hepatic Flashcards
hepatic enzymes
ALP- cholestatic enzyme, short half life in cats
ALT- hepatocellular damage, short half life in cats
markers of liver dysfunction
cholesterol, BG, bilirubin, ALB
liver function test
ammonia, bile acids (not sensitive except in PSS
UA and liver disease
cats: low USG bilirubin, urate crystals
dogs: low USG, bilirubin can be normal, urate crystals
CBC/clotting factors
anemia, leukocytosis, low platelets, decreased clotting factors
congenital liver disease in dogs
portosystemic shunt
lg breeds- intrahepatic
sm breeds- extrahepatic , portal vein hypoplasia
EHPSS C/S, dx, tx
one vessel shunting blood away from liver
C/S- ataxia, strange behaviour, PU/PD, seizures, stunting, copper iris in cats
dx- microcytic anemia, low liver function, high liver enzymes
isosthenuria, urate crystals
bile acids-> >100 2h post
abd U/S, CT w contrast
tx- lactulose, metro, omeprazole
surgery (coil, ligation)
portal vein hypoplasia
sm breed, no C/S
high ALT/ALP, bile acids 2h post under 100, U/S to r/o EHPSS
no tx
hepatic lipidosis causes
secondary to anorexia-> decreased insulin, increased lipase-> fat accumulation in liver
primary- anorexia
secondary- diseases causing anorexia or insulin resistance (GI, pancreatitis, DM, obesity)
hepatic lipidosis dx
CBC- anemia
chem- high ALP, bilirubin
high Pt/ptt
big liver on rads, bright on U/S
FNA/biopsy
hepatic lipidosis tx
nutrition- NGT, e tube
start at 1/4RER per day and increase gradually
antinausea, vit K, appetite stimulants
K supplement
SAMe
monitor PCV, liver values, electrolytes weekly
hepatic encephalopathy
clinical dx
neuro signs- ataxia, head pressing, circling, seizures, coma
tx- IVF, metro, lactulose, enemas
feline cholangitis types
inflammation of liver, bile ducts
lymphocytic, neutrophilic, chronic
lymphocytic cholangitis
younger cats, not very sick
high globulins, ascites
pancreatitis uncommon
dx- r/o other causes of fever, BW
tx- imunosuppression w pred, ursodiol
neutrophilic cholangitis
ascending bacterial infection from gut
older cats, more sick (anorexia, icterus) pancreatitis, IBD (triaditis).
normal globulins, no ascites
dx- liver biopsy/culture, GB centesis
tx- abx (clavamox, metro until culture) 6-8wks, SAMe, vit K, pain meds, nutrition w etube
triaditis
concurrent inflammation of liver/pancreas/GI
C/S- anorexia, icterus, fever, abd pain, v+
only 30% have all 3
approach to liver cat
canine chronic hepatitis pathogenesis, C/S, dx
inflammation-> hepatic antigens-> inflammatory cells-> necrosis, fibrosis-> liver failure after years
higher risk in cocker spaniel, labs, samoyed, doberman
C/S- reduced appetite, lethargy, icterus, ascites, Pu/PD
dx- high ALT, everything else normal until later, need biopsyc
chronic hepatitis tx
immune suppression- pred 1-2mg/kg/d
liver protectants- ursodiol, SAMe
supportive care
liver medications and uses
SAMe- antioxidant, protective for liver insult, helps w liver disease
ursodiol- stimulates bile release, not often used in dogs
NAC- anti inflammatory, replaces cysteine to improve metabolism, given during acute toxicities
copper accumulation
1/3 of dogs w CH have copper accumulation (bedlington terrier, WHWT, lab, doberman)
- hepatocyte accumulation-> primary copper disease
- periportal accumulation-> secondary to inflammation, cholestasis
if >1000ug/g-> d-penicillamine, low copper diet
CH monitoring
repeat biopsy at 6m
repeat ALT/copper testing
check for C/S
vacuolar hepatopathy
fat, glycogen, water
secondary to DM, cushings, chronic pred
dx- ALP elevation, non progressive, nodules on U/S
nodular hyperplasia
benign lesion, older dogs
high ALP, nodules
GB mucocele pathophysiology
bile becomes harder-> mucous filled cysts-> pressure necrosis of GB-> bile peritonitis
higher risk w cushing, hypothyroid
sheepdogs, cocker spaniel, pom, beagles
GB mucocele C/S, dx
C/S from rupture only
dx- ALP»>ALT, POCUS
immature-> sludge buildup
mature-> anechoic rim w fracture lines (stellate)
GB mucocele tx
surgery-> no accepted timeframe, consider elective
medical->ursodiol 10-15mg/kg q24
SAMe 20mg/kg q2 for liver
GB mucocele monitoring
repeat U/S q3-6m, check ALT/ALP
GB rupture
present unstable, shocky
fever, tachycardia
icterus, painful abd, v+, anorexia
dx- free abd fluid, abdominocentesis
acute liver injury causes
infectious hepatitis (CAV1), lepto, neoplasia, copper storage disease
toxins (tylenol, xylitol)
acute liver injury tx
supportive care- nutrition, NAC, SAMe, ursodiol
