GI And Hepatic All Literature Flashcards
Objective - to prospectively evaluate kaolin activated TEG in dogs with acute liver disease (ALD) and compare with plasma based coagulation assays
21 dogs with acute liver disease diagnosed based on clinical presentation, minimum database, PT/PTT, and TEG. A subset also had fibrinogen, antithrombin, protein C, D diners, VWF measured. a PT >1.5 x prolonged defined acute liver failure.
Dogs with acute liver disease had increases in R, K, LY30, PT, PTT and vWF with DECREASES in alpha angle, MA, G, AT activity, and protein C activity.
**Overall - ~50% of dogs were hypocoagulable, 38% of dogs were normocoagulable, and 9% were hypercoagulable based on TEG
**38% of dogs had increases in LY30, indicating hyper fibrinolysis, and a majority of these dogs were also hypocoagulable
hypocoagulable and hyperfibrinolytic dogs had lower fibrinogen and protein C activities than dogs without these abnormalities
Acute liver failure dogs had greater increases in K (time to 20 mm clot formation) and LY30 (% of clot degraded 30 min after reacting MA or maximal clot strength), and decreases in MA, G (measure of clot strength/ firmness) and protein C activity than dogs with less severe hepatic impairment.
dogs with acute liver failure typically become hypocoagulable and hypofibrinolytic with progressive functional impairement.
**TEG was discordant from traditional coagulation testing 25% of the time
Objective - to characterize the observed incidence, timing and risk factors for azathioprine hepatotoxicosis in dogs treated clinically, and to determine the relationship between the development of hepatotoxicosis and cytopenias
**Hepatotoxicity (as defined by a >2 fold increase in serum ALT) was observed in 15% (5/34) dogs with a median onset of 14 days. Dogs had a median 9 fold ALT increase and 8 fold ALP increase, which stabilized or resolved after the drug was stopped or the dose was reduced. GSD were overrepresented
**Thrombocytopenia or neutropenia were seen in 8% of dogs, but occurred later in treatment (median onset 53 days into treatment)
What is the mechanism of action of azathioprine?
Purine analog, immunosuppressive
Is hepatotoxicity secondary to azathioprine idiosyncratic or dose dependent?
It’s BOTH - WOW!
Objective - to describe the distribution of histopathologic abnormalities between liver lobes.
Population - prospective study evaluating 70 dogs undergoing necropsy - liver samples were obtained from all lobes
***In the study population, biopsy of at least 2 liver lobes identified the predominant histologic abnormality in 99% of cases **
14% of dogs had = 3 lobes in agreement and could not be assigned a predominant diagnosis
The same diagnosis was present in 6/6 lobes in 57% of dogs , 5/6 lobes in 15% dogs, 4/6 loves in 15% of dogs, 3/6 lobes in 10% of dogs, and 2/6 lobes in 4% of dogs
****Biopsy of more than one lobe is important in obtaining representative samples
Objective - To investigate the effect of a low copper, high zinc diet on hepatic copper concentration in labs with increased hepatic copper concentrations
Populations - 28 clinically healthy labs with a mean hepatic copper concentration of 919 mg/kg dw that were related to dogs previously diagnosed with clinical copper associated hepatitis
Dogs were fed a low copper, high zinc diet, and hepatic copper concentrations were determined in liver biopsy samples approximately every 6 months
**54% of dogs responded - hepatic copper concentrations decreased a mean of 710 mg/kg dw copper to 343 mg/kg dw after a median of 7.1 months. Dogs that were more severely affected or that were from a severely affected pedigree were less likely to respond to copper restricted diet and zinc
**21% of dogs continued to accumulate copper despite diet
Objective - to compare histopathologic results of liver samples obtained by punch, cup, and 14 gauge needle to large wedge samples collected at necropsy.
Population - prospective study 70 dogs undergoing necropsy
***Mean number of portal triads observed by each sampling method were: 2.9 in needle samples, 3.4 in cup samples, 12 in punch samples, and 31 in necropsy samples (control).
**66% of needle samples, 60% of cup samples, and 69% of cup samples were in agreement with necropsy control samples. Indicates that histopathologic interpretation of a liver sample in dogs is unlikely to vary if biopsy specimens contains 3-12 portal triads. The accuracy of test methods was low compared to control. Getting multiple lobes is more important than sampling technique.
Objective - to examine the effects of PO administered ranitidine and omeprazole on intragastric pH in cats and to compare the efficacy of once daily vs twice daily dosage regimens for omeprazole
Randomized 4 way cross over design - cats were given enteric coated omeprazole granules q 24 or q 12, ranitidine (1.5-2.3 mg/kg q 12h) and placebo. Intragastric pH was monitored for 96 hours continuously.
**BID omeprazole administration raised intragastric pH >/= 3 and >/= 4 67% and 55% of the time respectively. All other treatments (ranitidine, SID omeprazole, placebo) did not raise intragastric pH for as long, but SID omeprazole raised pH ~15-20% of the time.
**BID omeprazole = best
Background - Serum N terminal pro-C-natriuretic peptide (NT-proCNP) - thought to be a potential diagnostic biomarker for sepsis
Objective - to evaluate the use of an ELISA for the measurement of NT-pro-CNP in canine abdominal fluid and to describe the peri operative pattern of abdominal fluid and serum NT-proCNP in dogs with septic peritonitis
Prospective pilot study of 5 dogs with non septic peritoneal effusion, 12 dogs with septic peritoneal effusion
**dogs with septic peritonitis had lower abdominal fluid NT-proCNP than concurrent serum concentrations, and lower than control canine abdominal fluid concentrations. Post-operatively, abdominal fluid NT-proCNP concentrations remained lower than serum, except on day 4. Low serum NT-proCNP cannot be explained by abdominal compartmentalization. Unknown diagnostic utility for sepsis
Objective - to determine feasibility of using contrast enhanced ultrasound to detect pancreatic and duodenal perfusion changes in naturally occurring canine pancreatitis
**Dogs with pancreatitis tended to have delayed time to peak hyperechoic enhancement with prolonged hyperechoic enhancement of the pancreas. Duodenal peak intensity was also increased.
Objective - to compare the effect of PO administered famotidine, fractionated omeprazole tablet, and omeprazole reformulated paste on intragastric pH in cats in a four way crossover design
**both omeprazole formulations administered BID were superior to famotidine in gastric acid suppression
**In healthy cats, gastric acid suppression (gastric pH >/= 3) was superior in fractionated enteric coated omeprazole (68%) and reformulated omeprazole paste (74%) compared to famotidine (43%) and placebo (16%)
- *Reformulated omeprazole paste was still effective in gastric acid suppression despite the disruption in enteric coating
- *Omeprazole levels by HPLC were similar between the two formulations
Objective - to compare the effect of IV coadministration of famotidine and pantoprazole to mono therapy with pantoprazole on intragastric pH in dogs.
Randomized 2 way crossover placebo controlled design
Dogs initially received saline for 24 hours, then 1 mg/kg pantoprazole q 12h for 3 days, then famotidine + pantoprazole for 3 days
**Results were comparable for combination treatment and stand alone treatment. Pantoprazole alone (MPT pH >3 79% MPT pH >4 68%) compared to dual therapy (MPT pH >3, 74%, MPT >4 64%)
**Note - human targets to treat gastroduodenal ulceration = Mean percentage time (MPT) pH > 3, 75% and MPT > 4, 67%
What is the mechanism of action of pantoprazole?
It is a proton pump inhibitor
PPIs become protonated and trapped in their active form in the acidic environment of parietal cells. After activation, PPIs form disulfide bonds with available active parietal cell H/K ATPase enzymes
After 24 hours of PPI treatment, how much gastric acid suppression typically occurs?
30% of maximum
When is the maximal inhibitor effect of PPIs though to plateau?
4 days
Prospective pilot case series of 10 dogs with pancreatitis
3 phase angiographic CT scan was performed under sedation, then dogs had US guided aspiration of the pnacreas performed and blood drawn for cPLI
**an enlarged homogeneously to heterogeneously attenuating and contrast enhancing pancreas with ill defined borders was seen on CT in all dogs. CT found more features characterizing pancreatic abnormalities compared to ultrasound (thrombi were found in 30% of dogs). The dogs with heterogeneous contrast (potentially indicative of necrosis) enhancement had an overall poorer outcome than those with homogeneous contrast enhancement.
Objective - to examine the relationship between serum 25 hydroxyvitamin D concentrations at diagnosis and clinical outcome in dogs with chronic enteropathy
**retrospective review
**serum concentrations of 25 hydroxyvitamin D at the time of chronic enteropathy diagnosis were significantly lower in non survivors (4.4 Ng/ml) compared to those that survived (25 Ng/ml)
36% of dogs did not survive
**Serum 25 hydroxyvitamin D concentration was a significant predictor of death in dogs with chronic enteropathy (OR 1.1).
Objective - to determine if there is an association between the histologic diagnosis of gall bladder mucocele in dogs and administration of selected drugs
Retrospective study app 81 dogs with a histologic diagnosis of GBM and 162 age, breed and admission date matched controls
- *Dogs with GBM were 2.2 x more likely to have been treated with levothyroxine (have hypothyroidism)
- *GBM dogs were 3.6 more likely to have reported treatment for Cushings disease
- *2.3 x more likely to have reported use of products containing imidocloprid
- *Analysis of Shetland sheepdogs only — Shetland sheep dogs with GBM were 9.3 x more likely to have used imidocloprid than control Shetland sheepdogs (28% of GBM cases of Shetland sheepdogs were associated with this drug
What breeds are potentially predisposed to gallbladder mucoceles?
Shetland sheepdog Cocker spaniel Pomeranians Miniature schnauzers Chihuahua
Background - administration of probiotics alleviate colitis in people. In vitro effects of the probiotic Enterococcus faecium NCIMB 10415 E1707 (EF) previously have been evaluated using canine cells
Hypothesis - Administration of EF to dogs with food responsive chronic enteropathy will improve clinical outcome and decrease the intestinal inflammatory profile
Dogs received a hydrolyzed elimination diet trial plus either a synbotic product containing EF or a placebo
**there was no difference between the EF group and the placebo group regarding clinical efficacy (CCECAI), histology scores or expression of any of the investigated genes (various inflammatory cytokines). Standard dietary treatment induced rapid clinical response in all cases. Underpowered study.
Objective - to evaluate the safety and diagnostic utility of percutaneous ultrasound guided cholecystocentesis in cats with suspected hepatobiliary disease
Retrospective study of 83 cats that underwent cholecystocentesis
- *Complications were in 17% of cases, mostly minor but included increased abdominal fluid (most common), then needle tip occlusion, failure to penetrate GB, pneumoperitoneum — most complications were associated with other procedures
- *NO reports of GB rupture, bile peritonitis, or hypotension necessitating emergent treatment
- *87% of cats survived to discharge, and those that died - there was no definitive association with cholcytocentesis
- *Bacteria was seen cytologically in 14% of samples and cultures were positive in 14% of samples, and cytology agreed to culture results < 50% of the time. The most common cytologic diagnosis was hepatic lipidosis, while the most common histopathologic diagnosis was cholangitis
- **useful diagnostic information was found in ~30% of cats
Objectives - to report the hematological parameters and coagulation times for cats with congenital PSS, and the influence of surgical shunt attenuation on these parameters; and second, to identify any association between prolongation in coagulation profiles and incidence of peri operative hemorrhage
Retrospective study of 42 cats that underwent surgical shunt attenuation
- *86% of cats had extrahepatic CPSS
- *14% of cats had intrahepatic CPSS
- **~75% cats were micro cystic pre operatively
- *postoperatively there was a significant increased in HCT, MCV, and MCH, but most patients were still microcytic postoperatively despite this increase.
- *Preoperative PT was high in 88% of cats and PTT was high in 69% of cats - no peri operative clinical bleeding was seen
Microcytosis was not associated with shunt type or ability to completely attenuate the shunt
Objective - to describe the extent of bleeding and the occurrence of complications after percutaneous ultrasound guided liver biopsy in cats
Bleeding post biopsy was classified as minor or major dependent on whether there was a less than 6% drop or greater than 6% drop in PCV
- **18G needle was used for biopsy
- *All cats had a drop in PCV after biopsy. The mean change in PCV was - 6.9% (to up to an 11% drop in PCV)
- *minor bleeding occurred in 43%, major bleeding occurred in 57% of cats, non lethal bleeding complications occurred in 17%. Neither the complication rate nor the presence of major bleeding were significantly associated with high morbidity/ mortality
- cats with complications had a lower pre biopsy PCV, and major bleeding was more likely when there was a diagnosis of hepatic lipidosis.
- *There was no correlation between change in PCV or complications and signalment, coagulation parameters, serum parameters, number of biopsies, ultrasound findings, radiologist experience, concurrent procedures and vitamin K administration
- *conventional coagulation tests did not predict complications or the magnitude of change in PCV
Objective - to assess serum lipoprotein profiles using rapid single spin continuous lipoprotein density profiling in healthy control cats and cats with hepatic lipidosis
23 hepatic lipidosis, 20 healthy controls
- *LDL content was significantly higher in cats with hepatic lipidosis than in healthy controls
- *HDL was LOWER in cats with hepatic lipidosis than healthy controls
- *there was no difference in triglyceride and cholesterol levels between groups
***The specific fraction (1.037-1.043 g/ml) within nominal LDL in serum distinguished healthy controls From cats with hepatic lipidosis with a sensitivity of 87% and 90% — in other words - amounts of lipid within the density = 1.037-1.043 g/ml fraction of serum distinguished healthy cats from cats with hepatic lipidosis at a cut off of 7.6%