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BVetMed3 Alimentary > Hepatic Disease In Dogs And Cats > Flashcards

Hepatic Disease In Dogs And Cats Flashcards

1
Q

What clinical signs can be associated with hepatic disease?

A 
Inappetance 
V+D
Jaundice 
Depression/lethargy 
PU/PD 
Neuro signs (HE)
Bleeding tendencies - coagulopathy 
GI ulceration
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2
Q

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

A

Changes more subtle due to shorter half life of enzymes

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3
Q

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

A

CAN - confirm presence of liver disease

CAN’T - tell you the type of lesion present

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4
Q

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

A 
Liver enzymes (ALT+ALP, GGT, AST)
Bilirubin 
Bile acids 
albumin/globulin 
Cholesterol 
Glucose
Urea
Ammonia
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5
Q

What levels of urea would you expect in hepatobiliary disease?

A

LOW

Reduced urea cycle

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6
Q

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

A

Low - synthesised in the liver

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7
Q

What can you do to investigate hepatobiliary disease?

A

Rads
Ultrasound
Biopsy - ultrasound guided or ex lap

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8
Q

Why might a liver biopsy not be performed?

A

Invasive
Expensive
Requires specialist skill

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9
Q

How long do acute hepatopathies last?

A

Days to a week

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10
Q

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

A

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

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11
Q

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

A

Labs

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12
Q

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

A

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

Drugs- Phenobarbitone (AED), carprofen

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13
Q

What neoplastic diseases can cause an acute hepatopathy?

A

Diffuse tumour infiltrate e.g. LYMPHOMA

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14
Q

What acute hepatopathy has a genetic cause?

What breed?

A

BEDLINGTONS (young animals)

Acute hepatic necrosis - copper storage disease

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15
Q

What is the end stage of chronic hepatitis?

A

Cirrhosis

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16
Q

What are the two types of cirrhosis?

A

Micro nodular

Macronodular

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17
Q

What broad categories can cause acute hepatopathies?

A

Infections/parasites
Toxic/drug related
Neoplasia
Genetic

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18
Q

What broad categories can cause chronic hepatopathies?

A 
Inflammatory 
Cirrhosis 
Neoplastic 
Drug related 
Developmental / congenital
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19
Q

What inflammatory conditions can cause chronic hepatopathy

A 
Idiopathic chronic hepatitis 
Chronic progression of acute hepatitis 
Eosinophilic and granulomatous hepatitis 
Lobular dissecting hepatitis 
Doberman hepatopathy
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20
Q

What breeds get lobular dissecting hepatitis?

A

Standard poodles

GSDs

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21
Q

What are the potential pathogeneses of Doberman hepatopathy?

A

Immune mediated

Copper toxicosis

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22
Q

What drugs can cause chronic hepatopathy?

A

GLUCOCORTICOIDS

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23
Q

What vascular developmental conditions can cause a chronic hepatopathy?

A

Congenital PSS

Portal vein hypoplasia

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24
Q

What breeds get copper storage diseases?

A

Bedlington terriers
WHWs
Dobermans (+/- immune mediated)

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25
Q

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

A 
Inflammatory 
Neoplastic 
Hepatic lipidosis 
Infectious 
Toxic/drug induced
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26
Q

What inflammatory conditions can cause acute hepatitis?

A

Acute suppurative/ neutrophilic cholangitis

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27
Q

Describe the arrangement of the bile and pancreatic ducts in the cat.

How does this affect bacterial movement?

A

have a common opening

Bacteria can therefore travel from one to the other

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28
Q

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

A

Cat

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29
Q

What neoplastic condition can cause acute hepatopathy in cats?

A

Diffuse tumour infiltrate e.g. lymphoma

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30
Q

What are the infectious causes of acute hepatitis in cats?

A

Endotoxaemia/septicaemia
Toxoplasma
FIP

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31
Q

What drugs can cause acute hepatitis in cats?

A

Diazepam
Phenobarb
Potentiated sulphonamides (not used)

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32
Q

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

A 
Inflammatory 
Amyloidosis 
Neoplasia 
Infectious 
Congenital
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33
Q

What inflammatory conditions can cause chronic hepatopathies in cats?

A

Lymphocytic cholangitis

Chronic neutrophilic cholangitis

34
Q

How can you treat lymphocytic/neutrophilic cholangitis ?

A

Corticosteroids

35
Q

What neoplastic conditions tend to cause chronic hepatopathies in cats?

A

Lymphoma

Biliary carcinoma

36
Q

What infectious conditions cause chronic hepatopathies in cats?

A

FIP

Toxoplasmosis

37
Q

What congenital conditions cause chronic hepatopathy in cats?

A

Vascular disorders e.g. PSS

38
Q

What could you use to treat hepatic disease?

A

Supportive treatment e.g. fluid therapy, acid base, electrolyte derangement.

Dietary/nutritional management

Treat underlying cause

39
Q

What diet should be used for patients with hepatopathies?

A

Low fat, Low carb

40
Q

What is a common cause of hepatopathies in cats?

What could you use to treat them?

A

Bacteria

Antibiotics

41
Q

When might you use corticosteroids to treat a hepatopathy?

A

Lymphocytic cholangitis

Immune mediated conditions

42
Q

How could you treat a copper storage disease?

A

Copper chelators

43
Q

How could you reduce ammonia levels?

44
Q

Where is jaundice most easily seen?

A

Sclera
Mucous membranes
Non-pigmented skin

45
Q

How is bilirubin formed?

A

Breakdown of haemoglobin from aged RBCs

46
Q

Which form of bilirubin is water soluble?

A

Conjugated bilirubin

47
Q

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

A

Needs to be conjugated in the liver

48
Q

Where is conjugated bilirubin excreted?

A

Kidneys - urine

Intestine

49
Q

What can cause an increase in unconjugated bilirubin?

A

Increased RBC breakdown
Decreased liver function
Decreased bilirubin excretion

50
Q

What is prehepatic jaundice?

A

HAEMOPOIETIC - Anaemia

H A E M O L Y S I S

51
Q

What type of anaemia is associated with prehepatic jaundice?

A

ALWAYS a significant regenerative anaemia

52
Q

What can cause prehepatic jaundice?

A

HAEMOLYSIS

IMHA 
Microangiopathic conditions 
Congenital 
Babesia infection 
Toxins - onion, garlic, zinc, leeks
53
Q

What microangiopathic conditions can cause prehepatic jaundice?

A

Haemangiosarcoma
Caval syndrome
Splenic torsion

54
Q

What is caval syndrome?

A

Acute manifestation of heartworm

  • large numbers of worms right side of heart
55
Q

What toxins can cause pre-hepatic jaundice?

A

Onions
Leeks
Garlic
Zinc

56
Q

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

A

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

57
Q

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

A

Inflammatory

  • acute/ chronic neutrophilic
  • chronic lymphocytic

FIP
Neoplasia
Hepatic lipidosis (uncommon UK)

58
Q

What are some causes of post-hepatic jaundice?

A 
Toxic/infectious cholangitis 
Pancreatic disease 
Infiltrating or space occupying biliary lesions
Bile duct rupture 
Intestinal pathology
59
Q

How can pancreatic disease cause post-hepatic jaundice?

What pancreatic diseases?

A

Pancreatitis
Pancreatic abscess
Pancreatic carcinoma

Interferes with bile ducts - blocks when inflamed
—> reduced biliary flow

60
Q

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

A

Abscess
Neoplasm
Mucocoele (in gall bladder)

61
Q

What is a potential consequence of bile duct rupture?

A

IRRITANT - can cause septic peritonitis

62
Q

How can intestinal pathology cause post hepatic jaundice?

A

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

63
Q

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

A

Patient seems moderately ‘well’

64
Q

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

A

Fever
Starvation
Sepsis or significant inflammation (esp. CATS)

65
Q

How much bilirubin is required to cause jaundice?

A

3X ref range

66
Q

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

A

Limited amount by Renal enzymes

67
Q

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

A

Low renal threshold so mild bilirubinuria can be NORMAL

— especially if the urine is concentrated

68
Q

Describe the renal threshold of cats for bilirubin.

A

HIGH (9X higher than dogs)

69
Q

How would you interpret a mild bilirubinuria in cats?

70
Q

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

A

Neuro - aimless walking, wall seeking, head pressing. Ultimately COMA

Intermittent GIT signs - V+D
Poor growth
PU/PD
Prolonged barbiturate/sedative recovery

71
Q

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

A

Hypersalication
Behaviour changes - aggression
Seizures
Copper coloured irides

72
Q

What Clin path findings would you associate with a PSS?

A

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

73
Q

What features of red blood cells could indicate PSS?

A

Microcytosis without evidence for anaemia

74
Q

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

A

Ammonium bifurcate crystalluria

75
Q

When might you see seizure in a dog with PSS?

A

Hypoglycaemia

76
Q

What dog breeds have an increased prevalence of PSS?

A 
Cairn terriers 
Irish wolfhounds 
Yorkshire terriers 
Maltese
Australian cattle dogs
77
Q

What are the three types of shunt?

A

Intrahepatic
Extrahepatic
Multiple

78
Q

Which breeds tend to get intrahepatic shunts?

A

Large dogs

79
Q

Which breeds tend to get extrahepatic shunts?

A

Small breeds and cats

80
Q

When are multiple shunts typically seen?

A

Secondary to hepatic cirrhosis

Occasional congenital

81
Q

What medical PSS treatment can be used?

A

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

BVetMed3 Alimentary (16 decks)

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