Digestion & Metabolism 2: Feline Hepatic Dz Flashcards
CAUSES of…
- PRE-hepatic icterus?
- HEPATIC icterus?
- POST-hepatic icterus?
- PRE-hepatic icterus = HEMOLYSIS
- HEPATIC icterus = LIVER DYSFUNCTION
- POST-hepatic icterus = EXTRAHEPATIC BILE OBSTRUCTION
if an animal has a PORTOSYSTEMIC SHUNT & ICTERUS, what 2 clinical signs can we see?
- DYSURIA
- URATE UROLITHIASIS
6 main clinical signs of LIVER DISEASE in CATS?
- VOMITING
- D+
- HEPATIC ENCEPHALOPATHY
- PU/PD
- ABDOMINAL DISTENTION (hepatomegaly or ascites)
- DYSURIA
what 2 things can ABDOMINAL RADS tell you about the liver?
2 things?
1. the SIZE of the LIVER
- how/if it varies from normal based on the GASTRIC AXIS
= define the GASTRIC AXIS
= gastric acid should be on the plane PARALLEL to the RIBS and SHOULD NOT EXTEND BEYOND THE COSTAL ARCH
id SIZE of a certain organ…
HEPATOMEGALY
id SIZE of a certain organ…
MICROHEPATICA
for FELINE hepatic dz, what imaging modality is MOST helpful for LIVER?
this is (sensitive/specific), not (sensitive/specific)
LIVER ULTRASOUND MOST HELPFUL
this is SENSITIVE, not SPECIFIC
meaning that IF DZ IS THERE IT’S THERE, but if not could still be there
what KIND of biopsy do we usually perform on the liver?
often LAPAROSCOPIC biopsies because LESS INVASIVE but CAN STILL GET A GOOD CHUNK OF TISSUE
what is the MOST common LIVER DISEASE IN CATS?
HEPATIC LIPIDOSIS
HEPATIC LIPIDOSIS…
= definition?
____ cause is MORE COMMON
= pathophysiology
5 potential SECONDARY causes?
= HEPATOCELLULAR FAT ACCUMULATION following ANOREXIA or CONGENITAL
SECONDARY cause is MORE COMMON
pathophys?
–> IMBALANCE between MOBILIZATION OF PERIPHERAL FAT STORES to LIVER and METABOLISM of FAT WITHIN HEPATOCYTES for ENERGY
5 potential SECONDARY causes?
1. CHOLANGITIS
2. IBD
3. PANCREATITIS
4. NEOPLASIA
5. PYELONEPHRITIS
LIPOPROTEIN LIPASE…
OVERALL function is to do WHAT?
in WELL-FED animals…
in STARVED animals….
OVERALL function is to PROMOTE FAT UPTAKE & STORAGE
in WELL-FED animals = ACTIVE
in STARVED animals = DOWNREGULATED
HORMONE SENSITIVE LIPASE…
OVERALL function is to do WHAT?
stimulated by WHAT 3 hormones?
inhibited by WHAT?
what can PREVENT this INHIBITORY SYSTEM rom working?
OVERALL PROMOTES BREAKDOWN of TRIGLYCERIDE that’s STORED IN FAT for RELEASE OF FATTY ACIDS for ENERGY
stimulated by…
1. STRESS HORMONES
2. CATECHOLAMINES
3. THYROID HORMONE
inhibited by INSULIN
if an animal is MARKEDLY OBESE, can cause INSULIN RESISTANCE and CANNOT USE HORMONE-SENSITIVE LIPASE & CANNOT BREAK DOWN FAT
TRUE/FALSE
cats with hepatic lipidosis are ALWAYS overweight
FALSE
HEPATIC LIPIDOSIS…
4 common clinical signs?
2 signs in SEVERE disease?
what on CBC is most commonly ABNORMAL with this dz?
4 common signs?
1. anorexia
2. weight loss
3. lethargy/hiding
4. ICTERUS
2 signs in SEVERE disease?
1. HEPATIC ENCEPHALOPATHY
2. NEUROLOGIC SIGNS
on CBC = ALP ELEVATED
if we suspect HEPATIC ENCEPHALOPATHY secondary to ____ ____…
what clinical sign do we usually see first?
what diagnostic should we do?
HEPATIC ENCEPHALOPATHY secondary to HEPATIC LIPIDOSIS
usually see PTYALISM (excessive drooling)
should do AMMONIA level
2 diagnostics for HEPATIC LIPIDOSIS?
what is the PREFERRED definitive diagnostic test?
what ELSE can we use for diagnostics/what should we see? what situation might this be preferred for?
2 diagnostics?
1. ABDOMINAL RADS
–> HEPATOMEGALY
- ABDOMINAL US
–> ENLARGED, BRIGHT LIVER
–> also allows us to look for INTESTINAL or PANCREATIC dz that could’ve caused this
PREFERRED definitive diagnostic test? = LIVER BIOPSY
we can also perform CYTOLOGY and look for HEPATIC VACUOLES; might be better for UNSTABLE CASES
if we perform LIVER ASPIRATES (cytology) or BILE SAMPLES, what other diagnostic should we do/why?
ALWAYS CULTURE because MANY BACTERIALLY-INDUCED LIVER DISEASES IN CATS
should cats with HEPATIC LIPIDOSIS have PROTEIN-RESTRICTED diets?
NO, unless they have HEPATIC ENCEPHALOPATHY
HEPATIC LIPIDOSIS…
first, WHAT should we do for tx?
2 treatment options?
watch out for ____ syndrome
prognosis?
recovery time?
3 NEGATIVE prognostic indicators?
first, TREAT UNDERLYING DISEASE
2 treatment options?
1. IV FLUIDS until TOLERATING ORAL
2. ANTI-EMETICS
watch out for REFEEDING syndrome
prognosis is GUARDED, most tend to survive
recovery time = 4-6 WEEKS, PROLONGED
3 negative prognostic factors?
1. PANCREATITIS
2. COAGULOPATHY
3. HEPATIC ENCEPHALOPATHY
FELINE CHOLANGITIS can include inflammation of….
the LIVER
NEUTROPHILIC CHOLANGITIS
aka? (2 names)
what do we see on BIOPSY?
in CHRONIC cases, what 3 cells/type of inflammation can we see? what 2 pathologic processes?
aka ACUTE or SUPPURATIVE CHOLANGIOHEPATITIS
on BIOPSY = NEUTROPHILS within LUMEN or EPITHELIUM of BILE DUCTS
in CHRONIC cases, see these 3 cells…
1. NEUTROPHILS
2. LYMPHOCYTES
3. PLASMA CELLS
–> MIXED INFLAMMATION
in CHRONIC cases, see these 2 pathologic processes….
1. BILIARY HYPERPLASIA
2. FIBROSIS
NEUTROPHILIC CHOLANGITIS…
etiology?
diagnosis is mostly based on SUSPICION of 2 CBC findings: HIGH ___ ___ & ____
two findings on US?
DEFINITIVE diagnosis based on… (2)
cytology on the liver is…
etiology? = ASCENDING BACTERIAL INFECTION from GUT BACTERIA IN BILE DUCTS
diagnosis mostly based on SUSPICION of 2 CBC findings: HIGH LIVER ENZYMES & HYPERBILIRUBINEMIA
findings on US?
1. THICKENED bile ducts
2. THICKENED gallbladder
DEFINITIVE diagnosis based on LIVER BIOPSY & CULTURE
CYTOLOGY on the liver is NOT HELPFUL
lesion & dz!
THICKEND GALLBLADDER WALL
found in NEUTROPHILIC CHOLANGITIS
2 TREATMENTS for NEUTROPHILIC CHOLANGITIS?
prognosis?
- ANTIBIOTICS –> can do BROAD-SPECTRUM pending a culture result
- SYMPTOMATIC & SUPPORTIVE therapy
prognosis = GENERALLY GOOD
most of the bugs that cause NEUTROPHILIC CHOLANGITIS come from the ____ ____, so they have these 2 descriptors..
2 common examples?
come from the GI TRACT, so they are…
1. GRAM-NEGATIVE
2. ANAEROBE
2 common examples?
1. E. COLI
2. ENTEROCOCCUS
LYMPHOCYTIC CHOLANGITIS..
aka? (2 names)
can see ?? inflammation, so might see WHAT 2 cells?
if CHRONIC, can see WHAT TWO things on biopsy?
we can see WHAT kind of neoplasia that resembles this in the LIVER? what 2 things could we do to confirm NEOPLASIA?
CHRONIC or NON-SUPPURATIVE CHOLANGIOHEPATITIS
can see MIXED inflammation
1. EOSINOPHILS
2. PLASMA CELLS
if CHRONIC, can see…
1. VARIABLE BILIARY HYPERPLASIA
2. FIBROSIS
SMALL CELL LYMPHOMA resembles LYMPHOCYTIC CHOLANGITIS
–> can do IHC & PARR on the LIVER BIOPSY SAMPLE to confirm
LYMPHOCYTIC CHOLANGITIS…
etiology is UNKNOWN but LIKELY…
fever?
duration of illness is…
2 CBC findings?
we should perform WHAT 2 DIAGNOSTICS & why?
2 medications for treatment? what other therapy should be done?
prognosis generally…
LIKELY IMMUNE-MEDIATED
AFEBRILE
duration of illness is LONG
2 CBC?
1. HYPERBILIRUBINEMIA
2. INCREASED LIVER ENZYMES
we SHOULD perform LIVER BIOPSY & CULTURE bc many have BACTERIAL INFECTION
2 medications?
1. PREDNISOLONE
2. URSODIOL for ANTI-INFLAMMATORY effects
–> also DO SUPPORTIVE/SYMPTOMATIC therapy as needed
prognosis generally GOOD
MAST CELL TUMORS…
commonality in cats?
tend to involve WHAT organ?
look for what 2 signs?
what surgical treatment could be recommended/why?
prognosis range?
prognosis depends on what 2 things?
RARE in cats
tends to involve SPLEEN > LIVER
2 signs…
1. LIVER FAILURE
2. GASTRIC ULCERATION
Sx treatment?
1. SPLENECTOMY if SPLENIC INVOLVEMENT
prognosis is FAIR to POOR
prognosis depends on…
1. LOCATION
2. AGGRESSIVENESS
SOLITARY HEPATOILIARY NEOPLASIA…
commonly arises from…
most of the time, these are benign/malignant
but tumors arising from the ____ & ____ ____ are usually benign/malignant
commonly arises from INTRAHEPATIC BILE DUCTS
most of the time, these are BENIGN
but tumors arising from the GALLBLADDER and EXTRAHEPATIC DUCTS are usually MALIGNANT
HEPATOCELLULAR CARCINOMAS ARE ____ IN CATS
RARE
