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Clinical pathology (small) > Hepatic, intestinal and pancreatic function > Flashcards

Hepatic, intestinal and pancreatic function Flashcards

1
Q

what can be tested for relating to the liver?

A

hepatocellular injury
cholestasis
hepatocellular function
hepatic portal circulation

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2
Q

what is hepatocellular injury and how is it tested?

A

damage to hepatocytes leading to enzyme leakage

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3
Q

what is cholestasis and how is it tested for?

A

reduced/blocked bile excretion leading to enzyme release through pressure being exerted onto cells

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4
Q

what is actually being measured when looking for liver enzymes?

A

activity of enzyme (rather than the concentration)

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5
Q

what are the liver “leakage” enzymes?

A

ALT, AST, LDH, SDH, GLDH

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6
Q

what is a liver “leakage” enzyme?

A

enzymes that can be found in blood after hepatocellular damage or death

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7
Q

is ALT liver specific?

A

largely liver specific but also found in muscle

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8
Q

is AST liver specific?

A

no, found in liver and muscle

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9
Q

is LDH liver specific?

A

no, found in liver and muscle

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10
Q

is SDH liver specific?

A

yes

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11
Q

is GLDH liver specific?

A

yes

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12
Q

what does increased liver enzymes suggest?

A

hepatocellular damage

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13
Q

what does the magnitude of increase in liver “leakage” enzymes correlate to?

A

degree of hepatocellular damage

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14
Q

why are even small increases in liver “leakage” enzymes in cats significant?

A

they have a very short half life (hours)

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15
Q

what enzymes are released due to cholestasis?

A

ALP and GGT

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16
Q

what is ALT?

A

alanine aminotransferase

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17
Q

what is AST?

A

aspartate aminotransferase

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18
Q

what is LDH?

A

lactic dehydrogenase

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19
Q

what are the main liver leakage enzymes used in small animals?

A

ALT and AST

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20
Q

other than hepatocellular damage what can cause increased liver “leakage” enzymes?

A

myocyte damage can cause mild increase of AST and LDH
haemolysis can increase AST and LDH

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21
Q

what can be used to validate whether raised AST/LDH is due to muscle damage?

A

creatinine kinase (increased would indicate myocyte damage)

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22
Q

does magnitude of liver “leakage” enzymes correlate with prognosis?

A

no - magnitude of enzymes only correlates with degree of damage

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23
Q

what are the cholestatic enzymes?

A

ALP and GGT

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24
Q

where are cholestatic enzymes found?

A

on the cell membrane (pressure from cholestasis causes them to fall off)

25
Q

what is ALP?

A

alkaline phosphatase

26
Q

what can increase ALP other than cholestasis?

A

corticosteroids or phenobarbital
Scottish terriers predisposed to vacuolar hepatopathy and hence higher ALP

27
Q

what is the most specific enzyme marker for cholestasis?

A

GGT

28
Q

what bile components can increase due to cholestasis?

A

bilirubin
bile salts
cholesterol

29
Q

what are the two isoenzymes of ALP?

A

intestinal and non-tissue specific

30
Q

where does unconjugated bilirubin come from?

A

breakdown of RBCs

31
Q

where does bilirubin become conjugated?

A

liver

32
Q

what are the types of hyperbilirubinaemia?

A

pre-hepatic
hepatic
post-hepatic

33
Q

what causes pre-heptic hyperbilirubinaemia?

A

haemolysis (check anaemia)

34
Q

what causes hepatic hyperbilirubinaemia?

A

decreased bilirubin uptake, conjugation or excretion (hepatocyte dysfunction)

35
Q

what causes post-hepatic hyperbilirubinaemia?

A

obstruction of extra hepatic bile ducts

36
Q

what forms can bilirubin be measured directly as?

A

total or conjugated

37
Q

what form of bilirubin can’t be measured directly?

A

unconjugated (total minus conjugated)

38
Q

what are some clinical signs of hyperbilirubinaemia?

A

jaundice (icterus)

39
Q

why can jaundice persist even after the livers function returns to normal?

A

some bilirubin binds to albumin (delta-albumin) which persists in circulation

40
Q

how can you determine if jaundice is due to delta-albumin or not?

A

if it is due to delta-bilirubin there will be no biliruburia

41
Q

what are the functions of the liver?

A

detoxification
cholesterol and bile acid synthesis
plasma protein synthesis
RBC breakdown
carbohydrate, lipid and amino acid metabolism
removal of bacteria
clotting factor production
glycogen, iron, copper, vitamin storage

42
Q

what ways can we test for hepatocellular function?

A

decreased uptake/excretion of bilirubin and blue acids
decreased conversion of ammonia to urea
decreased synthesis of metabolites
decreased synthesis of coagulation proteins
decreased immunologic function

43
Q

what metabolites of the liver will decrease if hepatocellular function is impaired?

A

albumin, cholesterol, coagulation factors, glucose

44
Q

what is the main coagulation protein tested for in cases of suspected decreased hepatocellar function?

A

fibrinogen

45
Q

if blood supply to the liver is decreased (portosystemic shunts) what changes can be tested for?

A

decreased uptake/excretion of bile acids
decreased conversion of ammonia to urea
decreased immunologic function

46
Q

where is ammonia produced?

A

by protein digestion of bacteria metabolism in the gastrointestinal tract

47
Q

how is ammonia metabolised?

A

enters the liver via the portal vein and is taken up by hepatocytes to synthesise urea, amino acids and proteins

48
Q

how are bile acids metabolised?

A

bile salts are produced by hepatocytes and released into the biliary system and then the intestines to allow fat absorption/digestion

49
Q

what happens to the majority of bile salts released into the intestine?

A

reabsorbed from the ileum into the portal vein and return to the liver (rest is lost in faeces)

50
Q

why may bile acids be increased?

A

reduced uptake/excretion by hepatocytes
disruption of enterohepatic circulation (shunts/cholestasis)
reactive hepatopathies

51
Q

what values of fasting serum bile acids indicate hepatobiliary pathology?

A

> 25-30 mmol/L

52
Q

how are post prandial serum bile acids (bile acid stimualtion) tests carried out?

A

take resting serum bile acid
feed animal a fatty meal
sample 2 hours after feeding

53
Q

what are some possible extra hepatic diseases that lead to elevated liver enzymes?

A

hypoxia
GI and pancreatic disease
endocrine diseases
sepsis

54
Q

what are extrahepatic disease that cause elevated liver enzymes sometimes referred to as?

A

reactive hepatopathies

55
Q

how are bile acid levels effected by reactive hepatopathies?

A

usually normal or mildly elevated

56
Q

what are some abnormalities that may be seen on haematology of liver disease cases?

A

microcytosis in portosytemic shunts or severe liver insufficiency due to altered iron transport/metabolism)
ovalocytes in cats with hepatic lipidosis
acanthocytes due to disruption of normal vasculature

57
Q

what may be seen on urinalysis of liver disease cases?

A

isothenuria or low USG
bilirubinaemia
ammonium biurate crystals or uroliths (portosystemic shunts)

58
Q
A

Clinical pathology (small) (1 decks)

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