G11 Flashcards
What are the 4 cornerstones of treating hepatobiliary disease?
Aetiological tx where possible
Symptomatic tx
Nutritional support
Liver support only if evidence it might work - do not harm patient!
Tx for hepatic infectious disease
AB
C&S
Tx for hepatic inflam
Anti-inflam
Tx for Cu storage disease
Cu chelation
Diet
Tx for hepatic neoplasm
Surgery and/or chemo
Tx for hepatic lipidosis
Gradual feeding
Supportive measures
What might symptomatic tx entail in hepatobilairy disease - 3
Gastroprotectants
Anti-emetics
IVFT
What are the 2 main aims in hepatic encephalopathy tx?
Reduce ammonia production by gut bac
Reduce ammonia abs from GIT
How would an emergency case of hepatic encephalopathy be managed?
IVFT
Rectal enema - remove ammonia
Lactulose in rectal enema - prevent ammonia production by gut bac
Airways MUST be protected
What drug can help manage chronic hepatic encephalopathy be managed? What are the effects of administering this drug?
Oral lactulose
Pre-biotic - reduced ammonia-producing bac
Increase faecal pH - Less NH3 —> NH4
(NH4 more easily absorbed)
Laxative - shorter GI transit time = less ammonia production
Non-emergency hepatic encephalopathy tx?
Lactulose - reduce ammonia levels
Hepatic diet
Oral ABs - reduce GI flora ammonia production
A dog with PSS is presented and also has ascites. Name one commonly used drug and one less commonly used drug in this situation.
Spironolactone - common - anti-fibrotic and diuretic
Colchicine - less common - anti-thrombotic - little info about efficacy and safety, and side effects common
What are the three main features of a hepatic diet?
Moderate easy-to-digest animal prot - prevent HE
Increased zinc —> Anti-oxidant and Cu chelation
Decreased Cu - Prevent Cu accumulation
What is the effect of a choleretic?
A drug that facilitates bile production and flow
E.g. Ursodeoxycholic acid (UDCA)
What are the 4 actions of ursodeoxycholic acid?
Makes bile hydrophilic - easier to excrete
Anti-inflam
Anti-oxidative
Epithelial protection
