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SA DX & TX II > Exam 3 - Feline Liver Disease > Flashcards

Exam 3 - Feline Liver Disease Flashcards

1
Q

what are the 5 most common hepatic diseases in cats?

A
  1. hepatic lipidosis - > 50% of feline hepatic disease
  2. feline cholangitis syndrome - 25% of feline hepatic disease
  3. lymphosarcoma
  4. feline infectious peritonitis
  5. reaction to a drug or toxin
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2
Q

how do you differentiate hepatocellular disease from biliary tract obstruction in a cat?

A

abdominal ultrasound

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3
Q

what is the classic history of a cat with hepatic lipidosis?

A

obese cat that stops eating & then becomes icteric

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4
Q

what is the pathophysiology of hepatic lipidosis in cats?

A

cat stops eating - starvation causes lipidosis by causing body fat to be mobilized

too much fat is mobilized, so there is more fat entering the hepatocytes than there is exiting & at the same time the fat is being broken down, less protein is being taken into the body due to anorexia

fat can’t get out of the liver because there is no protein to form lipoproteins

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5
Q

why are obese cats more at risk for hepatic lipidosis?

A

these cats can mobilize large amounts of fat very quickly

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6
Q

why is hepatic lipidosis a positive feedback loop?

A

cat can get sick from any cause & become anorexic

cat breaks down fat while simultaneously becoming deficient in protein

fat builds up in the liver & hepatic cytoplasm is replaced with fat

hepatic insufficiency develops & this hepatic disease causes anorexia

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7
Q

what are the classic clin path findings seen in hepatic lipidosis cats?

A

hyperbilirubinemia, increased ALP despite normal ALT

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8
Q

what further diagnostics are needed for a cat with a high ALP, hyperbilirubinemia, normal ALT, & normal GGT? why?

A

liver biopsy

FNA can easily miss other infiltrative hepatic diseases that could cause lipidosis - if an FNA only detects mild to modest amounts of fat in hepatocytes of a seriously ill cat/cat fails to respond to treatment

consider a more substantial liver biopsy

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9
Q

what treatment is absolutely necessary for a cat with hepatic lipidosis?

A

feeding tube!!!!! high protein/high energy dense diet & monitor for refeeding syndrome

appetite stimulants - can help prevent lipidosis but are poorly effective in patients with established clinical lipidosis

IV fluids - may have to supplement potassium & phosphorus

vitamin K

SAMe, vitamin E

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10
Q

what is the prognosis of hepatic lipidosis in cats?

A

20-30% mortality depending upon how sick the animal is upon admission

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11
Q

what are the two types of feline cholangitis syndrome?

A

due to ascending infection - neutrophilic cholangitis

immune-mediated disease - lymphocytic cholangitis

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12
Q

what are the classic clin path findings seen in feline cholangitis syndrome?

A

increased ALT, ALP, & bilirubin

finding a major increase in ALT is classic for cholangitis but isn’t reliable for distinguishing cholangitis from lipidosis however increased GGT is more common in cholangitis

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13
Q

how do you make a definitive diagnosis for feline cholangitis syndrome?

A

usually need a hepatic biopsy & culture/cytology on bile

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14
Q

what supportive therapy is used for treating both types of feline cholangitis syndrome patients?

A

ursodeoxycholic acid, vitamin E, & SAMe

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15
Q

what treatment is indicated for neutrophilic cholangitis in cats?

A

ANTIBIOTICS!!!! amoxicillin, ampicillin, cefazolin, cefadroxil, or enrofloxacin

need to use something that kills both aerobes & anaerobes

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16
Q

what treatment is indicated for lymphocytic cholangitis in cats?

A

prednisolone at 1-2 mg/kg/day, ursodeoxycholic acid, & SAMe - don’t send home too many meds

chlorambucil may be useful in cats that don’t respond to pred

NO AZATHIOPRINE!!!

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17
Q

what drugs are known to be hepatotoxic to cats?

A

azathioprine

oral diazepam

aspirin

voriconazole

acetaminophen

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18
Q

what causes FIP?

A

mutated feline coronavirus

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19
Q

what clinical signs are seen in cats with FIP?

A

fever, CNS signs, ocular lesions

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20
Q

how is FIP diagnosed?

A

history, physical exam, hyperglobulinemia, thrombocytopenia, may see ALT/ALP, & may see jaundice

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21
Q

T/F: cats with FIP always have effusions

A

false

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22
Q

what disease is a major cause of CNS signs in cats under 5-8 years of age?

A

feline infectious peritonitis

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23
Q

_________ lesions, especially uveitis, can be suggestive of FIP

A

ocular

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24
Q

T/F: FeLV status is not useful in diagnosing or eliminating lymphoma in cats

A

true

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25
Q

what lab abnormalities may be seen in a cat with hepatic lymphoma?

A

normal or increased ALT and/or ALP

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26
Q

what are some pre-hepatic causes of icterus in cats?

A

causing hemolysis

secondary IMHA - mycoplasma, FeLV, cytauxzoon, lymphoma
primary IMHA - uncommon
non-immune mediated - heinz bodies, hypophosphatemia

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27
Q

what pathology is seen on this blood smear?

A

heinz bodies

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28
Q

what are some hepatic causes of icterus in cats?

A

cholangitis

hepatic lipidosis

neoplasia - lymphoma, biliary carcinoma, biliary cystadenoma

FIP

toxins - acetaminophen, diazepam, phenols, & tetracycline

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29
Q

what are 6 examples of post-hepatic causes of icterus in cats?

A
  1. cholecystitis
  2. pancreatitis
  3. biliary carcinoma/cystadenoma
  4. liver flukes
  5. biliary rupture
  6. cholelithiasis
30
Q

what are the 4 most common causes of icterus in cats?

A
  1. feline hepatic lipidosis
  2. cholangitis
  3. hemolytic anemia
  4. feline infectious peritonitis
31
Q

what is the first question you should consider when presented with an icteric cat?

A

is the cat anemic or not!

32
Q

is there a steroid induced ALP in the cat?

A

no

33
Q

are minor increases in ALP/ALT in cats clinically significant?

A

YES!!!

the magnitude of liver enzyme increases in cats is less than dogs & extrahepatic disease can cause secondary increases in ALT/ALP activity

34
Q

what 4 body organs/systems are you checking for abnormalities in an abdominal ultrasound in an icteric cat?

A
  1. hepatobiliary
  2. pancreatic
  3. gastric
  4. intestinal
35
Q

what happens when there is triglyceride accumulation in the liver of cats?

A

intrahepatic cholestasis

icterus

vitamin K deficiency

36
Q

what are the risk factors for hepatic lipidosis?

A

obese cats

periods of anorexia - protein/calorie malnutrition

underlying disease

37
Q

what is the most common underlying disease in cats with hepatic lipidosis?

A

IBD

38
Q

what is the typical signalment of cats with hepatic lipidosis?

A

middle aged cats

no breed or sex predilection

39
Q

what is the minimum age of cats with hepatic lipidosis? median? max?

A

minimum - 6 months

median - 7 years old

max - 20 years old

40
Q

what signs are seen on physical exam of cats with hepatic lipidosis?

A

icterus - 70% of cats

overweight/obese cats

weakness - cervical ventroflexion & plantigrade stance

ptyalism

rare - signs of hepatic encephalopathy

vomiting/diarrhea

41
Q

what may be seen on urinalysis of a cat with hepatic lpidosis?

A

bilirubinuria

lipiduria

42
Q

what is seen on hematology of a cat with hepatic lipidosis?

A

non-regenerative anemia - heinz bodies & poikilocytosis

mild lymphopenia & neutrophilia

inflammatory leukogram suggests that there is an underlying inflammatory disorder

43
Q

what is seen on abdominal ultrasound of a cat with hepatic lipidosis?

A

enlarged hyperechoic liver

changes can occur in obese or diabetic cats

useful for diagnosing underlying diseases

44
Q

how is a presumptive diagnosis made for hepatic lipidosis?

A

FNA showing lipid type vacuolation of the liver

alongside clinical signs, lab tests, & imaging

45
Q

what is required to make a definitive diagnosis of hepatic lipidosis in cats?

A

biopsy for histology!

46
Q

what electrolytes are you worried about in a cat with hepatic lipidosis?

A

hypokalemia - can lead to muscle weakness

hypophosphatemia - can lead to hemolysis

hypomagnesemia - can lead to muscle weakness

47
Q

what makes up the initial supportive care for a cat with hepatic lipidosis?

A

IV fluids - account for dehydration, ongoing loss, & maintenance requirements

electrolyte correction

vitamin K

n-acetylecysteine

anti-emetics - maropitant or ondansetron

48
Q

what is the maintenance fluid rate used for cats in this class?

A

40 ml/kg/day

49
Q

what is Kmax?

A

0.5 mEq/kg/hr

50
Q

how is nutrition approached in cats with hepatic lipidosis?

A

correction of protein is crucial!!! it is the most important of the macronutrients - feed a calorie dense food

aim to feed 30-40% of metabolizable energy as protein

give vitamin K first & place a feeding tube - need to avoid syringe feeding

51
Q

why give a cat with hepatic lipidosis antioxidants?

A

oxidative damage plays an important role in feline hepatic lipidosis - beneficial

52
Q

how is cobalamin supplemented for cats with hepatic lipidosis?

A

given when serum levels are <400 ng/L

give cyanocobalamin - 250 ug SQ once weekly for 6 weeks & then once monthly

also can be used as an appetite stimulant

53
Q

why is l-carnitine used for cats with hepatic lipidosis?

A

shuttles the fatty acids to the mitochondrial matrix & increases hepatic utilization of fatty acids during weight loss

250 mg/cat PO every 24 hours

54
Q

what are some negative prognostic factors for cats with hepatic lipidosis?

A

anemia, hypokalemia, & incurable underlying disease

55
Q

T/F: cats can make a complete recovery with early & aggressive treatment

A

true

56
Q

what is feline cholangitis? what are the 3 types seen clinically?

A

inflammation centered around the biliary tract with expansion into the parenchyma

  1. neutrophilic
  2. lymphocytic
  3. liver-fluke associated
57
Q

why do we believe cats to be more sensitive to developing cholangitis/pancreatitis?

A

they have a shared duct between the pancreatic duct & bile duct entering the duodenum

58
Q

what clinical signs are associated with neutrophilic cholangitis?

A

acute onset of illness - pyrexia, anorexia, vomiting, icterus

59
Q

what clinical signs are associated with lymphocytic cholangitis?

A

chronic signs - lethargy/hyporexia that can wax & wane or be progressive

60
Q

what signs are seen upon physical exam of a cat with cholangitis?

A

dehydration, icterus, pyrexia, cranial abdominal pain, & emaciation

61
Q

what clin path abnormalities are seen in cats with cholangitis?

A

increased liver enzymes

hyperbilirubinemia

hyperglobulinemia

hypoalbuminemia

62
Q

what is seen on hematology that is supportive of cholangitis in a cat?

A

neutrophilia - +/- a left shift, but less common with lymphocytic cholangitis

non-regenerative anemia

thrombocytopenia

63
Q

what is seen on abdominal ultrasound of a cat with cholangitis?

A

findings consistent with inflammatory disease

hepatomegaly, bile duct dilation, & choleliths

64
Q

how is a cholecystocentesis done?

A

use a right-sided transhepatic approach - get an FNA of the bile & look for the presence of bacteria & neutrophilic inflammation

65
Q

what are some examples of different ways a liver biopsy can be performed?

A

needle biopsy

laparotomy

laparoscopy

66
Q

how long do you treat a cat with antimicrobials for neutrophilic cholangitis?

A

4-6 weeks

67
Q

what do you do for treatment if you have a cat with neutrophilic cholangitis that has a negative culture & doesn’t respond to antibiotics?

A

prednisolone!!!

68
Q

what is triaditis?

A

syndrome encompassing concurrent inflammation of the liver, pancreas, & small intestines

69
Q

how is RER calculated?

A

(30 X BWkg) + 70

70 X (body weight in kg ^0.75)

70
Q

how is a feeding plan used for a cat with hepatic disease?

A

only feed 25% of RER on the first day & increase to 100% over 3-4 days dividing the daily ration into 4 meals fed over 10-15 minutes

71
Q

T/F: cats commonly get combinations of chronic enteropathy, pancreatitis, & inflammatory liver disease

A

true

72
Q

T/F: failure of a cat to respond well to prednisolone does not rule out small cell lymphoma

A

true

SA DX & TX II (62 decks)

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