G9&10 Flashcards
Which organ secretes Cu?
Liver
What is the consequence of a Cu excretion defect?
Secondary inflam
Fibrosis
6 breeds prone to Cu storage hepatitis
Bedlington terrier Lab Dalmatian Doberman Pinscher WHWT Skye Terrier
Pattern of Cu distribution in primary Cu storage disease?
Centrilobular
Pattern of Cu distribution in Cu storage disease secondary to chronic hepatitis
Periportal
A Bedlington Terrier has elevated ALT. What diagnostic test do you plan on doing and why?
Liver biopsy
Quantify Cu
Prone to Cu storage disease
Discuss medical management of Cu storage disease
Zinc acetate or glauconate added to diet
Binds dietary Cu
Cu chelation if systemically ill or v high Cu levels
Later maintained on hepatic diet and zinc supplement
What is vacuolar hepatopathy?
Glycogen accumulate in hepatocytes
Swelling and cholestasis
What drug class can cause vacuolar hepatopathy?
Steroids
What breed of dog is prone to primary vacuolar hepatopathy
Scottish terriers
What diagnostic results point to vacuolar hepatopathy?
Elevated:
ALP
GGT
Bile acids
In a case of vacuolar hepatopathy, what would ultrasound reveal?
Hepatomegaly
Hyperechoic liver
How is vacuolar hepatopathy diagnosed?
Presumptive based on; characteristic changes and absence of other changes on US
Cytology will show change.
Biopsy = Definitive diagnosis
Tx for vacuolar hepatopathy?
No treatment
Withdraw assaulting agent - e.g. steroid
What causes hepatic lipidosis?
Anorexia —> -ve energy balance —> Peripheral fat to liver
Dietary deficiencies in; methionine, carnitine and taurine —> Inability to process fats
What are the clinical signs of hepatic lipidosis?
Jaundice V+ D+ Hepatomegaly Signs of hepatic encephalopathy Underlying disease that led to anorexia
What blood and biochem results point to hepatic lipidosis? (Think about function)
Elevated ALP, GGT, ALT Increased bilirubin Decreased urea Hypokalaemia - poorer prognosis Hypophosphataemia Hypomagnesaemia Prolonged PT/aPTT Decreased Vit K recycling
What diagnostic test results (excluding bloods and biochem) point to hepatic lipidosis?
Rx and US - Hepatomegaly, hyperechoic liver
Cytology - Vacuolar change
How is hepatic lipidosis treated?
Feeding - restore +Ve energy balance GRADUALLY Feeding tube often needed IVFT + electrolytes Vit K - coag Anti-oxidants —> Replace glutathione Prognosis good
List examples of hepatic NPs
Hepatoma Hepatocellular carcinoma Biliary carcinomas Lymphoma MCT Haemangiosarcomas
What is an important differential for NP of the liver?
Regenerative nodules
FNA to diagnose
Describe the 2 types of cholecystitis/cholangitis in cats
Neutrophilic - acute, ascending infection, E. coli
Lymphocytic - Chronic sequal to infection/immune mediated disease
What is triaditis and in which species is it most commonly seen?
Inflammation of the:
Liver
Intestines
Pancreas
Cats
What is the most important DDx for FIP in cats and why?
Lymphocytic cholangitis
Due to hyperglobulinaemia
What diagnostic results are associated with cholangitis?
Neutrophilic leukocytosis
Liver enz elevation
Bilirubin and bile acids sometimes elevated
Bile cytology and culture - ± neutrophilic inflam, ±bac infection
What is abd US used to rule out in cholangitis?
Extrahepatic bile duct obstruction
Mucocele- dog
Choleliths - rare
NP
Cholangitis Tx
AB based on C&S
Empirical - potentiated amoxicillin
Nutritional support - risk of hepatic lipidosis
What is extrahepatic bile duct obstruction?
Compression of bile duct - intra- or extraluminal
Potential causes of extrahepatic biliary obstruction
Triaditis - or any individual component
Biliary NP
Choleliths - rare
Blood work changes with extrahepatic biliary obstruction
Elevated cholestatic liver enzs
Elevated bilirubin
Abnormal coag panel - Decreased fat soluble Vit abs —> Vit K deficient
What changes might be visible on Rx or US in extrahepatic biliary obstruction
Dilation of gall bladder and bile duct
Extrahepatic bile duct obstruction Tx
Vit K supplementation
Anti-cholelithic drugs
Anti-oxidants
Surgery avoided
Prognosis guarded
What is a gallbladder mucocele
Mucoid concentrations in gall bladder
Lead to biliary obstruction
Gall bladder mucocele predisposing factors
Endocrinopathies
Some breeds - Shetland Sheepdog, Cocker Spaneil, Miniature Schnauzers
Mucocele Clin signs
Anorexia Lethargy V+ Jaundice Abd pain if bile peritonitis from rupture Often incidental diagnosis
Gallbladder mucocele - bloods
Elevated cholestatic enzs
Elevated bile acids
Gallbladder mucocele - US appearance
‘Kiwi’ shape
Gallbladder mucocele Tx
Surgery - cholecystectomy
Medical - Ursodeoxycholic acid, low fat diet, tx underlying endocrinopathies
What is a congenital PSS
Congenital vascular anomaly connecting portal circulation directly to systemic circ
Intrahepatic or extrahepatic
Which type of PSS is more common in small breeds
Extrahepatic
Which type of PSS is more common in large breeds
Intrahepatic
What are the main presenting signs of PSS
Neurological
GI
Urinary
General body condition - small, underweight
Congenital PSS - Discuss neurological signs
Hepatic encephalopathy
Due to metabolic waste products building up
Ammonia (NH3) - commonly assessed
Depression, lethargy, circling, blindness, seizures
Congenital PSS - Discuss GI signs
V
D
Anorexia
Congenital PSS - Urinary signs
PUPD
Urate crystals
Cystoliths
Congenital PSS - Blood work
Microcytic, hypochromic anaemia
Normal to mildly elevated liv enzs
Bile acid stim test v sensitive for PSS —> Abnormal = Could be PSS, normal ≠ Not PSS
Congenital PSS - US
If seen = Shunt confirmed
Not seen ≠ Not present
Congenital PSS - How is CT used to Dx
Angiography
Extrahepatic PSS - surgery
Attenuation of vessel
Intrahepatic PSS - Surgery
Transjugular coil embolisation
PSS surgery may not always be possible (animal/finance). Discuss PSS medical management
General aim to reduce ammonia production - reduce HE risk
Hepatic diet
Oral lactulose - reduces ammonia-producing bac and changes gut pH to prevent ammonia —> Ammonium (enters cells easily)
ABs
Anti-epileptics
What are the 3 features of a hepatic diet
Good quality, easily digested prot
Low Cu
High Zn
How can chronic liver disease lead to an acquired PSS?
Liver disease —> Fibrosis over time
Portal hypertension —> Ascites
Multiple PSSs form to alleviate hypertension
Ascites resolves
Which region is common to find acquired PSSs?
R kidney region
Acquired PSS - Tx
Shunt closure NOT indicated - keeping animal alive
Medical management of underlying hepatic condition or more likely supportive measures
Acquired PSS - Medical management
Treat ascites - spironolactone
Anti-oxidants
Hepatic diet
Treat HE
Anti-fibrotics rarely used - side effects common
Which species is more prone to chronic hepatitis?
Dogs
Which species is more prone to suppurative cholangitis/cholangiohepatitis?
Cats
Which species is more prone to EHBDO? Why?
Cat
Anatomical differences
Follows severe inflam/infection/NP
Which species is more prone to hepatic lipidosis?
Only cats show clinical signs
Which species is more prone to PSS?
Dogs
What distinctive feature does a cat with a PSS have?
Cu coloured eyes
Leptospirosis infection has what effects?
Hepatitis
Acute/acute-on-chronic renal failure
Which species is more prone to leptospirosis?
Dogs
Cats do not show clinical signs
When is leptospirosis more likely?
Autumn and Winter
In dogs in endemic areas
What are the 2 advantages of vaccination against leptospirosis?
Prevent infection (Not 100%) Less severe clinical signs if infected
What are the clinical signs of leptospirosis infection?
Acute or chronic
Liver function effected
Systemic infection
Severe cases - pulmonary pathology and blood loss anaemia
What are the clinical signs of leptospirosis?
Acute hepatitis Hepatocellular destruction Jaundice Hyperbilirubinaemia Coagulopathy - prolonged PT/aPTT PUPD Reticulated interstitial lung or alveolar pattern - due to bleeding
How is leptospirosis definitively diagnosed?
PCR - urine»_space;> blood
Serology - can be -ve in v acute infection
Either
Why is it better to test for leptospirosis in urine over blood?
Leptospira not in blood for long
Urine more likely true +ve
Leptospirosis Tx
Immediate amoxicillin/potentiated amoxicillin - stops shedding by 24hrs
First take urine and blood for PCR
Full eradication in confirmed cases 2 weeks doxycycline
Why is it important to give immediate AB treatment even before PCR results confirm leptospirosis infection?
Zoonotic
Amoxicillin/potentiated amoxicillin stops shedding in 24 hrs
What is the prognosis with leptosirosis infection?
Variable
Pulmonary involvement - Poor, may req artifical vent
Acute kidney injury - Can recover, may req. haemodialysis
What is the prevalence of leptospirosis?
Becoming more common
Why are special measures in place when dealing with leptospirosis patients? What are these measures?
Zoonotic
Gloves and apron min Urine sample handled w/ gloves Aerosols avoided Airway protection if surgery Flu-like symptoms - see GP
In cats, what are the 2 most common infectious causes to rule out in hepatic parenchyma/biliary disease?
Toxoplasmosis (rarer in dogs)
Feline infectious hepatitis (FIP)
In infectious hepatobiliary disease of the cat, how is toxoplasmosis tested for?
Serology
-ve result and acute signs, repeat 7-14 days after
Rising titers = acute infection
Infectious hepatobilairy disease in cats - How is FIP tested for?
Ascites present - ‘wet form’ - PCR ascites fluid = +ve for coronavirus
‘Dry form’ - Liver biopsy to differentiate from cholangitis
