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Large Animal Medicine > Hepatic Disease - Equine > Flashcards

Hepatic Disease - Equine Flashcards

1
Q

The liver accounts for what percentage of an adult horse’s body weight?

A

1.6%

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2
Q

What are the functions of the liver?

A
  • processing nutrients from food
  • storing glucose, vitamins, and minerals
  • maintaining immune function
  • removing toxins from the blood
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3
Q

What percentage of the horse’s total blood volume resides in the liver?

A

10%

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4
Q

How much of the liver must be damaged before there is abnormal function or failure?

A

70-80%

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5
Q

What are the general clinical signs of acute liver dysfunction?

A
  • depression
  • HE
  • icterus
  • colic
  • anorexia
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6
Q

What is indicated by a high level of fibrinogen?

Low level?

A

high - inflammatory process

low - issues with production in liver

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7
Q

What is indicated by elevated bilirubin?

A
  • liver failure
  • bile blockage
  • excess production
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8
Q

Which enzymes can be used to evaluate liver function?

A

SDH
ALP
AST
GGT

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9
Q

Which coagulation factors are produced in the liver?

A

I, II, V, VII, IX, and X

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10
Q

Where should the ultrasound probe be positioned to evaluate the liver?

A

right side, caudal to the lungs, in the 6th to 14th intercostal spaces

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11
Q

What are the possible causes of icterus/jaundice?

A

decreased excretion or increased production of bilirubin

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12
Q

What is photosensitization type 1?

A

primary photodynamic agent enters skin by ingestion

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13
Q

What is photosensitization type 2?

A
  • accumulation of endogenous photodynamic agents

- congenital prophorias

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14
Q

What is photosensitization type 3?

A

hepatogenous secondary photosensitization

- phylloerythrin

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15
Q

What are the clinical signs associated with photosensitization type 3?

A
  • erythema initially
  • edema
  • sloughing and exposure of subcutaneous tissue
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16
Q

How is photosensitization treated?

A
  • eliminate photodynamic agent
  • remove animal from sunlight
  • treat as skin burn
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17
Q

What is hepatic encephalopathy?

A
  • neuropsychiatric syndrome secondary to hepatic insufficiency
  • CNS characteristics
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18
Q

What are the clinical signs associated with hepatic encephalopathy?

A
  • frequent yawning
  • abnormal behavior
  • aimless wandering and foot stomping
  • head pressing, circling, seizures
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19
Q

Describe the proposed pathophysiology of hepatic encephalopathy

A
  • decreased branched-chain amino acids, and increased aromatic amino acids
  • aromatic amino acids cross BBB into CNS
  • increase inhibitory neurotransmitters
  • increase GABA and L-glutamate
  • imbalance of inhibitory and excitatory neurotransmitters
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20
Q

How is hepatic encephalopathy treated?

A
  • eliminate underlying cause
  • supplement with branched amino acids
  • low protein, high carb diet
  • avoid alfalfa
  • supportive therapy
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21
Q

What is idiopathic acute hepatic disease?

A
  • Theiler’s disease or serum sickness

- most common cause of acute hepatitis and hepatic failure in horses

22
Q

What are the possible causes of IAHD?

A
  • viral infection
  • tetanus antitoxin
  • hypersensitivity type 3
  • dietary factors
  • pyrrolizidine alkaloid toxicity
23
Q

What are the clinical signs associated with IAHD?

A
  • abrupt presentation
  • CNS signs
  • yawning as early sign
  • photodermatitis
  • intravascular hemolysis
  • weight loss and ventral edema
24
Q

What are the hematology/chem features of IAHD?

A
  • elevated bilirubin, AST, SDH, and GGT
  • increased bile acids
  • decreased BUN
  • hyperammonemia
  • prolonged clotting time
25
Q

What are the histopathologic features of IAHD?

A
  • hepatocellular necrosis
  • portal accumulation of mononuclear cells and neutrophils
  • proliferation of bile ductules
26
Q

Which disease results in a “dishrag” liver?

A

idiopathic acute hepatic disease (IAHD)

27
Q

What is choledocholithiasis?

A

stone found in the common bile duct

28
Q

What is hepatolithiasis?

A

presence of calculi in the intrahepatic bile duct

29
Q

What are the possible causes of cholelithiasis?

A
  • ascending biliary infection or inflammation
  • parasites (ascarids)
  • biliary stasis/reflux
  • changes in bile composition
  • foreign body
30
Q

What are the clinical signs associated with cholelithiasis?

A

colic with pyrexia and icterus

31
Q

What are the hematology/chem features of cholelithiasis?

A
  • neutrophilic leukocytosis
  • increased liver enzymes
  • increased bile acids and bilirubin
  • hyperammonemia
  • prolonged clotting time
32
Q

What are the histopathological features of cholelithiasis?

A
  • periportal fibrosis

- bile duct stasis and hyperplasia

33
Q

Which bacteria can be present with cholelithiasis?

A

Bacteriodes vulgtus and E. coli

34
Q

How is cholelithiasis treated?

A
  • antimicrobials, fluids, anti-inflammatories, DMSA, dietary management
  • choledocholithiotomy +/- choledocholithotripsy
35
Q

What are the histological and gross features of chronic active hepatitis?

A
  • infiltration of inflammatory cells into portal areas, necrosis, and fibrosis
  • liver is firm, and often pale brown-green
36
Q

What are the clinical signs associated with chronic active hepatitis?

A
  • progressive weight loss
  • intermittent fever
  • icterus
  • moist exfoliative dermatitis
  • necrotic leathery skin at coronary band
37
Q

How is chronic active hepatitis treated?

A
  • supportive care
  • corticosteroids
  • antimicrobials
  • anti-inflammatories
  • Colchine
38
Q

What is the action of Colchine?

A

inhibits production of collagen and macrophages/cytokine-induced inflammation

39
Q

Describe the pathophysiology of pyrrolizidine alkaloid toxicity

A
  • alkaloids metabolized in liver to pyrroles
  • cross links DNA and causes antimitotic effect
  • hepatocytes die and are replaced by fibrous tissue
  • inhibition of enzymes and protein synthesis
  • veno-occlusive
40
Q

What is found on liver biopsy with prryolizidine alkaloid toxicity?

A
  • fibrosis
  • bile duct proliferation
  • megalocytosis
41
Q

What is Tyzzer’s Disease?

A
  • bacterial hepatitis in foals

- rapidly fatal

42
Q

What organism is responsible for Tyzzer’s disease?

A

Clostridium piliformis

43
Q

What are the clinical signs associated with Tyzzer’s disease?

A
  • sudden death
  • fever, depression, anorexia, diarrhea
  • icterus, hypoxia, tachypnea, seizures
44
Q

What is found on hematology/chemistry with Tyzzer;s disease?

A
  • elevated liver enzymes

- severe hypoglycemia

45
Q

How is Tyzzer’s disease diagnosed?

A

PCR
post-mortem is the only definitive dx
- Warthin-Starry Stain

46
Q

How is Tyzzer’s disease treated?

A
  • aggressive supportive therapy

- penicillin, tetracycline, erythromycin

47
Q

What are the possible causes of hepatic failure in foals?

A
  • pre-colostral iron fumarate toxicity
  • perinatal herpesvirus
  • leptospirosis
  • cholangitis associated with duodenal ulcers
  • ascarid migration
  • portosystemic shunt
  • hepatotoxicity (neonatal isoerythrolysis)
48
Q

What is the treatment for abnormal behavior from hepatic disease?

A

Xylazine

- avoid diazepam

49
Q

What are the methods for decreasing blood ammonia?

A
  • mineral oil, oral neomycin
  • oral lactulose
  • Metronidazole
50
Q

What are the terminal signs of hepatic disease?

A

hemolytic crisis

severe hepatoencephalopathy with fibrotic liver

Large Animal Medicine (16 decks)

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