Hepatobiliary 2

Question 1

what is a common hepatic disease in dogs? it is hepatic inflammation lasting over 4-6 months, and is characterized by historical features

Answer 1

canine chronic hepatitis

Question 2

most cases of canine chronic hepatitis are caused by what

Answer 2

idiopathic (drug, infectious, toxins, primary immune, Cu storage, ???)

Question 3

what diagnostic findings with canine chronic hepatitis

Answer 3

elevation of ALT especially and less dramatically cholestatic parameters
late stage hypoalb and hyperbili
micro hepatic and fluid may be present late stage
US may see acquired shunts or increased nodularity

Question 4

what should you do prior to a liver biopsy

Answer 4

coagulaition testing

Question 5

canine chronic hepatitis: what are you looking for on histopath and biopsy?

Answer 5

histopath: extent of fibrosis, necrosis, inflammation primary lymphocytic and plasma cells, infectious agent or Cu (underlying etiology)
other biopsy: see Cu analysis (staining and quantification), culture

Question 6

treatment of canine chronic hepatitis

Answer 6

specific therapy: remove etiology (leptospirosis, CU associated toxicity) or if no underlying etiology ID’d use corticosteroids (prednisone 1-2 mg/kg, taper) and cyclosporine for immunomodulatory therapy
if ascites, diuretic (spironolactone) and abdominocentesis PRN
treat HE if present
hepatoprotectants

Question 7

what is prognosis with canine chronic hepatitis

Answer 7

early dx with appropriate therapy: good
late dx with extensive bridging fibrosis or cirrhosis: poor to guarded

Question 8

both ______ and ________ can lead to copper accumulation

Answer 8

primary liver dz and primary Cu storage dz

Question 9

breed predispositions to Cu storage dz

Answer 9

Bedlington terrier, Wecie, Lab

Question 10

how is Cu -assoc liver dz dx

Answer 10

histopath: Cu accumulation, inflamamtion, fibrosis
quantitative metal analysis
genetic analysis: Bedlingtin terrier and Lab screen
the C/S are: either acute pressure, chronic hepatitis, or subclinical

Question 11

when is Cu-assoc liver disease therapy recommended

Answer 11

elevated Cu on quantification, which can vary lobe to lobe; when deposition is focused on zone 3 (perivenular); when there is hepatic necrosis intermixed with Cu-positive granules

Question 12

what are therapeutic options for Cu-assoc liver dz, in general

Answer 12

diet: liver diet with low CU, higher Zn (nnec commercially avail, home cooked can be good too)
chelation therapy D-penicillamine
Zn supplementation bc this decreases Cu absorption
hepatosupportive meds