Hepatic

Question 1

hepatic enzymes

Answer 1

hepatocellular - ALT, GLDH, AST
cholestatic - ALP, GGT

Question 2

Albumin and globulin

Answer 2

increased - inflammation, neoplasia
decreased - severe liver disease, eg portosystemic shunt

Question 3

bile acids

Answer 3

increased - billiary obstruction, reduced hepatic function, portosystemic shunt

bile acid stimulation test - liver function (Can’t use if jaundiced)

Question 4

neutrophilic cholangitis

Answer 4

usually e coli

antimicrobials
fluids
SAMe
analgesia

Question 5

jaundice

Answer 5

accumulation of excess bilirubin

pre hepatic -
extra formation of bilirubin
usually hemolysis
usually with regenerative or pre-regenerative anemia
ddx - primary or secondary IMHA

hepatic -
inability to clear billirubin
impaired hepatic function
ALT proportionally higher than ALP
ddx - cholangitis, FIP, lepto, chronic canine hepatitis, hepatic lipidosis, diffuse neoplasia

post hepatic -
inability to excrete bilirubin
ALP proportionally higher than ALT
ddx - cholelithiasia, pancreatitis, gall bladder, rupture, rupture common bile duct of gall bladder

Question 6

supportive care for hepatic disease

Answer 6

diet - high quality protein, highly digestible
monitor protein on biochem
monitor bodyweight
antioxidants - SAMe, vitamine E, silymarin, zinc
choleretics and bile acid modifiers - UDCA (destolit)
anti-inflammatories - steroids (not if known or suspected infectious causes or if ascites)

antimicrobials - only if strongly suspected infectious cause (lepto - penicillin or doxycycline)

Question 7

pre surgical considerations - hepatic surgery

Answer 7

anemia
hypoproteinemia
hepatic encephalopathy
extended coagulation times
ascites
dehydration