Final: Liver and Pancreas Flashcards
What are the 5 functions of the liver?
Metabolic
Excretory
Synthetic
Storage
Detoxification
(MESS’D)
*Stressed in class*
The ________ delivers oxygenated blood into sinusoids of the liver.
The __________ delivers deoxygenated, nutrient-rich blood from GIT to sinusoids of the liver.
Hepatic artery (25% of total blood)
Hepatic Portal vein (75% of total blood)
What is responsible for the absorption and digestion of fat and fat soluble vitamins (A, E, D, K)?
Bile acids
What happens to cholesterol blood levels when the bile duct is obstructed?
They increase
(Bile is the major elimination route)
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.
True
Which zone of the liver is most prone to hepatotoxins? Which is most prone to hypoxia?
Zone 1 (Area of portal triads)
Zone 3 (Area around central vein)
Where in the liver is plasma filtered?
Space of Disse (between hepatocytes and endothelial cells)
Biliary System:
Intrahepatic ducts -> ______ bile duct -> cystic duct -> ________
Common bile
Gallbladder
What cells located in sinusoids scavange bacteria and other foreign material in the liver?
Kupffer cells
At what serum bilirubin level is bilirubinemia clinically detectable?
>2.0 mg/dl
T/F: Bilirubinuria is always abnormal in the cat.
True
*Stressed in class*
Severe pancreatitis causing bile duct obstruction is what type of icterus (preheptatic, posthepatic, hepatic)?
Posthepatic
Acute cholangitis is what type of icterus (preheptatic, posthepatic, hepatic)?
Hepatic
What type of icterus (preheptatic, posthepatic, hepatic) is characterized by increased production of bilirubin with cholestasis? What are your main rule outs?
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
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?
Hepatic
R/O: Lipidosis, inflammatory hepatopathyies, extrahepatic infections (Toxoplasia, FIP), acetaminophen (toxins)
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.
<5
5-10
>10
Match liver enzyme to liver site:
Hepatocyte membrane integrity
Hepatocyte or biliary epithelial necrosis
Cholestasis
Induction phenomenon (dogs)
ALT, AST, ALP, GGT
Hepatocyte membrane integrity and Hepatocyte or biliary epithelial necrosis: ALT, AST
Cholestasis and Induction phenomenon (dog): ALP, GGT
What does ALP do when you administer steroids? What other drug does this to liver enzymes?
Increases
Phenobarbitol
What crystals can occur due to any cause of decreased hepatic function, including shunts and organ failure?
Ammonium biurate urinary crystals
What endocrine diseases cause elevated liver enzymes?
Hyperadrenocorticism (Cushing’s)
Hyperthyroid
Hypothyroid
Diabetes mellitus
Hypoglycemia only occurs after approximately ___% of hepatic function is lost. It is the result of reduction in hepatic ______ stores, gluconeogenesis, and clearance of _____.
75
Glycogen
Insulin
Bile acids are useful to diagnose what in dogs and cats?
PSS - dogs and cats
Cirrhosis- dogs
Value limited for screening of most other hepatobiliary diseases
*Stressed on slides/in lecture*
What diagnostic modality has the highest correlation with actual liver weight in dogs (include patient positioning)?
Right lateral abdominal rads
*Starred on slides*
What can be used to determine liver size as well as for diagnosing hepatic mass lesins and PSS?
CT
*Starred on slides*
What is the best way to biospy a liver (according to Dr. Settles)?
Laparoscopic biopsy
What are the 3 most common causes of hepatic infections?
Leptospirosis (dogs)
Tick-bourne infections
Heartworm
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.
True
T/F: Substantial weight loss is a predisposing factor for hepatic lipidosis in cats.
True (>25% of body weight)
Which liver enzyme is usually the highest in cats with hepatic lipidosis?
ALP (more than GGT or ALT)
Which 2 cell types are abundant in the periportal area with inflammatory liver disease?
Lymphocytes
Neutrophils
What are the 2 causes of “Steroid” vacuolar hepatopathy?
Iatrogenic steriods
Cushing’s disease
What element can accumulate in the liver with any cause of liver inflammation?
Copper
What does portal vein hypoplasia (PVH) without portal hypertension indicate? Do you usually treat this?
Microvascular dysplasia
Usually no treatment needed
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.
FALSE, cats not dogs
Each pancreatic lobule is composed of ____ cells, which synthesized and store digestive enzymes, and a branching duct system, as well as endocrine ______ cells.
Acinar
Langerhans
Which enzyme produced by the pancreas is cleared by gomerular filtration, when increased indicates renal disease especially in cats?
Amylase
Which of these ezymes digest protein? Carbs? Fat?
Amylase
Trypsin/Chemotrypsin
Lipases
Carboxypeptidase
Protein: Trypsin/Chemotrypsin, Carboxypeptidase
Carbs: Amylase
Fat: Lipases (incl. cholesterol lipase and phospholipase
Enzymes sythesized by the pancreas are stored and secreted as inactive ______.
Zymogens
What develops when there is digestive enzyme activation and resultant pancreatic autodigestion?
Pancreatitis
Injury to which cell type leads to autodigestion of the pancreas?
Acinar cells
What are the principal mediators of pancreatic enzyme secretion?
Cholecystokinin
Acetylcholine
What is the most important plasma protease inhibitor consumed when there is acute pancreatitis?
Alpha Macroglobulin
What are the clinical features of dogs with pancreatitis? Cats?
Dogs: Anorexia, Vomiting, Weakness, Abdominal pain, Dehydration, Diarrhea
Cats: Anorexia, Lethargy, other vague non-specific signs
Why may you see bilirubin elevation in a cat with pancreatits?
Inflammation of pancreas causing common bile duct obstruction
T/F: Cats with spontaneous pancreatitis do not get elevated lipase.
True
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?
Trypsin-like Immunoreactivity (TLI)
What is the most sensitive test for pancreatitis? Is the test better for dogs or cats?
Pancreatic Lipase Immunoreactivity (PLI)
Better for dogs
What is the test of choice for EPI?
TLI
Spec cPL (PLI) concentrations are significantly higher in dogs with which condition?
Hyperadrenocorticism (Cushing’s)
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.
False, ultra low in FAT (otherwise statement is correct)
What can you do if your pancreatitis patient is consistently vomiting even with aggressive antiemetic therapy but you need to provide nutritonal support?
Jejunostomy tube
What is your treatment plan for a cat with pancreatitis who is dehydrated, hypokalemic, hypoglucemic, hypoalbuminemic, and acidemic? You have ruled out autoimmune pancreatitis.
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
What are 2 agents that modify free radical scavengers and may stabilize lysosomal and other membranes?
Selenium
Omega 3 Fatty Acids
How many times ober normal must amylase/lipase be, in conjunction with other findings, for a diagnosis of pancreatitis?
3-5 times
How does the diet for a pancreatitis cat differ from the diet of a pancreatitis dog?
Do not restrict fat in cats
What is triaditis? What species has it been reported in?
Concurrent inflammation of the pancreas, liver and small intestines (based on histological confirmation)
Cats (aka Feline Inflammatory Disease)
How much secretory capacity of the pancreas must be lost for a diagnosis of EPI?
90%
What are the 2 etiologies of Pancreatic acinar atrophy leading to EPI?
Genetic
Immune Mediated
*Stressed/starred*
What breeds are predisposed to EPI?
German shephard
Rough Coat Collie
Eurasians
Insufficient secretion and production of pancreatic enzymes, commonly caused by atrophy of _____ cells, leads to maldigestion. This characterizes EPI.
Acinar
What is the primary clinical sign of EPI? In which species may this be the only sign?
Weight loss
Cats
What is the characteristic appearance of the stool of a dog with EPI?
Steatorrhea: loose, pale, oily, foul smelling
T/F: Dogs with EPI typically have a ravenous appetite with concurrent weight loss.
True
Can canine and feline TLI tests be used interchangeably?
No, species specific
What vitamin is often low in EPI and why?
B-12
Combination of malabsorption and maldigestion
In cats treatment for EPI must be combined with cobalamin supplementation for a good resposne
What is the major source of intrinsic factor in dogs? What is intrinsic factor’s role?
Pancreas
For B-12 absorption
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?
Tylosin - can be given long term
Metronidazole (long term can cause neurotoxicity)
Dogs with EPI should be fed a highly _____, ____-restricted diet and avoid foods high in _____.
Digestible
Fat
Fiber
