Hepatobiliary 2 Flashcards
Which blood test would be considered critical prior to performing liver FNA or liver biopsy in an animal who is suspected of having a hepatopathy?
Coagulation times- whether it is safe to stick a needle in and possibly cause a bleed
Define chronic liver and biliary disease
Long-standing, chronic, recurrent or waxing-waning signs
List the clinical signs of chronic liver and biliary disease
inappetence and weight loss
V+
D+
PU/PD
lethary
jaundice
ascites
List 6 common differentials of chronic liver and biliary disease
Idiopathic chronic hepatitis
Copper-associated liver disease
True copper storage disease
Congenital vascular disease
Neoplasia
biliary tract disease
What is a Portosystemic Shunt
Anomalous connection between the portal and systemic venous systems- bypasses the liver
List the neuro clinical signs seen with portosystemic Shunt (PSS)-
lethargy
ataxia
obtundation
pacing
circing
blindness
seizures
come
describe how to diagnose portosystemic Shunt (PSS)-
raised liver enzymes - but not always as liver is small
Raised fasting and post-prandial bile acids; increased ammonia
Ultrasound; portogram (radiograph/ fluoroscopy); contrast CT
describe how to treat PSS
surgical ligation - generally offers greater survival times
Two types:
- complete attenuation- not tolerated well
- partial attenuation- second surgery 3-6 months later
Why is metastatic disease common in the liver
excellent blood and lymphatic supply
T/F primary liver tumours are relatively common in dogs
False- uncommon
List the signs seen with primary liver neoplasia
often non-specific- lethargy, poor appetite
or
abdominal bleed if ruptured mass
palpable mass may be only sign
describe how to treat liver neoplasia
surgery is often treatment of choice - assess for metastatic disease first
chemo only effective for lymphoma
what happens to ALT in chronic hepatitis
moderate to severe increase - due to hepatic death
what is the signalment of chronic hepatitis in dogs
middle-aged and older 8yrs but younger in springers and dobermans
describe how to treat chronic hepatitis due to inflammation
corticosteroids
anti-oxidants: SAMe; silybin/silymaris; VitE
Describe how to treat chronic hepatitis due to infection
antibiotics
Describe how to treat chronic hepatitis due to slow biliary flow
Destolit (ursodeoxycholic acid)
Describe how to treat chronci hepatitis due to ascites
diuretics
don’t tend to drain
List 3 functions of steroids
anti-inflammatory
immune-modulating
anti-fibrotic - Reduce scarring of the liver- allows liver function to be maintained for longer
what dose of prednisolone do you give to a chronic hepatitis case
immune suppressive dose
NOT just anti inflammatory
what does Ursodeoxycholic Acid do
Hydrophilic bile acid that displaces more toxic hydrophobic bile acids
Draws water in to bile
when should you not use Ursodeoxycholic Acid (UDA) in chronic hepatitis
if there is any blockage in biliary ducts (cholestasis)
describe when we use antibiotics in chronic hepatitis
- don’t do unless have C and S
if have to give ampicillin and metronidazole
List 2 histopathology changes that indicate use of antibiotics in chronic hepatitis case
○ ascending cholangitis
significant neutrophilic component to any inflammation
describe the dietary management of chronic hepatitis
High quality, highly digestible, palatable protein sources
Complex carbohydrates preferred
Only restrict fat if steatorrhoea develops
define Cirrhosis
end stage Chronic hepatitis, when architecture is very distorted, fibrosis and portal hypertension are present.
describe the prognosis of chronic hepatitis
very variable
Stable disease- might do well for years with supportive care
Springers- 6 months - steroids can increase this
list 5 biliary diseases
Inflammation of the gallbladder (cholecystitis)
Obstruction of the bile duct
Gallbladder mucocele
Gallstones (Choleliths)
Rupture of the gallbladder or bile duct
what causes Neutrophilic cholangitis
ascending infection or haematogenous spread
describe how to diagnose Neutrophilic cholangitis
bile sample
describe how to treat Neutrophilic cholangitis
antibiotic treatment based on culture results; treat for 8 weeks minimum
supportive care
list the clinical signs of Neutrophilic cholangitis
lethargy, pyrexia, vomiting, jaundice
can be acute
what do you tend to see on blood tests with Extrahepatic bile duct obstruction
Very high bilirubin
Very high ALP and GGT
Can increase ALT and AST
what causes a Bile duct rupture
usually the same as EHBDO
or possibly trauma- RTA
describe how to treat bile duct rupture
manage underlying cause
cholecystectomy - surgical repair
List the 3 endocrine diseases that gall bladder mucocoele is associated with
Hypothyroidism
Hyperadrenocorticism
Hyperlipidaemia
List 5 indications of cholecystectomy
Ruptured gallbladder
Primary neoplasia of the gallbladder
Cholecystitis that is unresponsive to medical management
Gallbladder mucocoele
Cholelithiasis
