Hepatic Disease In Dogs And Cats Flashcards by Harrie Long

What clinical signs can be associated with hepatic disease?

Inappetance 
V+D
Jaundice 
Depression/lethargy 
PU/PD 
Neuro signs (HE)
Bleeding tendencies - coagulopathy 
GI ulceration

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Why is it more difficult to assess liver disease with Clin path in cats?

Changes more subtle due to shorter half life of enzymes

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What can and can’t clinical path tell you about liver disease?

CAN - confirm presence of liver disease

CAN’T - tell you the type of lesion present

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What can you look for on Clin path which would indicate hepatobiliary disease?

Liver enzymes (ALT+ALP, GGT, AST)
Bilirubin 
Bile acids 
albumin/globulin 
Cholesterol 
Glucose
Urea
Ammonia

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What levels of urea would you expect in hepatobiliary disease?

LOW

Reduced urea cycle

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What levels of albumin/globulins would you expect in hepatobiliary disease?

Low - synthesised in the liver

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What can you do to investigate hepatobiliary disease?

Rads
Ultrasound
Biopsy - ultrasound guided or ex lap

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Why might a liver biopsy not be performed?

Invasive
Expensive
Requires specialist skill

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How long do acute hepatopathies last?

Days to a week

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What Infections/ parasites can cause an acute hepatopathy in dogs?

Bacteria - Leptospira
Viruses - Adenovirus (CAV-1)
Parasites - Liver flukes
(Secondary acute hepatopathy =) Bacterial endotoxaemia/septicaemia

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In what breed is there the potential for carprofen to cause an acute hepatopathy?

Labs

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What toxins/drugs can cause an acute hepatopathy in dogs?

Toxins - aflatoxin (mouldy hay), fungi, mycotoxin (blue-green algae)

Drugs- Phenobarbitone (AED), carprofen

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What neoplastic diseases can cause an acute hepatopathy?

Diffuse tumour infiltrate e.g. LYMPHOMA

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What acute hepatopathy has a genetic cause?

What breed?

BEDLINGTONS (young animals)

Acute hepatic necrosis - copper storage disease

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What is the end stage of chronic hepatitis?

Cirrhosis

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What are the two types of cirrhosis?

Micro nodular

Macronodular

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What broad categories can cause acute hepatopathies?

Infections/parasites
Toxic/drug related
Neoplasia
Genetic

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What broad categories can cause chronic hepatopathies?

Inflammatory 
Cirrhosis 
Neoplastic 
Drug related 
Developmental / congenital

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What inflammatory conditions can cause chronic hepatopathy

Idiopathic chronic hepatitis 
Chronic progression of acute hepatitis 
Eosinophilic and granulomatous hepatitis 
Lobular dissecting hepatitis 
Doberman hepatopathy

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What breeds get lobular dissecting hepatitis?

Standard poodles

GSDs

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What are the potential pathogeneses of Doberman hepatopathy?

Immune mediated

Copper toxicosis

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What drugs can cause chronic hepatopathy?

GLUCOCORTICOIDS

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What vascular developmental conditions can cause a chronic hepatopathy?

Congenital PSS

Portal vein hypoplasia

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What breeds get copper storage diseases?

Bedlington terriers
WHWs
Dobermans (+/- immune mediated)

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What broad categories of conditions can cause acute hepatopathies in cats?

``` Inflammatory Neoplastic Hepatic lipidosis Infectious Toxic/drug induced ```

What inflammatory conditions can cause acute hepatitis?

Acute suppurative/ neutrophilic cholangitis

Describe the arrangement of the bile and pancreatic ducts in the cat. How does this affect bacterial movement?

have a common opening Bacteria can therefore travel from one to the other

Which animal has a higher bacterial load in the small intestine?

Cat

What neoplastic condition can cause acute hepatopathy in cats?

Diffuse tumour infiltrate e.g. lymphoma

What are the infectious causes of acute hepatitis in cats?

Endotoxaemia/septicaemia Toxoplasma FIP

What drugs can cause acute hepatitis in cats?

Diazepam Phenobarb Potentiated sulphonamides (not used)

What are the broad categories of causes of chronic hepatopathies in cats?

``` Inflammatory Amyloidosis Neoplasia Infectious Congenital ```

What inflammatory conditions can cause chronic hepatopathies in cats?

Lymphocytic cholangitis | Chronic neutrophilic cholangitis

How can you treat lymphocytic/neutrophilic cholangitis ?

Corticosteroids

What neoplastic conditions tend to cause chronic hepatopathies in cats?

Lymphoma | Biliary carcinoma

What infectious conditions cause chronic hepatopathies in cats?

FIP | Toxoplasmosis

What congenital conditions cause chronic hepatopathy in cats?

Vascular disorders e.g. PSS

What could you use to treat hepatic disease?

Supportive treatment e.g. fluid therapy, acid base, electrolyte derangement. Dietary/nutritional management Treat underlying cause

What diet should be used for patients with hepatopathies?

Low fat, Low carb

What is a common cause of hepatopathies in cats? What could you use to treat them?

Bacteria Antibiotics

When might you use corticosteroids to treat a hepatopathy?

Lymphocytic cholangitis Immune mediated conditions

How could you treat a copper storage disease?

Copper chelators

How could you reduce ammonia levels?

Lactulose

Where is jaundice most easily seen?

Sclera Mucous membranes Non-pigmented skin

How is bilirubin formed?

Breakdown of haemoglobin from aged RBCs

Which form of bilirubin is water soluble?

Conjugated bilirubin

What needs to happen to haemoglobin before it can be excreted?

Needs to be conjugated in the liver

Where is conjugated bilirubin excreted?

Kidneys - urine Intestine

What can cause an increase in unconjugated bilirubin?

Increased RBC breakdown Decreased liver function Decreased bilirubin excretion

What is prehepatic jaundice?

HAEMOPOIETIC - Anaemia H A E M O L Y S I S

What type of anaemia is associated with prehepatic jaundice?

ALWAYS a significant regenerative anaemia

What can cause prehepatic jaundice?

HAEMOLYSIS ``` IMHA Microangiopathic conditions Congenital Babesia infection Toxins - onion, garlic, zinc, leeks ```

What microangiopathic conditions can cause prehepatic jaundice?

Haemangiosarcoma Caval syndrome Splenic torsion

What is caval syndrome?

Acute manifestation of heartworm - large numbers of worms right side of heart

What toxins can cause pre-hepatic jaundice?

Onions Leeks Garlic Zinc

What are the most common causes of hepatic jaundice in dogs?

Infectious - Leptospirosis, adenovirus Inflammatory Neoplastic (diffuse - lymphoma) Toxins

What are the most common causes of hepatic icterus in cats?

Inflammatory - acute/ chronic neutrophilic - chronic lymphocytic FIP Neoplasia Hepatic lipidosis (uncommon UK)

What are some causes of post-hepatic jaundice?

``` Toxic/infectious cholangitis Pancreatic disease Infiltrating or space occupying biliary lesions Bile duct rupture Intestinal pathology ```

How can pancreatic disease cause post-hepatic jaundice? What pancreatic diseases?

Pancreatitis Pancreatic abscess Pancreatic carcinoma Interferes with bile ducts - blocks when inflamed —> reduced biliary flow

What infiltrating/space occupying lesions could cause post-hepatic jaundice?

Abscess Neoplasm Mucocoele (in gall bladder)

What is a potential consequence of bile duct rupture?

IRRITANT - can cause septic peritonitis

How can intestinal pathology cause post hepatic jaundice?

Obstruction of bile flow at the entrance of the common bile duct into the duodenum

What general clinical presentation may indicate that the jaundice is post hepatic ?

Patient seems moderately ‘well’

What are non-hepatic, non-anaemic causes of increased bilirubin?

Fever Starvation Sepsis or significant inflammation (esp. CATS)

How much bilirubin is required to cause jaundice?

3X ref range

Other than in the liver, where else can bilirubin be conjugated?

Limited amount by Renal enzymes

How would you interpret a mild bilirubinuria (2+) in a male dog?

Low renal threshold so mild bilirubinuria can be NORMAL — especially if the urine is concentrated

Describe the renal threshold of cats for bilirubin.

HIGH (9X higher than dogs)

How would you interpret a mild bilirubinuria in cats?

PATHOLOGY

What clinical signs are associated with PSS and HE (in dogs and cats)?

Neuro - aimless walking, wall seeking, head pressing. Ultimately COMA Intermittent GIT signs - V+D Poor growth PU/PD Prolonged barbiturate/sedative recovery

What clinical signs are additionally seen predominantly in cats? (PSS+HE)

Hypersalication Behaviour changes - aggression Seizures Copper coloured irides

What Clin path findings would you associate with a PSS?

Decreased albumin and globiluins Slight/moderate increase in ALT and ALP (or not) Low blood urea hypoglycaemia Increased fasting blood ammonia concentration Increased fasting and post-prandial bile acids Erythrocyte microcytosis

What features of red blood cells could indicate PSS?

Microcytosis without evidence for anaemia

What might you find in the urine of a patient with a PSS?

Ammonium bifurcate crystalluria

When might you see seizure in a dog with PSS?

Hypoglycaemia

What dog breeds have an increased prevalence of PSS?

``` Cairn terriers Irish wolfhounds Yorkshire terriers Maltese Australian cattle dogs ```

What are the three types of shunt?

Intrahepatic Extrahepatic Multiple

Which breeds tend to get intrahepatic shunts?

Large dogs

Which breeds tend to get extrahepatic shunts?

Small breeds and cats

When are multiple shunts typically seen?

Secondary to hepatic cirrhosis Occasional congenital

What medical PSS treatment can be used?

Medium protein diet (ammonia) Avoid red meat Lactulose Antibiotics to reduce gut flora