Digestion & Metabolism 2: Canine Hepatic Dz Flashcards
what 2 MAIN breeds are PREDISPOSED for HEPATIC DZ?
- WEST HIGHLAND TERRIER
- SKYE TERRIER
CHRONIC hepatitis…
LIKELY etiology?
signalment?
diagnosis tends to be made through… + 2 others
LIKELY etiology = IMMUNE-MEDIATED
signalment = MIDDLE-AGED FEMALES
diagnosis = tends to be from BLOODWORK with LIVER ENZYME ABNORMALITIES, +…
1. ULTRASOUND
2. BIOPSY
in EARLY CHRONIC HEPATITIS, on ABDOMINAL US, expect liver to be _____/_____ & in LATE CHRONIC HEPATITIS, expect liver to be _____/_____
HYPERECHOIC/LARGE, HYPOECHOIC/SMALL
what 2 biopsy findings should we expect in CHRONIC hepatitis?
- INFLAMMATION (lymphocytic, plasmacytic)
- HEPATOCELLULAR APOPTOSIS or NECROSIS
TREATMENT for CHRONIC HEPATITIS…
overall, aims to do what?
2 examples?
why is it important to determine if ANY treatment is necessary?
overall = AIMED AT MODULATING INFLAMMATION through IMMUNOSUPPRESSANTS
2 examples?
1. CORTICOSTEROIDS
2. CYCLOSPORINE
important to know if ANY tx necessary because STEROIDS CAN SOMETIMES CAUSE WORSE SIDE EFFECTS THAN DISEASE ITSELF
overall, prognosis for CHRONIC HEPATITIS IS ____
but once HEPATIC ____ present, then prognosis becomes ____, can see this on bloodwork….
once ____ develops, the prognosis becomes _____
VARIABLE, so many ranges of CHRONIC HEPATITIS
once HEPATIC FAILURE present, then prognosis becomes GUARDED –> can see DECREASED LIVER FUNCTIONAL PARAMETERS (ABC GLUCOSE)
once CIRRHOSIS (END-STAGE LIVER DZ) develops, prognosis becomes GRAVE
ALT/AST vs. ABC GLUCOSE?
ALT/AST = LIVER DAMAGE ENZYMES, TELL YOU NOTHING ABOUT LIVER FUNCTION
ABC GLUCOSE = LIVER FUNCTIONAL PARAMETERS
many breeds that develop CHRONIC HEPATITIS are also at risk of developing WHAT?
give 3 of these breeds
also at risk of developing INCREASED HEPATIC COPPER
3 breeds?
1. BEDLINGTON TERRIER
2. WESTIE
3. SKYE TERRIER
BEDLINGTON COPPER STORAGE DZ…
origin/pathophysiology? (3)
in CERTAIN BREED, presence of INCREASED HEPATIC COPPER leads to ____ ____
origin?
1. inherited as an AUTOSOMAL RECESSIVE trait in BEDLINGTON TERRIERS
- protein that NORMALLY excretes COPPER INTO BILE NO LONGER WORKS, so COPPER STAYS IN HEPATOCYTES
- causes INFLAMMATION, NECROSIS, FIBROSIS
in BEDLINGTON TERRIERS, INCREASED HEPATIC COPPER leads to development of CHRONIC HEPATITIS
2 diagnostics for INCREASED COPPER in CHRONIC HEPATITIS?
what do we expect to SEE in both?
- LIVER BIOPSY
–> findings consistent with CHRONIC HEPATITIS
–> COPPER STAINING primarily around CENTRILOBULAR REGION (around central vein) - COPPER QUANTIFICATION
–> copper >1,000 ug/g DRY WEIGHT
2 treatment options for INCREASED COPPER in CHRONIC HEPATITIS?
when is each treatment INDICATED?
- LOW COPPER DIET
–> indicated when HEPATIC COPPER > 600 ug/g DRY WEIGHT - COPPER CHELATION via D-PENICILLAMINE that BINDS COPPER so it can be EXCRETED
–> indicated when HEPATIC COPPER > 1,000 ug/g DRY WEIGHT
CHOLANGITIS/CHOLANGIOHEPATITIS….
____ > ____
usually has a ____ component to the inflammation
what is the first and second MOST COMMON BACTERIAL causes?
2 treatments?
when is Sx indicated?
CATS > DOGS
usually has NEUTROPHILIC inflammation
bacterial causes?
1. E. COLI MOST COMMON
2. ENTEROCOCCUS second common
3 treatments?
1. ANTIBIOTICS
2. SUPPORTIVE THERAPY
Sx indicated if BILE DUCT OBSTRUCTED
CIRRHOSIS….
= definition
4 common causes?
on BLOODWORK, can see.. (2)
= END-STAGE condition resulting from ANY HEPATIC INSULT
3 common causes?
1. PORTAL HYPERTENSION
2. ASCITES
3. GASTRIC ULCERS
4. ACQUIRED PORTOSYSTEMIC SHUNTS
on BLOODWORK…
1. LIVER ENZYMES = NORMAL or HIGH
2. LIVER FUNCTION ABNORMALITIES = LOW ABC GLUCOSE
CIRRHOSIS…
2 BIOPSY findings?
treatment? (2)
prognosis?
BIOPSY findings…
1. DIFFUSE FIBROSIS
2. REGENERATIVE NODULES
treatment?
1. SUPPORTIVE THERAPY, not much you can do
2. ANTIFIBROTICS to help SLOW PROGRESSION of FIBROSIS
–> COLCHICINE
–> GCCs
prognosis = GENERALLY POOR
what should we keep in mind about HEPATIC SUPPORTIVE THERAPY?
typically safe w/ minimal side effects, but WE DO NOT HAVE EVIDENCE OF THEIR BENEFIT
URSODIOL
= what does it do?
INCREASES the FLOW OF BILE ACIDS to help PREVENT TOXIC BUILD-UP in LATE LIVER DZ
S-ADENOSYLMETHIONINE (SAMe)
2 indications?
generates ___ which helps play a role in protecting ____ against ____ injury
also has ____-____ effects
2 indications?
1. HEPATIC LIPIDOSIS
2. HEPATOTOXICITY
generates GLUTATHIONE which helps play a role in protecting HEPATOCYTES against TOXIC injury
also has ANTI-INFLAMMATORY effects
MILK THISTLE…
what is the active ingredient?
4 functions?
what POPULAR medication for liver dz is it in?
active ingredient = SILYMARIN or SILYBIN
4 functions?
1. ANTIOXIDANT
2. CHOLERETIC
3. ANTI-INFLAMMATORY
4. PROTECTION AGAINST MUSHROOM TOXICITY
often used in DENAMARIN
75-80% of LIVER BLOOD SUPPLY is from the ___ ____, which contains _____ blood from….
20-25% of LIVER BLOOD SUPPLY is from the ____ ____ which contains _____ blood from…
75-80% = PORTAL VEIN, drains DEOXYGENATED blood from ALL INTRA-ABDOMINAL ORGANS
20-25% = HEPATIC ARTERY, contains OXYGENATED blood from SYSTEMIC ARTERIAL SYSTEM
hepatic veins drain into the…
CAUDAL VENA CAVA
describe the 3 types of PORTAL HYPERTENSION
- PRE-HEPATIC = something causing hypertension BEFORE portal vein
–> PORTAL VEIN THROMBUS
–> MASS causing COMPRESSION - HEPATIC = LIVER DZ that causes INCREASED RESISTANCE TO BLOOD FLOW
–> usually CHRONIC HEPATITIS causing FIBROSIS & increased VASCULAR RESISTANCE - POST-HEPATIC = from a lesion that causes INCREASED PRESSURE in CAUDAL VENA CAVA
–> CHF
–> CAVAL SYNDROME
when there’s both ASCITES & PROTAL HYPERTENSION, what type of fluid is present? (2)
- TRANSUDATE
- MODIFIED TRANSUDATE
3 possible clinical manifestations of PORTAL HYPERTENSION?
- ASCITES
- GASTRODUODENAL ULCERATION/EROSION
- HEPATIC ENCEPHALOPATHY
3 treatment options for dogs with ASCITES? + which MEDICATION is best for hepatitis?
what LIVER DZ is this usually associated with?
3 treatments?
1. DIETARY SALT RESTRICTION
2. DIURETICS –> SPIRONOLACTONE BEST
3. ABDOMINOCENTESIS for animals with SEVERE ABDOMINAL DISTENTION/DIFFICULTY BREATHING
usually associated with PORTAL HYPERTENSION
HEPATIC ENCEPHALOPATHY…
usually patients with this have SIGNS of… because of….
has a ____ pathogenesis, with ____ being the MOST SIGNIFICANT REASON
usually have SIGNS of BILATERAL CEREBRAL CORTICAL DYSFUNCTION because of CIRCULATING SUBSTANCES THAT SHOULD BE METABOLIZED BY THE LIVER
usually because of AMMONIA, often need to treat HYPERAMMONEMIA
what is the TREATMENT of HEPATIC ENCEPHALOPATHY centered around?
what are 2 examples of this treatment? which one is more common?
centered around treating HYPERAMMONEMIA
2 examples?
1. REDUCE DIETARY PROTEIN, can use DAIRY or VEGETABLE source
2. PREVENT GI HEMORRHAGE (ulcers, erosions, etc.) bc that could PRODUCE AMMONIA
PREVENTION of FORMATION & ABSORPTION of AMMONIA via what 2 drugs?
give 2 examples for first
- ANTIBIOTICS to KILL BACTERIA THAT MAKE THE AMMONIA
–> NEOMYCIN or METRONIDAZOLE - LACTULOSE
–> can be an ENEMA
–> can be ORAL to PREVENT ABSORPTION OF AMMONIA
LACTULOSE…
METABOLIZED BY ___ ___ into ____ ____
helps to INCREASE ____ in ____ and causes the formation of ____+, which….
also helps increase….
what DISEASE can it be used to treat? (1 secondary dz, 1 primary dz)
LACTULOSE
METABOLIZED BY COLONIC BACTERIA to ORGANIC ACIDS
helps to INCREASE ACID in COLON causing formation of AMMONIUM ION (NH4+), which CANNOT BE ABSORBED ACROSS GI EPITHELIUM
also helps increase INTESTINAL TRANSIT TIME, less time for BACTERIA TO MAKE AMMONIA
can be used to treat HYPERAMMONEMIA caused by HEPATIC ENCEPHALOPATHY
SUPERFICIAL NECROLYTIC DERMATITIS…
aka? (2 names)
causes ___ disease
can be caused by WHAT medication?
what BREED can get this primarily?
3 skin lesions?
see WHAT on biopsy?
aka = HEPATOCUTANEOUS SYNDROME or ACHES
causes LIVER disease
can be caused by PHENOBARBITAL
SHIH TZUs can get this congenitally
3 skin lesions?
1. crusts
2. erosions
3. ulcers
see HYPERKERATOSIS on BIOPSY
SUPERFICIAL NECROLYTIC DERMATITIS…
treatment options? (2)
prognosis?
MST?
treatment options?
1. AMINO ACID INFUSIONS
2. HIGH PROTEIN, HOME-COOKED DIET
prognosis is GUARDED
MST = 1 YEAR
what is the MOST common PRIMARY liver neoplasia?
HEPATOCELLULAR CARCINOMA
HEPATOCELLULAR CARCINOMA…
solitary vs. diffuse?
age of patients?
clinical signs are usually ___-___
diagnosis (3, which one is DEFINITIVE)
treatment?
prognosis for SOLITARY vs. DIFFUSE?
SOLITARY > DIFFUSE
patients tend to be OLD
clinical signs are usually NON-SPECIFIC
diagnosis?
1. US
2. RADS
3. BIOPSY for CONFIRMATION
prognosis for…
–> SOLITARY = GOOD if no metastasis
–> DIFFUSE = POOR
HEPATIC LYMPHOMA…
usually a ____ cell ____ lymphoma
this is usually…
this can be a component of ____ lymphoma, putting the disease at stage ____, or it can be ____ in the liver
we can make a PRESUMPTIVE diagnosis based on… (2)
DEFINITIVE diagnosis? (2, which one tends to be SUFFICIENT)
prognosis for the TWO TYPES?
usually a LARGE cell LYMPHOBLASTIC lymphoma
this is usually INFILTRATIVE
this can be a component of MULTICENTRIC lymphoma, putting the disease at stage FOUR, or it can be PRIMARY in the liver
PRESUMPTIVE diagnosis?
1. ABNORMAL US FINDINGS
2. INCREASED LIVER ENZYMES on CBC
DEFINITIVE diagnosis?
1. CYTOLOGY usually sufficient
2. BIOPSY
prognosis for…
1. PRIMARY = POOR, MST 2 MONTHS
2. MULTICENTRIC = FAIR, MST 1 YEAR
NON-SPECIFIC REACTIVE HEPATOPATHY…
see WHAT kind of inflammation? (2)
LACK of what 4 things?
associated with ____-____ disease, often ___ in origin
causes ____ in liver ____
inflammation?
1. MIXED inflammatory population
2. PORTAL INFLAMMATION
LACK of…
1. NECROSIS
2. APOPTOSIS
3. FIBROSIS
4. REMODELING
associated with EXTRA-HEPATIC dz, usually GI
causes INCREASE (mild) in LIVER ENZYMES
