Digestion & Metabolism 2: Equine Hepatic Dz Flashcards
equine liver is predominantly on WHAT side of the horse? (give a fraction)
has HOW many lobes?
mostly on the RIGHT SIDE, 3/5
has 3 LOBES (right, middle, left)
3 NORMAL functions of the liver?
3 functions?
1. METABOLISM
2. EXCRETION
3. IMMUNE FUNCTION
hepatic INSUFFICIENCY usually shows _____ clinical signs because..
we see failure of _____ to _____ in HEPATIC INSUFFICIENCY
NO clinical signs until 80% of LIVER AFFECTED because REGENERATIVE, but once we DO see clinical signs, LIKELY HEPATIC FAILURE
we see failure of BILIRUBIN to CONJUGATE (be taken up) in HEPATIC INSUFFICIENCY
TWO SPECIFIC signs of liver disease & why we see them
- ICTERUS
–> from INCREASE in BILIRUBIN from HEMOLYSIS - ANOREXIA
–> EATING is VERY IMPORTANT for CONJUGATION/UPTAKE of BILIRUBIN, but if we have TOO MUCH then WANT TO NOT EAT
CHOLESTASIS…
= definition?
often see REDUCED _____ of ____, leading to…
= REDUCED EXCRETION by the BILE DUCTS
often see REDUCED EXCRETION of BILIRUBIN, leading to RESORPTION into the PLASMA
HEPATIC ENCEPHALOPATHY…
often see INCREASED ____
–> what OTHER disease PRESENTS WITH THIS
–> occurs due to….
liver disease can also increase PERMEABILITY of…
clinical signs are ____ & tend to be ____, including…
AMMONIA
–> other disease is INTESTINAL HYPERAMMONEMIA
–> occurs due to LIVER failure to EXCRETE AMMONIA
can INCREASE permeability of BLOOD BRAIN BARRIER
clinical signs are VARIABLE & tend to be NEUROLOGIC, including…
1. YAWNING
2. INCREDIBLY DULL
3. HEAD-PRESSING
4. ATAXIA
5. SEIZURES
PHOTOSENSITIZATION…
this can be a CLINICAL manifestation of ____ ____
commonality?
pathophys? (three)
most common in ____ regions of the body
clinical manifestation of LIVER DISEASE
UNCOMMON
pathophys?
1. due to CHLOROPHYLL in plants/grass getting digested into PHYLLOERYTHRIN that is NORMALLY CONJUGATED IN THE LIVER
- but when LIVER is diseased, it ACCUMULATES IN SKIN
- when skin is EXPOSED TO LIGHT, REACTION occurs and FREE RADICALS AND ENERGY PRODUCED
most common in NON-PIGMENTED regions of the skin
if we see FEVER with HEPATIC DZ, can be what 5 diseases?
- NEOPLASIA = from CHRONIC condition causing CYTOKINE RELEASE
- ACUTE HEPATITIS
- CHRONIC ACTIVE HEPATITIS
- HEPATIC ABSCESS
- OBSTRUCTIVE CHOLELITHLIASIS (gallbladder stones)
3 reasons we can see D+ in LIVER dz?
is D+ a COMMON clinical sign for liver dz?
- PORTAL HYPERTENSION
- ALTERED GI MICROFLORA from ANOREXIA
- ABNORMAL BILE METABOLISM
NOT a common presentation of liver dz
2 reasons we can see COLIC with liver dz?
- BILIARY OBSTRUCTION
- HEPATOCELLULAR SWELLING from INFLAMMATION
4 overall GI signs we can see with HEPATIC DZ?
- D+
- COLIC
- TENESMUS
- STEATORRHEA
5 common clinical signs with HEPATIC DZ?
(put here bc not necessarily in the same category)
which one is RARE in horses?
which one is COMMON IN PONIES?
which one is usually in CHRONIC cases?
- WEIGHT LOSS, especially in CHRONIC cases
- PHARYNGEAL/LARYNGEAL COLLAPSE (common in PONIES)
- HEMORRHAGE
- HEMOLYSIS
- PRURITUS (RARE in horses)
LIVER on US in horse…
mostly tilted to WHAT direction?
where do we stand & how should we hold PROBE to see liver?
what does liver look like?
what lies RIGHT NEXT to it that we might see? why this important for BIOPSY?
mostly tilted to the RIGHT
usually go on RIGHT SIDE between 8th & 11th ICS
HYPOECHOIC with HYPERECHOIC FLECKS
right NEXT to it = LUNG, so need to BE CAREFUL TO NOT PUNCTURE IT WHEN DOING BIOPSY
three reasons why do we do US-guided PERCUTANEOUS BIOPSY of LIVER in horses?
how many biopsies do we usually perform?
- to determine ETIOLOGY in ACUTE cases (VIRAL testing)
- to determine PROGNOSIS in CHRONIC cases
- CULTURE tissue for BACTERIA
we usually perform AT LEAST 3 BIOPSY SAMPLES
if we see an ABNORMAL COAGULATION PROFILE…
this DOES NOT PUT HORSE AT A HIGH RISK FOR BLEEDING
when is PERCUTANEOUS LIVER BIOPSY CONTRAINDICATED? why?
if there’s a LIVER ABSCESS because it could cause RUPTURE
2 POOR prognostic indicators for LIVER DZ IN HORSES…
2 GOOD prognostic indicators for LIVER DZ IN HORSES…
POOR indicators…
1. MARKED, BRIDGING FIBROSIS
2. PA TOXICOSIS
GOOD indicators…
1. SURVIVAL 5 DAYS AFTER ACUTE INSULT
2. serial DECREASE GGT & bile acids
8 possible CAUSES of liver DZ in horses?
- IDIOPATHIC INFLAMMATORY
- INFECTIOUS (bacterial or viral)
- TOXIC (plants, drugs, blood transfusion)
- METABOLIC LIPIDOSIS
- OBSTRUCTIVE (RDC displacement, choleliths)
- NEOPLASTIC
- VASCULAR (portosystemic shunts, portal thrombosis)
- PARASITIC
CHRONIC ACTIVE HEPATITIS…
USUALLY considered ___ ____ _____
whatever the INSULT was is ____, but ____ ____ continues to cause ____ or it’s a ____ syndrome
3 potential causes?
USUALLY considered IDIOPATHIC PROGRESSIVE HEPATOPATHY
whatever the INSULT was is GONE, but IMMUNE SYSTEM continues to cause DAMAGE or it’s a HYPERSENSITIVITY syndrome
3 potential causes?
1. CHOLANGIOHEPATITIS
2. TOXIN
3. another INFECTIOUS agent that caused it
CHRONIC ACTIVE HEPATITIS…
three diagnostics we usually perform?
what CBC finding do we usually have?
does this usually give us an answer as to what we’re looking for?
2 treatments?
three diagnostics? = liver BIOPSY, HISTOPATH & CULTURE
CBC finding = ELEVATED LIVER ENZYMES (especially GGT)
usually TELLS US NOTHING
2 treatments?
1. SUPPORTIVE CARE
2. CORTICOSTEROIDS
ACUTE HEPATITIS…
3 alternative names?
USUALLY caused by…
a possible INFECTIOUS cause? but horses often
3 names?
1. THEILER’S DZ
2. SERUM SICKNESS
3. IDIOPATHIC ACUTE HEPATIC DZ
USUALLY caused by a COMPLICATION of EQUINE-ORIGIN BLOOD PRODUCT (plasma, serum or antitoxin)
possible infectious cause = EQUINE PARVOVIRUS-HEPATITIS, but NOT ALL ANIMALS HAVE CLINICAL DZ
ACUTE hepatitis…
6 common clinical signs?
treatment?
prognosis? (include if they have a certain DZ)
clinical signs?
1. DEPRESSION
2. JAUNDICE
3. INAPPETENCE
4. YAWNING
5. PHOTOSENSITIVITY
5. HEPATIC ENCEPHALOPATHY
treatment = SUPPORTIVE CARE
prognosis is POOR but GRAVE if NEUROLOGICAL SIGNS PRESENT (hepatic encephalopathy)
VIRAL HEPATITIS…
can be caused by WHAT 2 viruses?
how are they DIAGNOSED?
can be caused by…
1. EQUINE PARVOVIRUS
2. EQUINE HEPACIVIRUS
diagnosis? = INTERPRET PCR with HISTOLOGY & PROGRESSION
EQUINE PARVOVIRUS..
can cause ___ ___ hepatitis
can cause what 2 kinds of damage? does this always happen?
can cause ACUTE VIRAL hepatitis
can cause…
1. LYMPHOCYTIC INFLAMMATION
2. NECROSIS
–> but THIS DOESN’T ALWAUS HAPPEN
EQUINE HEPACIVIRUS…
can cause ___ ___ hepatitis
MOST animals infected with this will have ____ infection, and the rest will have a ____ infection that can lead to these 4 clinical signs…
can cause ACUTE VIRAL HEPATITIS
MOST have SUBCLINICAL/MILD HEPATITIS, but the rest then have PERSISTENT infection (–> CHRONIC LIVER DZ) that can lead to…
1. FIBROSIS
2. LYMPHOCYTIC INFLAMAMTION
3. NECROSIS
4. POLYCYTHEMIA
CHOLELITHIASIS/CHOLEDOCHOLITHIASIS & CHOLANGIOHEPATITIS…
= definition of first 2 terms?
can be an ____ finding
often causes what 2 diseases?
= PRECIPITATION or AGGREGATION of NORMALLY SOLUBLE COMPONENTS OF BILE either in the GALLBLADDER or COMMON BILE DUCT causing LIVER & BILE DUCT INFLAMMATION
can be an INCIDENTAL finding
often causes…
1. BILIARY STASIS
2. ASCENDING BILIARY INFECTION
CHOLELITHIASIS/CHOLEDOCHOLITHIASIS & CHOLANGIOHEPATITIS…
6 clinical signs? + group 3 together!
- RECURRENT COLIC (g)
- INTERMITTENT FEVER (g)
- ICTERUS (g)
- HEPATIC ENCEPHALOPATHY
- WEIGHT LOSS
- PHOTOSENSITIZATION
CHOLELITHIASIS/CHOLEDOCHOLITHIASIS & CHOLANGIOHEPATITIS…
what is the DEFINITIVE diagnostic method?
ABDOMINAL US!
what are 3 effective ANTIBIOTICS for CHOLANGIOHEPATITIS?
these antibiotics are often given ____-____ until ____ is normal, so treat BEYOND…
- ENROFLOXACIN
- METRONIDAZOLE
- TMS + METRONIDAZOLE
often given LONG-TERM until GGT is NORMAL, so treat BEYOND resolution of CLINICAL SIGNS
CHOLANGIOHEPATITIS TREATMENTS? (6, give what they do for all but 2)
- ANTIBIOTICS
- NSAIDs
- FLUID THERAPY (to help increase bile flow in ACUTE phases)
- UROSIOL (makes bile more liquid-y)
- DMSO (dissolves stones)
- PENTOXIFYLLINE (anti-fibrotic)
TYZZER’S DZ…
caused by WHAT bacteria?
commonality?
causes ____ ____
what AGE/ANIMAL do we see it in?
exact pathogenesis is _____, yet…
caused by CLOSTRIDIUM PILIFORME
UNCOMMON
causes ACUTE HEPATITIS
common in FOALS 1-6 WEEKS
exact pathogenesis is UNKNOWN, but HIGH PROTEIN DIETS IN MARES CAN cause PROLIFERATION OF C. PILIFORME in their own GIT and FOALS’ COPROPHAGY
TYZZER’S DZ…
clinical signs? (4)
diagnosis via… & 2 findings?
prognosis? w/ HIGH likelihood…
clinical signs?
1. DEPRESSION
2. ANOREXIA
3. COLIC
4. SEIZURES
diagnosis via NECROPSY…
1. COAGULATIVE NECROSIS
2. can see INTRACYTOPLASMIC BACILLI w/ SILVER STAIN
prognosis = GRAVE, w/ HIGH likelihood of MORTALITY
EQUINE HERPESVIRUS-1…
can cause ___ in mares, or….
usually causes ____ ____
can cause ABORTION in mares, or FOALS ARE BORN VERY SICK with ACUTE HEPATITIS
usually causes ACUTE HEPATITIS
HEPATIC LIPIDOSIS in HORSES
more common in what 3 breeds? why?
ANY reason these breeds go ___ ___ will cause HEPATIC LIPIDOSIS, so they should ALL be given ____ ____
3 clinical signs? (third is two +/-)
3 breeds?
1. PONIES
2. DONKEYS
3. MINIATURE HORSES
–> prone to STORING FAT WELL
ANY reason these breeds go OFF FEED will cause HEPATIC LIPIDOSIS, so they should ALL be given NUTRITIONAL SUPPORT
3 clinical signs?
1. DEPRESSION
2. ANOREXIA
3. +/- ICTERUS/COLIC
HEPATIC LIPIDOSIS in HORSES….
diagnosis? (3 markers & what they are defined as)
we should always run ____ on these animals
diagnosis?
1. HYPERLIPIDEMIA = TRIGLYCERIDES <500 mg/dL
2. HYPERLIPEMIA = TRIGLYCERIDES >500 mg/dL
3. VARIABLE increases in SDH, GGT, liver function
we should always run TRIGLYCERIDES on these animals
FOUR TREATMENTS for HEPATIC LIPIDOSIS…
list what they are & WHY
- TREAT UNDERLYING DZ
- NUTRITIONAL SUPPORT (dextrose in IV fluids, enteral feeding, parenteral if necessary)
- INSULIN to DECREASE mobilization of PERIPHERAL FAT
- HEPARIN to INCREASE peripheral utilization of TRIGLYCERIDES
PYRROLIZIDINE ALKALOID TOXICITY…
horses are generally ___ likely to ingest these, but will if….
pathogenesis? (3)
what finding is PATHOGNOMONIC?
treatment?
prognosis?
generally LESS likely to ingest these, but WILL IF NOTHING ELSE IS AROUND
pathogenesis?
1. ALKALOIDS from plant are METABOLIZED IN LIVER to TOXIC PYRROLS
2. PYRROLS CROSSLINK HEPATOCYTE DNA & INHIBIT MITOSIS
3. cross-linked DNA causes CELL DEATH & NECROSIS
BIOPSY is PATHOGNOMONIC
treatment NOT USUALLY EFFECTIVE
prognosis POOR
AFLATOXICOSIS…
caused by WHAT genus/species & food?
pathogenesis? (4)
what 2 diseases can it cause?
diagnosis?
caused by ASPERGILLUS FLAVUS & MOLDY CORN
pathogenesis?
1. DROUGHT or INSECTS damage corn
2. followed by WARM, HUMID conditions
3. the MYCOTOXIN in corn is DIGESTED INTO TOXIC METABOLITES
4. metabolites have LIVER as a TARGET ORGAN
what 2 diseases?
1. CHRONIC or ACUTE LIVER DZ
2. ENCEPHALOMALACIA
diagnosis = DETECTION IN FEED
