts of liver dz + canine and feline liver dz Flashcards

1
Q

what % of the liver can be injured/ removed without evidence of dysfunction ?

A

75%

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2
Q

what is the most specific evidence for liver dz?

A

jaundice

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3
Q

general exam findings with liver dz

A
  • jaundice
  • low protein ascites <1.25 (portal hypertension 1-2.5; hypoalbuminemia 0-0.5)
  • high protein ascites >1.25 (r. heart failure; caval syndrome)
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4
Q

true / false

ascites is uncommon in a cat with liver dz

A

true

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5
Q

true/ false

cats get a copper colored iris with liver shunts

A

true

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6
Q

what is the first sign of liver dz

A

clin path abnormalities

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7
Q

do liver enzymes indicate function ?

A

NO

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8
Q

what liver enzymes indicate cell damage ?

A

ALT (cytoplasm, liver specific)
AST (cytoplasm and mitochondria; liver and muscles)
–> poor correlation between magnitude and severity of dz

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9
Q

what liver enzymes indicate cholestasis/drugs

A

ALP (bone, liver, steroid inducible in dogs; only 6hr half life in cat)
GGT (mostly liver)
–> both are membrane bound

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10
Q

what are some true liver function tests

A
  • ammonia

- serum bile acids (if already icteric there is NO reason to do it)

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11
Q

what are some pseudofunction liver tests

A
  • bilirubin
  • albumin
  • BUN (low suggests dysfunction)
  • cholesterol (decreased in liver dysfunction but increased in cholestatic dz)
  • glucose (gluconeogenesis, glycogen storage)
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12
Q

true / false

the cat has a higher renal threshold then the dog for bilirubin, so bilirubinuria in the cat is always significant

A

true

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13
Q

clinical signs of acute hepatitis

A
  • inappetance
  • lethargy
  • vomiting
  • abdominal pain
  • maybe icterus
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14
Q

acute hepatitis biochem

A
  • INCREASED ALT (magnitude depends on severity of damage)
  • ALP to a lower extend
  • bilirubin might join the party
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15
Q

true/ false

biopsy is commontly indicated for acute hepatitis dx

A

FALSE
rarely indicated/ useful
-dx is based on clinical findings

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16
Q

acute hepatitis tx

A

supportive
antiemetics
antioxidant therapy (silymarin, n-acetylcysteine

17
Q

what are the most common causes for extrahepatic bile duct obstruction in the dog and the cat

A

dog: pancreatitis
cat: neoplasia

18
Q

clinical signs of extrahepatic bile duct obstruction

A

inappetance, icterus, vomiting

19
Q

how to dx extrahepatic bile duct obstruction

A
  • increased ALP (usually higher then ALT)
  • icterus
  • UT
  • Confirm DX with laparotomy but might not be needed
20
Q

chronic hepatitis can be copper associates, what are some breeds that correlate with that

A

bedlington, doberman, westie, dalmation, lab

21
Q

biochem for chronic hepatitis

A
  • persistant increase in ALT and ALP ( ALT > ALP)
  • decreased: albumin, urea nitrogen, cholesterol
  • hyperbilirubinemia
  • abnormal bile acids
22
Q

how to dx chronic hepatitis

A 
BIOPSY 
can find: 
-mononuclear inflammation 
-single cell necrosis 
-bile duct hyperplasia (trying to repair) 
-fibrosis -> bridging 
RHODANINE STAIN if Copper
23
Q

chronic hepatitis Tx

A

immunosuppressive for cholestasis to improve

  • UDCA (synthetic hydrophilic bile)
  • anti oxidants
  • anti fibrotics
  • zinc if copper related, helps bing to the copper; chelation therapy
24
Q

what is the end stage of liver dz

A

cirrhosis

25
Q

hepatic encephalopathy signs

A

forebrain lesion signs

26
Q

hepatic encephalopahty tx

A
  • lactulose
  • antibiotics
  • restricted protein diet
27
Q

CPSS predisposed breeds, what they look like and signs

A
  • yorkies, schnauzers, maltese
  • HE signs
  • small for their age, young
  • PU/PD due to lack of urea production
  • urate stones
  • ptyalism
  • intra is more common in large dogs while extra is more common in small dogs
28
Q

CPSS lab diagnosis

A
  • biochem might be normal
  • ALT, AST, ALP, GGT might be normal or a little elevated
  • decreased albumin and urea
  • ammonium biurate crystals
  • microcytic anemia (50%)
  • LFT’s are abnormal
29
Q

CPSS dx

A

US: aortic to portal vein ratio, renomegaly, may even see shunt
CT angiogram
transplenic scintigraphy (not great)

30
Q

vacuolar hepatopathy lab results

A

ALP dramatically high

bilirubin is normal

31
Q

how to dx vacuolar hepatopathy

A

liver aspirate/ biopsy

32
Q

what is cholangitis

A

chronic feline inflammatory dz

33
Q

types of cholangitis and signs

A
  • neutrophilic (E.coli): anorexia, fever, vomiting, jaundice, +/- pain
  • Lymphocytic (immune): jaundice, ascites, weight loss, hepatomegaly
34
Q

cholangitis clin path

A

increased ALT, ALP, bilirubin
inflammatory leukogram
non-regenerative normochromic normocytic anemia
prolong clotting

35
Q

what is the best way to dx cholangitis

A

biopsy and culture both bile and tissue

36
Q

treating both types of cholangitis

A
  • neutrophilic: antibiotic (fluoroquinolone, metronidazole) + potentialted penicillin
  • lymphocytic: ped + vit. E + chlorambucil + ursodeoxychoic
37
Q

feline hepatic lipodosis biochem

A
  • dramatic ALP increase
  • mild increase in other liver enzymes
  • GGT is often normal or near normal

SA gastro (9 decks)

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