Hepatic Disease in Dogs and Cats

Question 1

Label this liver!

Answer 1

Question 2

What are the clinical signs of hepatic disease?

Answer 2

• Inappetence/anorexia, vomiting +/- diarrhea
• Jaundice, depression/lethargy, PU/PD
• Neurological - encephalopathy
• Bleeding tendencies - coagulopathies (lack of clotting factors)
• GI ulceration

Question 3

What is the timeline of acute vs chronic hepatopathies?

Answer 3

Acute - Days to weeks
Chronic - weeks to months

Question 4

What are the causes of acute hepatopathies in Dogs?

Answer 4

Infections/parasites
Toxic/Drug induced
Neoplasia
Genetic

Question 5

What are the causes of chronic hepatopathies in Dogs?

Answer 5

Inflammatory
Cirrhosis
Neoplastic
Drug-Related
Developmental/Congenital

Question 6

List the infectious (viral, bacterial, parasitic) causes of acute hepatitis in dogs?

Answer 6

Leptospira
Canine Adenovirus (CAV-1)
Bacterial endotoxemia/septicemia
Parasitic - liver flukes

Question 7

What are some toxic/drug-induced causes of acute hepatitis in dogs? How does this differ from the cause of drug-related chronic hepatitis?

Answer 7

Acute - phenobarbitone, carprofen, sulphonamides, fungi, alfatoxins, mycotoxins (blue-green algae)
Chronic - glucocorticoids

Question 8

Which neoplasia is commonly responsible for acute hepatopathies in dogs? What about in cats

Answer 8

lymphoma (both)

Question 9

List some inflammatory conditions associated with chronic hepatopathies in dogs?

Answer 9

Idiopathic chronic hepatitis
Chronic progession of acute hepatopathy
Eosinophilic/granulomatous hepatitis
Lobular dissecting hepatitis (hepatic reaction)
Doberman hepatopathy (copper storage? immune mediated?

Question 10

List some inflammatory conditions associated with chronic hepatopathies in cats?

Answer 10

Accute supperative/neutrophilic cholangitis
Common and leads to jaundice (post-hepatic)

Question 11

What are developmental/congenital causes of acute vs chronic hepatitis in dogs? What are the breed predispositions?

Answer 11

Same thing can cause both acute and chronic disease
Copper storage disease a cause of both
Possibly immune mediated
Bedlington terriers, Westies, Dobermans

Question 12

What is cirrhosis the end stage of? What are the 2 types?

Answer 12

End stage of chronic hepatitis
Macronodular and Micronodular

Question 13

How does hepatic lipidosis occur in cats? What is another (common) name for this disease? Does this cause acute or chronic hepatopathies in cats?

Answer 13

Not a disease on its own
Result of overweight cats not eating = changes in fat metabolism → accumulation of fat in liver (fatty liver)
Acute

Question 14

What are some infectious causes of acute hepatopathies in cats? Which of these can also cause chronic hepatopathies?

Answer 14

Bacterial endotoxemia/septicemia
Toxoplasmosis - also chronic
Feline Infectious Peritonitis (FIP) - also chronic

Question 15

What is the virus which causes FIP?

Answer 15

Feline coronavirus

Question 16

Which drugs can induce acute hepatopathies in cats?

Answer 16

Diazepam
Phenobarbitone
Potentiated sulphonamides

Question 17

Which drugs can induce acute hepatopathies in dogs?

Answer 17

phenobarbitone
Carprofen
potentiated sulphonamides

Question 18

Which toxins can induce acute hepatopathies in dogs?

Answer 18

Aflatoxins (Fungi on Corn/Maize)
Mycotoxins (Blue-green algae)

Question 19

What are the causes of chronic hepatopathies in cats?

Answer 19

Inflammatory
Amyloidosis
Neoplasia
Infectious
Congenital

Question 20

What are the inflammatory causes of chronic hepatopathies in cats?

Answer 20

lymphocytic cholangitis
Chronic neutrophilic cholangitis

Question 21

What is the name for cholangitis which also involves the pancreas and gut?

Answer 21

Triaditis

Question 22

Which biliary neoplasia is a common cause of chronic hepatopathies in cats?

Answer 22

biliary carcinoma

Question 23

What is a congenital cause of chronic hepatopathies in cats?

Answer 23

congenital portosystemic shunt

Question 24

What is the challenge with diagnosing hepatobiliary disease in dogs/cats

Answer 24

Clinical signs are few and unique

Question 25

What kind of organ is the liver? What does it do when another body system is not functioning well?

Answer 25

Reactive organ

Question 26

What are the challenges with clinical pathology assessment (BW)?

Answer 26

- May or may not indicate liver disease is present - More difficult to assess in cats than in dogs as changes are more subtle in part due to shorter half life of enzymes - Even if blood tests confirm presence of liver disease, they will usually not indicate the type of lesion present

Question 27

Which values do you test on clin path if you suspect liver disease?

Answer 27

- Liver enzymes (ALT, ALP, GGT, AST) - Bilirubin, Bile Acids, Albumin/Globulin - Cholesterol, Glucose, Urea, Ammonia

Question 28

What does ALT indicate? Why do you need to be careful with interpretation?

Answer 28

Alanine Transaminase Leakage enzyme Indicates hepatic parenchymal damage T = TRAUMA Liver leaks for many reasons (heart failure, gut disease, hemolysis, etc)

Question 29

Which tissue is ALT highest in? How does it get into the blood?

Answer 29

Liver Liver cells release ALT into the bloodstream when they are damaged

Question 30

Which tissue is ALP highest in?

Answer 30

Liver and bone

Question 31

Which tissue is AST highest in?

Answer 31

heart, muscle, kidney, brain, pancreas, lung

Question 32

Which tissue is GGT highest in?

Answer 32

liver, kidney, pancreas and intestine

Question 33

What does ALP/GGT indicate? What does ALP/GGT test?

Answer 33

Alkaline phosphatase - ALP tests how much ALP is circulating in the bloodstream Gamma-glutamyl transferase - GGT tests how much GGT is in bloodstream Indicates cholestasis (slow down of bile flow) and liver damage

Question 34

What does decrease in Albumin indicate?

Answer 34

Decreased levels indicate losses of >80% of hepatic function or renal/gut loss

Question 35

What do globulins indicate? Are they a reliable indicator of hepatic disease?

Answer 35

Can be increased or decreased in hepatic disease - Not reliable

Question 36

How do glucose levels change in advanced hepatic failure?

Answer 36

Decrease

Question 37

How do urea levels change in advanced hepatic failure?

Answer 37

Decrease

Question 38

How do ammonia levels change in advanced liver failure? What other abnormality can change ammonia levels?

Answer 38

Increased Shunts

Question 39

What are the best diagnostic imaging aids for diagnosing hepatobiliary disease?

Answer 39

Radiology Ultrasound CT Scanning

Question 40

What are the methods for biopsy in hepatobiliary disease?

Answer 40

U/S biopsy Laparoscopy Exploratory surgery

Question 41

Is "liver disease" a final diagnosis? How do you treat an animal with liver disease if you do not yet know the cause

Answer 41

No - need to continue to investigate Treat symptoms first, but do no harm Sometimes evidence will allow an informed guess based on species, demographics, age, etc.

Question 42

What can treatment of hepatic disease involve?

Answer 42

Supportive treatment (fluid therapy, management of acid/base and electrolyte derangements) Abx (if needed) Dietary mgmt/nutritional support Antioxidants Ursodeoxycholic acid (used for treatment of chronic cholestasis and jaundice) Anti-inflammatories (corticosteroids) Treatment of specific complications: - Copper chelators, Anti-fibrotics - Hepatic encephalopathy, gastroduodenal ulceration