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!Equine Medicine And Surgery > Hepatic Dz > Flashcards

Hepatic Dz Flashcards

1
Q

General CS of Hepatic Dz

A

Depression, anorexia, WL, Icterus, ataxia
+/- hepatic encephalopathy

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2
Q

Diagnostic tests for hepatic dz

A

Hx, CS, Chem, UA, Fecal (parasites), fibrinogen (MDB)
Enzymatic (detect dz): GGT, ALP, GLDH, AST, SDH
Function tests: BR, BA, globulin, glucose, BUN, triglycerides, albumin
Hepatic US and bx (histopathology)

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3
Q

Tx therapy goals for Hepatic Dz (general)

A

Remove cause and tx dz (prevent more absorption)
Prevent ammonia production and absorption (gut)
Diet (↓ protein and ↑ carbs)
Supportive therapy (IV, analgesics, abx)

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4
Q

Plant species associated with pyrrolizdine toxicity (PA)

A

Ragwort, buttereeed, groundsel, rattlebox,

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5
Q

How do horses obtain PA toxicity?

A

Consumed when it’s only green forage available or in baled hay (unpalatable when fresh)
CS 14d after ingestion

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6
Q

CS of PA toxicity

A

Chronic progressive
Liver failure signs, WL, behavior, aimless wandering and pacing
Licking inanimate objects, blindness
Convulsions & coma then death

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7
Q

Pyrrolizidine Toxicity (PA) pathology

A

GIT absorption → detox in the liver → pyrroles → bind to protein and nucleic acid within hepatocytes →cross linked DNA → megalocytosis →die and replaced by fibrous tissue

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8
Q

Dx PA

A

MBD: ↑ liver enzymes and BA
Bx (confirming)
Chemistries + CBC: BA, SDH, triglycerides

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9
Q

Results of bx of a horse with ACUTE PA toxicity

A

Acute: periportal changes, moderate to severe centrilobular necrosis with hemorrhage

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10
Q

Results of bx of a horse with CHRONIC PA toxicity

A

Hepatocellular death in portal areas
Megalocytosis, fibrosis, biliary hyperplasia

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11
Q

Tx of PA toxicity

A

Remove source, prevent further absorption
IV fluids, NSAIDs
Stabilize membranes (antioxidants, Vit E)

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12
Q

Modified diet of a horse with PA toxicity

A

Low amounts of high-quality protein
Large amounts of complex CHO (no grain, grass only)

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13
Q

Other hepatic toxins

A

Phenylbutazone, flunixin, acetaminophen, salicylates and antifungals
@ high doses for long time

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14
Q

Parsacaris equorum (parasite)

A

Horses <2y (adults immune)
Burrows in SI → migrate through veins to liver, heart and lungs

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15
Q

CS of P. equorum

A

Young, dull dry hair coat, slow growth, +/- cough, nasal discharge

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16
Q

Dx P. equorum

A

Hx, signalment and fecal (>400 eggs found)

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17
Q

Tx of P. equorum

A

slow kill anthelmintics (fenbendazole)
Vitamin/ mineral
Fluids, NSAIDs, analgesics PRN
If colic: sx

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18
Q

Verminous hepatitis

A

Larval migration through hepatic parenchyma
Tx: NSAIDs (dead worms in body) and DMSO (10%)

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19
Q

Large strongyles

A

S. edentatus (liver and peritoneum)
S equinus (liver)
S. vulgaris

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20
Q

CS of large strongyles infestation

A

Poor performance, dull/ rough hair coat, diarrhea, WL, recurring colic, pot belly and stunted growth

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21
Q

What diseases cause equine hepatitis

A

Acute Hepatic necrosis (Theiler’s/ serum sickness)
Parvovirus and hepacivirus
Tyzzer’s
Cholangiohepatitis

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22
Q

Acute Hepatic Necrosis

A

Associated with vaccines and summer/fall
Limited to adult horses
Acute to subacute

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23
Q

CS of acute hepatic necrosis

A

Admin vx 1-3w before
Hepatic failure, anorexic, icteric, head pressing and sudden death

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24
Q

Parvo and Equine Hepacivirus

A

Cause acute inflammation or no CS and ↑ liver enzymes for a few weeks
Healthy carriers with no CS = reservoirs for infection
Differentiate via serology

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25
Q

Equine Parvovirus Hepatitis (EqPV-H)

A

Adult horses 4-12w post admin of vx
CS: lethargy, anorexia, jaundice, neurologic symptoms (HE)

26
Q

What causes EqPV-H

A

Vx- infected blood products
Insect vector, nasal or fecal shedding

27
Q

Equine Hepacivirus (EqHV)

A

Subclinical dz in adult horses with transient mild elevated hepatic enzyme
Causes chr. hepatitis and liver failure during PI

28
Q

Cholangiohepatitis and Cholangitis

A

Acute liver failure: severe inflamm. of the biliary tract and parenchyma

29
Q

What causes Cholangiohepatitis and Cholangitis

A

Duodenitis, intestinal obstruction, cholelithiasis, parasitism and neoplasia

30
Q

CS of Cholangiohepatitis and Cholangitis

A

Mild, recurrent colic, inappetence, icterus, depression, HE, pyrexia
Chr: WL, head pressing and fever

31
Q

Pathophysiology of Cholangiohepatitis and Cholangitis

A

Asc. bacterial infection via sphincter of Oddi (gram- rods)
E. coli, Salmonella, Actinobacter
Choleliths
Large colon displacement in adult horse and duodenal ulceration in foals

32
Q

Dx Cholangiohepatitis and Cholangitis

A

MDB + US (swollen/ rounded edges + choleliths)
Liver bx: Neutros in portal triads and degenerate parenchyma + purulent exudate in ducts

33
Q

Tx of Cholangiohepatitis and Cholangitis

A

Decompression PRN (colic)
Antimicrobials (4-6w) analgesics and dietary change (bland diet)

34
Q

Prognosis of Cholangiohepatitis and Cholangitis

A

Good if no fibrosis
Guarded if HE, severe periportal or bridging fibrosis

35
Q

Tyzzer’s Dz

A

Acute necrotizing hepatitis (fatal)
Foals 7-42d in good flesh, well-nourished
+/- sudden death w/o CS (progress rapid)

36
Q

What causes Tyzzer’s Dz

A

Clostridium piliforme- motile, obligate intracytoplasmic gram- spore forming rod
In soil

37
Q

Risk facts associated with Tyzzer’s Dz

A

↑ protein and CHO in diet (affects microflora) → pathogenic bacteria overgrowth
Stress, immunosuppressive drugs and antibacterials

38
Q

Histopath for Tyzzer’s Dz

A

Foci areas of coagulative necrosis with infiltrate of neutros, macros and lymphos
Warthin-Starry or Diesterl’s silver stain

39
Q

CS of Tyzzer’s Dz

A

Non-specific: comatose or dead
Lethargy, depression, fever and jaundice
+/- loss of suckle reflex

40
Q

Necropsy for Tyzzer’s Dz

A

Hepatomegaly (1-5mm)
White foci scattered throughout parenchyma
Icterus and hemorrhage

41
Q

Tx for Tyzzer’s Dz

A

None, glucose +supportive therapy
Guarded to poor (fatal)

42
Q

Hyperlipemia and hepatic lipidosis

A

Metabolic dz of ponies, AMH, donkeys
Periods of negative energy balance and physiologic stress
Poor prog with hepatic signs

43
Q

History associated with Hyperlipemia and hepatic lipidosis

A

Prolonged stress/ WL
Obesity and sudden ↓/ change in feed
Heavy pregnancy, late or early lactation
↓ quality feed + high energy demand
↑ energy demand + poor quality feed intake/ ↓ feed intake

44
Q

Dx Hyperlipemia and hepatic lipidosis

A

CBC, chem and fibrinogen
BA >30, ↑ liver enzymes and triglycerides > 500 mg/dl
Grossly discolored serum/ plasma

45
Q

Necropsy for Hyperlipemia

A

Liver and kidneys: pale, swollen and friable. Greasy texture

46
Q

Histopath for Hyperlipemia

A

Fat deposits in the hepatocytes and bile duct epithelium
Hepatic sinusoids compressed and anemic

47
Q

Nutritional support for Hyperlipemia

A

Reverses negative energy balance
Promotes endogenous insulin release
Inhibits fat mobilization

48
Q

Hyperlipemia resolution

A

Resolves in 5-10d with tx and diet change
May not reverse in ponies and donkeys
If doesn’t resolve: hepatic fatty infiltration

49
Q

Hepatic lipidosis dx

A

Obese pony, AMH, or lactating
Blood serum/ plasma: opalescent
US: rounded edges, compressed ducts and diffuse parenchyma
Chem: hepatic dysfunction
Histopath: fatty infiltration

50
Q

Necropsy of Hepatic lipidosis

A

Swollen, pale, friable, cut surface
Nutmeg appearance and bulging

51
Q

Tx of hepatic lipidosis

A

Remove underlying cause
IV fluids with electrolytes, dexmeth, dextrose
Reduce workload of liver: glucose IV
Inhibit fat mobilization form adipose tissue (insulin and glucose)

52
Q

Cholelithiasis

A

Rare common biliary pathway dz
6-15y with icterus, abdominal pain that gets worse + pyrexia, depression and WL

53
Q

Pathophysiology of Cholelithiasis

A

Sludging of bile
Colic + intestinal inflamm. : bacteria → bile ducts open→ asc. nidus → precipitation of bile

54
Q

Dx Cholelithiasis

A

MDB
US: mult. hyperechoic lesions
Bx: fibrosis around intrahepatic bile duct (occlusion of common bile duct)

55
Q

Tx of Cholelithiasis

A

IV fluids + electros
Antimicrobials, lactulose (if high ammonia), DMSO and diet
Euthanize if bad!

56
Q

Prognosis of Cholelithiasis

A

Poor to grave: extensive/ bridging fibrosis, multiple choleliths + hepatic failure and atrophy and HE

57
Q

Which drug is contraindicated with hepatic insufficiency?

A

Diazepam: enhance effect of GABA and exacerbate HE

58
Q

When do you use HCO3-

A

Acidosis
If corrected to rapidly: ↑ blood ammonia, hypokalemia or alkalosis →↑ renal production of ammonia → ↑ diffusion of ammonia into CNS

59
Q

What should horses avoid in their diet with hepatic dz?

A

Avoid alfalfa and legume hay

60
Q

Hepaticencephalopathy

A

Benzodiazepine receptor antagonist- induces clinical and electrophysiologic remission of HE in human: flumazenil and bromocriptine (dopamine agonist)
Thiamine: reduce risk for neuropathies

61
Q

Abx for hepatic dz

A

Abx: ceftiofur, penicillin and gentamicin

62
Q

Aslike clover

A

Big liver syndrome
Chr. consumption
Irreversible liver dz associated with neurologic symptoms

!Equine Medicine And Surgery (18 decks)

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