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LA DX & TX I > Final Exam - Equine Hepatic Disorders > Flashcards

Final Exam - Equine Hepatic Disorders Flashcards

1
Q

what are the functions of the equine liver?

A

synthesis of 90% of plasma proteins

gluconeogenesis

elimination of ammonia - urea cycle

carb/lipid metabolism

bile excretion

conjugation of bilirubin

detoxification

vitamin/mineral storage & synthesis mononuclear phagocyte system

fetal hematopoiesis

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2
Q

what are some examples of causes of focal to multifocal liver injury?

A

abscess, infarction, & neoplasia

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3
Q

what are some examples of causes of acute generalized liver injury?

A

infection, necrosis, inflammation, & toxins

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4
Q

what are some examples of causes of chronic generalized liver injury?

A

hypoxia, inflammation, cholangitis, neoplasia, & toxins

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5
Q

what is hepatic insufficiency? how much damage must occur for this to become apparent in horses?

A

inability of the liver to perform its normal functions

loss of > 80% hepatic mass - liver has tremendous reserve capacity

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6
Q

why may you not see signs of hepatic insufficiency in horses?

A

hepatic regeneration may parallel hepatic destruction

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7
Q

T/F: to see clinical signs associated with liver disease, there must be a loss of > 80% hepatic mass with signs being abrupt (acute on chronic)

A

true

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8
Q

what are the main clinical signs associated with hepatic disease in horses?

A

lethargy, anorexia, & weight loss

sometimes icterus

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9
Q

other than liver disease, what else can cause icterus in horses?

A

hemolysis & anorexia

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10
Q

what are some less common clinical signs of hepatic disease?

A

photosensitization, ascites, hemolysis

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11
Q

what is hepatic encephalopathy?

A

complex syndrome characterized by abnormal mental status that accompanies hepatic insufficiency, augmented neuronal inhibition, & is potentially reversible

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12
Q

what is the 2nd stage of hepatic encephalopathy seen in horses?

A

drowsiness/disorientation, lethargy/depression, head-pressing, ataxia/aimless walking, excessively yawning, & personality/behavior changes

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13
Q

what is the 3rd stage of hepatic encephalopathy?

A

somnolence/stupor, & episodes of uncontrolled aggressive behavior

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14
Q

what is the 4th stage of hepatic encephalopathy?

A

coma, rarely seizures, & death

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15
Q

what is the pathophysiology of hepatic encephalopathy?

A

gut derived neurotoxins - ammonia & mercaptans

false neurotransmitters - decrease branched-chain AA & increase aromatic AA

  1. augmented inhibitory gaba activity
  2. increased permeability of the blood brain barrier
  3. impaired CNS energy metabolism
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16
Q

what are your big tools for evaluating liver disease in horses?

A

history/physical exam - ultrasound/biopsy

evaluation of bilirubin

liver enzymes/liver function

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17
Q

what are your main liver function tests?

A

serum bile acids, ammonia, & coagulation panel

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18
Q

what is the most liver-specific enzyme in horses?

A

IDH

normal < 6 u/L - foals under 4 weeks will have higher normals

few hours for 1/2 life

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19
Q

why do we see increases of ALKP in horses?

A

induction - cholestasis, glucocorticoids, phenobarbitol

20
Q

why is ALKP normally elevated in foals?

A

osteoblastic activity

21
Q

T/F: ALKP is liver-specific

A

false - bone, intestine, kidney, placenta, & WBC

22
Q

elevations of ALKP in adult horses are likely caused by what?

A

cholestasis or chronic liver disease

23
Q

T/F: AST is sensitive for liver disease but not specific

A

true - remains elevated several days after the problem has resolved

24
Q

T/F: cholestasis can cause increased GGT

A

true

25
Q

where is GGT released from?

A

microsomal membranes of biliary epithelium

26
Q

T/F: GGT is liver-specific except for the pancreas

A

true

27
Q

GGT levels have a higher normal in foals or adult horses?

A

foals < 45 days

28
Q

what are the 5 isoenzymes of LDH? which one is an indicator of acute hepatocellular disease?

A

liver, muscle, RBC, intestine, & kidney

LDH-5

29
Q

T/F: ALT is useful for assessing liver disease in horses

A

false - not helpful

30
Q

an increase in ________ bilirubin suggests liver disease?

A

conjugated

31
Q

what defines hyperbilirubinemia?

A

> 5mg/dl

32
Q

what are some potential causes of hyperbilirubinemia?

A

hemolysis, anorexia, & hepatobiliary disease

33
Q

T/F: a serum bile acid concentration test is highly specific for liver disease & highly sensitive for detecting liver dysfunction

A

true

34
Q

why should you run a coagulation panel in a horse that you think may have liver disease?

A

the liver synthesizes coagulation factors - need to run prior to a biopsy

35
Q

where is the liver located on the right side of the horse?

A

just caudal & ventral to the lung field - may see normal hepatic atrophy in older horses

36
Q

where is the liver located on the left side of the animal?

A

cranial aspect of the abdomen just ventral to diaphragm & adjacent to the spleen

37
Q

what type of transducer should you use for a liver ultrasound? what frequency?

A

curvilinear probe - 3.5-5.0 frequency

38
Q

what will hepatic fibrosis look like on ultrasound?

A

hyperechoic liver

39
Q

should the liver be hypoechoic or hyperechoic compared to the spleen?

A

hypoechoic

40
Q

what is this?

A

starry sky liver - multifocal granulomas in horses

41
Q

is this liver normal? why?

A

no - hyperechoic to spleen

42
Q

what are the risks associated with a liver biopsy?

A

pulmonary hemorrhage, hepatic hemorrhage, pneumothorax, peritonitis (bile leakage/colon puncture)

ultrasound guided minimizes risks

43
Q

what is the goal of treating hepatic disease in horses?

A

support the patient until the liver regenerates - fluids/electrolytes, acid/base support, dextrose infusion (help decrease liver work load)

44
Q

how can you help reduce production & absorption of ammonia in a horse with hepatic disease?

A

mineral oil via NG tube, neomycin, & metronidazole, lactulose syrup to reduce colonic pH/ammonia trapping

45
Q

what does the dietary management of hepatic disease include for horses?

A

low protein, high carb, rich in branched chain amino acids - no alfalfa hay

46
Q

why avoid diazepam for a horse with hepatic encephalopathy?

A

liver metabolizes the drug - use xylazine instead

LA DX & TX I (45 decks)

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