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SAM 2 scs RUSVM > Final: Liver and Pancreas > Flashcards

Final: Liver and Pancreas Flashcards

1
Q

What are the 5 functions of the liver?

A

Metabolic

Excretory

Synthetic

Storage

Detoxification

(MESS’D)

*Stressed in class*

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2
Q

The ________ delivers oxygenated blood into sinusoids of the liver.

The __________ delivers deoxygenated, nutrient-rich blood from GIT to sinusoids of the liver.

A

Hepatic artery (25% of total blood)

Hepatic Portal vein (75% of total blood)

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3
Q

What is responsible for the absorption and digestion of fat and fat soluble vitamins (A, E, D, K)?

A

Bile acids

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4
Q

What happens to cholesterol blood levels when the bile duct is obstructed?

A

They increase

(Bile is the major elimination route)

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5
Q

T/F: Anything that affects the blood flow from the hepatic artery or the hepatic portal vein (anemia, shock, heart failure, etc), can affect liver enzyme values.

A

True

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6
Q

Which zone of the liver is most prone to hepatotoxins? Which is most prone to hypoxia?

A

Zone 1 (Area of portal triads)

Zone 3 (Area around central vein)

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7
Q

Where in the liver is plasma filtered?

A

Space of Disse (between hepatocytes and endothelial cells)

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8
Q

Biliary System:

Intrahepatic ducts -> ______ bile duct -> cystic duct -> ________

A

Common bile

Gallbladder

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9
Q

What cells located in sinusoids scavange bacteria and other foreign material in the liver?

A

Kupffer cells

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10
Q

At what serum bilirubin level is bilirubinemia clinically detectable?

A

>2.0 mg/dl

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11
Q

T/F: Bilirubinuria is always abnormal in the cat.

A

True

*Stressed in class*

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12
Q

Severe pancreatitis causing bile duct obstruction is what type of icterus (preheptatic, posthepatic, hepatic)?

A

Posthepatic

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13
Q

Acute cholangitis is what type of icterus (preheptatic, posthepatic, hepatic)?

A

Hepatic

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14
Q

What type of icterus (preheptatic, posthepatic, hepatic) is characterized by increased production of bilirubin with cholestasis? What are your main rule outs?

A

Prehepatic

R/O: Parasites, agglutination (Make blood smear), IMHA (Do Coomb’s test), FeLV

PCV usually <20%, regenerative hemolytic anemia, enzymes WNL or mildly elevated

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15
Q

What type of icterus (preheptatic, posthepatic, hepatic) is defined as impaired hepatic uptake, conjugation or excretion of bilirubin resulting in severe intrahepatic cholestasis? What are your main rule-outs?

A

Hepatic

R/O: Lipidosis, inflammatory hepatopathyies, extrahepatic infections (Toxoplasia, FIP), acetaminophen (toxins)

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16
Q

An increase of ____ times the upper reference range indicates mild elevation, it is moderate if it is ____ times the upper reference range, and marked if ____ times the upper reference range.

A

<5

5-10

>10

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17
Q

Match liver enzyme to liver site:

Hepatocyte membrane integrity

Hepatocyte or biliary epithelial necrosis

Cholestasis

Induction phenomenon (dogs)

ALT, AST, ALP, GGT

A

Hepatocyte membrane integrity and Hepatocyte or biliary epithelial necrosis: ALT, AST

Cholestasis and Induction phenomenon (dog): ALP, GGT

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18
Q

What does ALP do when you administer steroids? What other drug does this to liver enzymes?

A

Increases

Phenobarbitol

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19
Q

What crystals can occur due to any cause of decreased hepatic function, including shunts and organ failure?

A

Ammonium biurate urinary crystals

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20
Q

What endocrine diseases cause elevated liver enzymes?

A

Hyperadrenocorticism (Cushing’s)

Hyperthyroid

Hypothyroid

Diabetes mellitus

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21
Q

Hypoglycemia only occurs after approximately ___% of hepatic function is lost. It is the result of reduction in hepatic ______ stores, gluconeogenesis, and clearance of _____.

A

75

Glycogen

Insulin

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22
Q

Bile acids are useful to diagnose what in dogs and cats?

A

PSS - dogs and cats

Cirrhosis- dogs

Value limited for screening of most other hepatobiliary diseases

*Stressed on slides/in lecture*

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23
Q

What diagnostic modality has the highest correlation with actual liver weight in dogs (include patient positioning)?

A

Right lateral abdominal rads

*Starred on slides*

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24
Q

What can be used to determine liver size as well as for diagnosing hepatic mass lesins and PSS?

A

CT

*Starred on slides*

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25
Q

What is the best way to biospy a liver (according to Dr. Settles)?

A

Laparoscopic biopsy

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26
Q

What are the 3 most common causes of hepatic infections?

A

Leptospirosis (dogs)

Tick-bourne infections

Heartworm

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27
Q

T/F: The biliary system is predominatly affected in cats while the parenchyma of the liver is the primary target of liver disease in dogs.

A

True

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28
Q

T/F: Substantial weight loss is a predisposing factor for hepatic lipidosis in cats.

A

True (>25% of body weight)

29
Q

Which liver enzyme is usually the highest in cats with hepatic lipidosis?

A

ALP (more than GGT or ALT)

30
Q

Which 2 cell types are abundant in the periportal area with inflammatory liver disease?

A

Lymphocytes

Neutrophils

31
Q

What are the 2 causes of “Steroid” vacuolar hepatopathy?

A

Iatrogenic steriods

Cushing’s disease

32
Q

What element can accumulate in the liver with any cause of liver inflammation?

A

Copper

33
Q

What does portal vein hypoplasia (PVH) without portal hypertension indicate? Do you usually treat this?

A

Microvascular dysplasia

Usually no treatment needed

34
Q

T/F: In the dog, the pancreatic duct fuses with the bile duct before the opening on the major duodenal papilla. 20% of dogs also have an accessory pancreatic duct.

A

FALSE, cats not dogs

35
Q

Each pancreatic lobule is composed of ____ cells, which synthesized and store digestive enzymes, and a branching duct system, as well as endocrine ______ cells.

A

Acinar

Langerhans

36
Q

Which enzyme produced by the pancreas is cleared by gomerular filtration, when increased indicates renal disease especially in cats?

A

Amylase

37
Q

Which of these ezymes digest protein? Carbs? Fat?

Amylase

Trypsin/Chemotrypsin

Lipases

Carboxypeptidase

A

Protein: Trypsin/Chemotrypsin, Carboxypeptidase

Carbs: Amylase

Fat: Lipases (incl. cholesterol lipase and phospholipase

38
Q

Enzymes sythesized by the pancreas are stored and secreted as inactive ______.

A

Zymogens

39
Q

What develops when there is digestive enzyme activation and resultant pancreatic autodigestion?

A

Pancreatitis

40
Q

Injury to which cell type leads to autodigestion of the pancreas?

A

Acinar cells

41
Q

What are the principal mediators of pancreatic enzyme secretion?

A

Cholecystokinin

Acetylcholine

42
Q

What is the most important plasma protease inhibitor consumed when there is acute pancreatitis?

A

Alpha Macroglobulin

43
Q

What are the clinical features of dogs with pancreatitis? Cats?

A

Dogs: Anorexia, Vomiting, Weakness, Abdominal pain, Dehydration, Diarrhea

Cats: Anorexia, Lethargy, other vague non-specific signs

44
Q

Why may you see bilirubin elevation in a cat with pancreatits?

A

Inflammation of pancreas causing common bile duct obstruction

45
Q

T/F: Cats with spontaneous pancreatitis do not get elevated lipase.

A

True

46
Q

What is the test for pancreatitis that uses pancreas-specific enzymes, may be increased with renal insufficiency and emaciation, and may not be evelated with severe cases?

A

Trypsin-like Immunoreactivity (TLI)

47
Q

What is the most sensitive test for pancreatitis? Is the test better for dogs or cats?

A

Pancreatic Lipase Immunoreactivity (PLI)

Better for dogs

48
Q

What is the test of choice for EPI?

A

TLI

49
Q

Spec cPL (PLI) concentrations are significantly higher in dogs with which condition?

A

Hyperadrenocorticism (Cushing’s)

50
Q

T/F: Dogs with pancreatitis should be fed whenever possible. The diet should be ultra low in protein and if the patient is inappetent a feeding tube should be placed.

A

False, ultra low in FAT (otherwise statement is correct)

51
Q

What can you do if your pancreatitis patient is consistently vomiting even with aggressive antiemetic therapy but you need to provide nutritonal support?

A

Jejunostomy tube

52
Q

What is your treatment plan for a cat with pancreatitis who is dehydrated, hypokalemic, hypoglucemic, hypoalbuminemic, and acidemic? You have ruled out autoimmune pancreatitis.

A

IVF + KCl + Dextrose + Bicarb (aggressive fluid therapy)

Ticarcillin/clav and/or Enrofloxacin (if this was a dog, prob no ABs)

Corticosteroids (Prednosolone)

Plasma

Ranitidine (or Famotidine, Omeprazole)

Cerenia (or Maropitant, Metoclopramide, Ondansetron)

Analgesia

53
Q

What are 2 agents that modify free radical scavengers and may stabilize lysosomal and other membranes?

A

Selenium

Omega 3 Fatty Acids

54
Q

How many times ober normal must amylase/lipase be, in conjunction with other findings, for a diagnosis of pancreatitis?

A

3-5 times

55
Q

How does the diet for a pancreatitis cat differ from the diet of a pancreatitis dog?

A

Do not restrict fat in cats

56
Q

What is triaditis? What species has it been reported in?

A

Concurrent inflammation of the pancreas, liver and small intestines (based on histological confirmation)

Cats (aka Feline Inflammatory Disease)

57
Q

How much secretory capacity of the pancreas must be lost for a diagnosis of EPI?

A

90%

58
Q

What are the 2 etiologies of Pancreatic acinar atrophy leading to EPI?

A

Genetic

Immune Mediated

*Stressed/starred*

59
Q

What breeds are predisposed to EPI?

A

German shephard

Rough Coat Collie

Eurasians

60
Q

Insufficient secretion and production of pancreatic enzymes, commonly caused by atrophy of _____ cells, leads to maldigestion. This characterizes EPI.

A

Acinar

61
Q

What is the primary clinical sign of EPI? In which species may this be the only sign?

A

Weight loss

Cats

62
Q

What is the characteristic appearance of the stool of a dog with EPI?

A

Steatorrhea: loose, pale, oily, foul smelling

63
Q

T/F: Dogs with EPI typically have a ravenous appetite with concurrent weight loss.

A

True

64
Q

Can canine and feline TLI tests be used interchangeably?

A

No, species specific

65
Q

What vitamin is often low in EPI and why?

A

B-12

Combination of malabsorption and maldigestion

In cats treatment for EPI must be combined with cobalamin supplementation for a good resposne

66
Q

What is the major source of intrinsic factor in dogs? What is intrinsic factor’s role?

A

Pancreas

For B-12 absorption

67
Q

Which 2 antibiotics, which also may have anti-inflammatory effects, can be used to help eliminate diarrhea associated with EPI? Which of these can be given longterm?

A

Tylosin - can be given long term

Metronidazole (long term can cause neurotoxicity)

68
Q

Dogs with EPI should be fed a highly _____, ____-restricted diet and avoid foods high in _____.

A

Digestible

Fat

Fiber

SAM 2 scs RUSVM (14 decks)

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