Hepatic Disease in Dogs and Cats Flashcards
Label this liver!
What are the clinical signs of hepatic disease?
- Inappetence/anorexia, vomiting +/- diarrhea
- Jaundice, depression/lethargy, PU/PD
- Neurological - encephalopathy
- Bleeding tendencies - coagulopathies (lack of clotting factors)
- GI ulceration
What is the timeline of acute vs chronic hepatopathies?
Acute - Days to weeks
Chronic - weeks to months
What are the causes of acute hepatopathies in Dogs?
Infections/parasites
Toxic/Drug induced
Neoplasia
Genetic
What are the causes of chronic hepatopathies in Dogs?
Inflammatory
Cirrhosis
Neoplastic
Drug-Related
Developmental/Congenital
List the infectious (viral, bacterial, parasitic) causes of acute hepatitis in dogs?
Leptospira
Canine Adenovirus (CAV-1)
Bacterial endotoxemia/septicemia
Parasitic - liver flukes
What are some toxic/drug-induced causes of acute hepatitis in dogs? How does this differ from the cause of drug-related chronic hepatitis?
Acute - phenobarbitone, carprofen, sulphonamides, fungi, alfatoxins, mycotoxins (blue-green algae)
Chronic - glucocorticoids
Which neoplasia is commonly responsible for acute hepatopathies in dogs? What about in cats
lymphoma (both)
List some inflammatory conditions associated with chronic hepatopathies in dogs?
Idiopathic chronic hepatitis
Chronic progession of acute hepatopathy
Eosinophilic/granulomatous hepatitis
Lobular dissecting hepatitis (hepatic reaction)
Doberman hepatopathy (copper storage? immune mediated?
List some inflammatory conditions associated with chronic hepatopathies in cats?
Accute supperative/neutrophilic cholangitis
Common and leads to jaundice (post-hepatic)
What are developmental/congenital causes of acute vs chronic hepatitis in dogs? What are the breed predispositions?
Same thing can cause both acute and chronic disease
Copper storage disease a cause of both
Possibly immune mediated
Bedlington terriers, Westies, Dobermans
What is cirrhosis the end stage of? What are the 2 types?
End stage of chronic hepatitis
Macronodular and Micronodular
How does hepatic lipidosis occur in cats? What is another (common) name for this disease? Does this cause acute or chronic hepatopathies in cats?
Not a disease on its own
Result of overweight cats not eating = changes in fat metabolism → accumulation of fat in liver (fatty liver)
Acute
What are some infectious causes of acute hepatopathies in cats? Which of these can also cause chronic hepatopathies?
Bacterial endotoxemia/septicemia
Toxoplasmosis - also chronic
Feline Infectious Peritonitis (FIP) - also chronic
What is the virus which causes FIP?
Feline coronavirus
Which drugs can induce acute hepatopathies in cats?
Diazepam
Phenobarbitone
Potentiated sulphonamides
Which drugs can induce acute hepatopathies in dogs?
phenobarbitone
Carprofen
potentiated sulphonamides
Which toxins can induce acute hepatopathies in dogs?
Aflatoxins (Fungi on Corn/Maize)
Mycotoxins (Blue-green algae)
What are the causes of chronic hepatopathies in cats?
Inflammatory
Amyloidosis
Neoplasia
Infectious
Congenital
What are the inflammatory causes of chronic hepatopathies in cats?
lymphocytic cholangitis
Chronic neutrophilic cholangitis
What is the name for cholangitis which also involves the pancreas and gut?
Triaditis
Which biliary neoplasia is a common cause of chronic hepatopathies in cats?
biliary carcinoma
What is a congenital cause of chronic hepatopathies in cats?
congenital portosystemic shunt
What is the challenge with diagnosing hepatobiliary disease in dogs/cats
Clinical signs are few and unique
What kind of organ is the liver? What does it do when another body system is not functioning well?
Reactive organ
What are the challenges with clinical pathology assessment (BW)?
- 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
Which values do you test on clin path if you suspect liver disease?
- Liver enzymes (ALT, ALP, GGT, AST)
- Bilirubin, Bile Acids, Albumin/Globulin
- Cholesterol, Glucose, Urea, Ammonia
What does ALT indicate? Why do you need to be careful with interpretation?
Alanine Transaminase
Leakage enzyme
Indicates hepatic parenchymal damage
T = TRAUMA
Liver leaks for many reasons (heart failure, gut disease, hemolysis, etc)
Which tissue is ALT highest in? How does it get into the blood?
Liver
Liver cells release ALT into the bloodstream when they are damaged
Which tissue is ALP highest in?
Liver and bone
Which tissue is AST highest in?
heart, muscle, kidney, brain, pancreas, lung
Which tissue is GGT highest in?
liver, kidney, pancreas and intestine
What does ALP/GGT indicate? What does ALP/GGT test?
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
What does decrease in Albumin indicate?
Decreased levels indicate losses of >80% of hepatic function or renal/gut loss
What do globulins indicate? Are they a reliable indicator of hepatic disease?
Can be increased or decreased in hepatic disease - Not reliable
How do glucose levels change in advanced hepatic failure?
Decrease
How do urea levels change in advanced hepatic failure?
Decrease
How do ammonia levels change in advanced liver failure? What other abnormality can change ammonia levels?
Increased
Shunts
What are the best diagnostic imaging aids for diagnosing hepatobiliary disease?
Radiology
Ultrasound
CT Scanning
What are the methods for biopsy in hepatobiliary disease?
U/S biopsy
Laparoscopy
Exploratory surgery
Is “liver disease” a final diagnosis? How do you treat an animal with liver disease if you do not yet know the cause
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.
What can treatment of hepatic disease involve?
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
