Hepatic And Pancreatic Disorders Flashcards

Question

Gamma gluteryl transferase (GGT)

Answer 1

More sensitive than ALP for cholestasis in cats | Corticosteroids in dogs

Answer 2

Urea- low if liver can't convert NH3 to urea Albumin- low if there is failure of synthesis but other causes too Glucose- severe loss of functional mass the liver can't maintain homeostasis Cholesterol- hypo with hepatopathies and hyper with cholestasis

Answer 3

Bile acids normally resorbed from the ileum and under go recirculation so if there is bile acids in the blood there is a liver problem except in the presence of cholestasis

Answer 4

If you think the animal is able to handle an anaesthesia and a coagulopathy test is done first If in cats an ex lap is preferred so that you can have access to and biopsy multiple sites such as pancreas and SI

Answer 5

Dog- Chronic parenchymal and portal hypertension | Cat- primary biliary disease and more resistant to setroids

Answer 6

Rarely causes icterus so diagnosed late stages Young to middle aged dogs mostly affected Mostly idiopathic but can have infectious or toxin cause Portal hypertension as a result of inflam and fibrosis Clinical signs start to appear once 75% of mass lost

Answer 7

``` Ascities develops due to hypertension If icterus develops, poor prognosis HE also develops at late stage Peristently elevated ALT Coagulation tests and wedge biopsy is definitive ```

Answer 8

ID and address underlying cause Slow progression of disease Supportive liver function- high quality and digestible protein +/- antibiotics and glucocorticoids depending on biopsy

Answer 9

Yes, but it is rare Can be caused by CAV-1, Panadol, heat stroke ect Acute onset, high liver enzymes Supportive care with IV fluids and good diet If they survive the initial insult, liver has good regenerative capacity

Answer 10

Dogs Congenital- diverts blood away from the liver Shunting associated with portal hypertension to try and relieve some pressure

Answer 11

``` Poor growth and BCS Neuro signs Other congenital defects and unable to handle anaesthetic Ultrasound is good but CT is better Surgery is the best option ```

Answer 12

Secondary are more common Must exclude primary liver disease Hepatic vacuolation- accumulation of glycogen or fat Hepatic congestion and oedema- CHF

Answer 13

Primary- massive accumulation of fat in hepatocytes leading to loss of function (obese cats) Secondary- occurs in any anorexic cat with concurrent disease

Answer 14

Middle aged cat with recent stress or concurrent disease Icterus, hepatomegaly, HE and coagulopathies common Diagnosis reflects cholestasis with high ALT, AST and GGT, low urea, biopsy needed for definitive diagnosis On radiographs there is weight loss but falciform fat remains Cats normally too sick for anaesthesia to do biopsy

Answer 15

Early and intensive feeding of high protein diet (1/4RER) Probably will need to tube them to get them eating IV fluids and antioxidants: S-adenosylmethionine

Answer 16

Biliary disease + pancreas + duodenum | Hard to diagnose because signs are nonspecific

Answer 17

Ascending bacterial infection from SI Triaditis, presents acutely in young-mid aged cats High ALT and bilirubin but not sensitive or specific Take a swab and MC&S of bile Antibiotics for 4-6wks IV fluids and tube feeding with ursodeoxycholic acid

Answer 18

Triaditis and neoplasia is second most common Ultrasound reveals distended biliary tree Treatment depends on what the underlying cause is Try choleretics Surgery doesn't normally go well so avoid if possible

Answer 19

Liver is weak and easily damaged | No treatment and poor porgnosis

Answer 20

IV fluids- perfusion of damaged liver is important Antibiotics- used in most cases Antiemetics and gastric protectants- most feel nauseated Analgesia- use opioid but not morphine > nausea

Answer 21

Ursodeoxycholic acid- hepatoprotective, choluretic and cholesterol reducing effects S-adenosyl methionine (SAMe)- use drug because liver cant make its own and its important Vit E- liver antioxidant, used with SAMe Milk thistle- antioxidant and metabolic effects

Answer 22

Cats- get them eating or tube them Feed a high protein that is highly digestible to stop tissue catabolism and nitrogenous waste If the gut works, USE IT

Answer 23

Thiamine Cobalamin L-carnitine Taurine

Answer 24

``` Emergency! Remove or treat precipitating factors IV fluid Remove ammonia from colon with enema IV ampicillin Manage seizure with propofol or phenobarbitone ```

Answer 25

Omeprazole to stop any GI bleeding and vitamin K if needed If you need to give fluids, give colloid so it stays in vessels and doesn't leak into abdo Only give frusemide if animal cant breathe due to ascities Avoid ulcerogenic drugs, sepsis, protein-calorie malnutrition

Answer 26

Coagulopathies common in liver disease | Provide parenteral vitamin K or fresh frozen plasma

Answer 27

There is always something wrong with the faeces

Answer 28

Pancreatic acinar atrophy- autoimmune disease that attacks acinar cells but not islets (young adults) Secondary to pancreatitis- major cause in cats, islet destruction and diabetes mellitus SI bacterial overgrowth normally seen

Answer 29

Lack of pancreatic digestive enzyme leads to maldigestion, bacterial overgrowth, malnutrition and weight loss but good appetitie Vit B 12 def causes villous atrophy and further loss of digestion

Answer 30

Chronic steatorrhea Seborrhea- essential fatty acid def Cats- triadidtis

Answer 31

CBC, biochem and urine often normal- maybe PLE | TEST OF CHOICE- trypsin-like immunoreactivity (TLI)

Answer 32

Pancreatic enzyme supplementation for life Available as powders or capsule or fresh raw cow pancreas, moderate fat and highly digestible diet SIBO is assumed and treated with tylosin or metronidazole 2 or more meals a day to be fed Good prognosis with owner compliance

Answer 33

Destruction of pancreatic parenchyma Autoimmune chronic- cocker spaniel Idiopathic chronic- most common form

Answer 34

Mild, intermittent GI signs Acute pancreatitis episode > EPI may cause extra-hepatic biliary obstruction

Answer 35

Mild and non-specific signs | Assoc with concurrent disease

Answer 36

Biopsy is the only definitive test but not commonly done because confirmation won't change treatment cPLI most sensitive for dogs but only shows up in acute flare ups Treatment is symptomatic only or treated acutely

Answer 37

Trypsin is stored in an inactive form called trypsinogen | The pancreas also releases a trypsin inhibitor

Answer 38

Premature activation of trypsin causing autodigestion and activation of other enzymes Autodigestion- multifactorial 90% of cases are idiopathic

Answer 39

History of high fat meal or over eating | Look for a position of relief, looks like GI obstruction

Answer 40

Concurrent features of other diseases | May have LI diarrhoea and develop icterus

Answer 41

Shock Pain on palpation of abdomen and a mass Concurrent endocrine disease

Answer 42

cPLI/fPLI- don't know if it has prognostic implications Best test to use US better than x-ray- enlarged hypoechoic pancreas with hyperechoic surrounding fat

Answer 43

IV fluids and electrolytes- 90mL/kg/hr for 30mins 4 shock Nutritional support- enteral nutrition as early as possible Analgesia- butorphanol or methadone if bad pain Antiemetics- maropitant Antibiotics if indicated- enrofloxacin + metronidazole