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Internal Medicine > Hepatobiliary > Flashcards

Hepatobiliary Flashcards

1
Q

How long due puppies and kittens have elevated ALP after birth due to rapid growth?

A

15 wk

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2
Q

What two enzymes are mostly IN hepatocytes and leak out?

A

ALT and AST

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3
Q

Where else is AST found?

A

Muscle so correlate with CK findings.

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4
Q

Is how marked liver enzymes are elevated relate to prognosis?

A

NO

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5
Q

What two enzymes are membrane associated?

A

ALP and GGT

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6
Q

Where else is ALP found?

A

Osteoblasts
INtestinal mucosa
Renal Cortex
Placenta

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7
Q

ALP is shorter in what animal, cat or dog?

A

Cat

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8
Q

Are mild elevations in ALP significant in cats? dogs?

A

Cats yes due to the half life

Dogs no

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9
Q

Siberian huskies can have elevated ALP due to?

A

Juvenile familial reasons

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10
Q

Cat with high ALP and less strikingly GGT is most consistent with?

A

Hepatic lipidosis.

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11
Q

Do you have to have concurrent decrease of globlins with hypoalbuminemia with GI disease (PLE)?

A

No becasue increase gamma globulins can mask losses

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12
Q

Hypoalbuminemia indicates what type of hepatic insufficiency in cat?

A

Chronic because albumin has a half life of 8-10 days.

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13
Q

What is the most common cause for low BUN?

A

Restricted protein intake

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14
Q

High Cholesterol is observed in cats and dogs with?

A

Severe intrahepatic cholestasis

Extra hepatic biliary duct obstruction

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15
Q

Why do you get hypoglycemia in hepatobiliary disease?

A

Loss of gluconeogenesis

Impaired hepatic degradation of insulin.

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16
Q

What are differentials for hypoglycemia?

A 
Functional hypoglycemia
Sepsis
Insulinoma
Paraneoplastic
PSS
Hepatic disease
Addisons
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17
Q

Biopsy can cause what in cats…of the liver or spleen?

A

Fatal shock.

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18
Q

What are weird causes for hyperbilirubinemia in aniamls?

A

Septic

Hyperthyroid in cats

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19
Q

Most common hepatobiliary disease in cats?

A

Hepatobiliary or acute hepatic lipidosis

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20
Q

What is the least common cause in cats for liver disease?

A

Chronic parenchymal disease

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21
Q

What is the most common hepatic disease in N. America in cats?

A

Primary/idiopathic hepatic lipidosis.

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22
Q

What is the diffference between primary and secondary hepatic lipidosis?

A 
Primary = fat cat that is starved
Secondary = skinny cat commonly DKA
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23
Q

Most common primary hepatobiliary diseases in cats?

A

Idiopathic lipdosis
Neurtophilic cholangitis
Lymphocytic cholangitis.

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24
Q

Cats do not produce what when it comes to ALP?

A

Steroid-induced isoenzyme so ALP will not go up on blood work

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25
Q

ALP has a short half life in what species?

A

Cat (6 hours) - This means any elevation of this enzyme is bad news.. because it is consistently being metabolized away.

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26
Q

Lipidosis can have a preliminary diagnosis from?

A

cytology

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27
Q

Primary idiopathic lipidosis can commonly see what mismatch in enzymes?

A

GGT normal or mildly elevated

ALP high elevation

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28
Q

What is the most common liver disease in Europe for cats?

A

Cholangitis

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29
Q

Three categories of cholangitis in cats?

A

Lymphocytic
Neuttrophilic
Liver Flukes

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30
Q

Quick pathophys of Neutrophilic cholangitis?

A

Ascending bacteriall infection

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31
Q

Quick pathophys of Lymhocytic cholangitis?

A

Unknown- maybe immune-mediated

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32
Q

Where can you find liver fluke eggs?

A

Feces or bile aspirates

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33
Q

What cat is over represented for lymphocytic cholangitis?

A

Persians

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34
Q

What is the difference in clinical presentation between lymphocytic and neutrophilic cholangitis in cats?

A

Lymphocytic is usually chronic clinical signs. Waxing and Wanning.
Neutrophilic is usually more acute

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35
Q

Lymphocytic cholangitis is commonly seen with protein rich ascites and its main ddx is?

A

FIP

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36
Q

Common US findings with lymphocytic cholangitis in cats?

A

Dilated CBD
Dilated Gall bladder
Sludge in gallbladder

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37
Q

Are bile aspirates warranted in lymphocytic cholangitis in cats?

A

No.. this is for more acute disease.

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38
Q

Sclerosing cholangitis can cause a liver to look like what on rads in a cat?

A

Big.. not small. Likely due to dilation of the bile duct.

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39
Q

Where are liver flukes commonly seen?

A

Florida and Hawaii

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40
Q

Liver flukes can also affect what other organ?

A

Pancreas

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41
Q

Cholecystitis in cats is commonly associated to what kind of cholangitis?

A

Neutrophilic

42
Q

Common US signs of cholecystitis in cats?

A

Thickened gallbladder wall/irregular

Sludge in gallbladder

43
Q

What cats are predisposed to liver cysts?

A

Persian

44
Q

What are the common causes for Extrahepatic bile duct obstruction in cats?

A

Inflammation of the duodenum, pancreas, or biliary tree

Neoplasia of the biliary tree or pancreas

45
Q

Choleliths are common or uncommon in cats?

A

Uncommon

46
Q

Cats that are predisposed to amyloidosis?

A

Siames and Abyssinians

47
Q

What other organ is commonly affected in amyloidosis besides the liver?

A

Kidneys

48
Q

What is the quick pathophys of amyloidosis?

A

Some underlying chronic inflammatory process in another organ… chronic gingivitis.

49
Q

Cats with hepatic amyloidosis commonly present how?

A

Anemia and hypotension secondary to hepatic capsule ruture and hemoabdomen.

50
Q

What enzyme is commonly normal in hepatic amyloidosis cats?

A

ALP… this helps you differentiate them from Cholangioheps and lipidosis.

51
Q

Liver tumors make up what percentage of tumors in a cat?

A

1-3%

52
Q

Myelolipoma in a liver is suggested to be associated with>

A

Chronic hypoxia

Hepatic involvemnt in a diaphragmatic hernia

53
Q

What is the most common malignant liver tumor in a cat?

A

Biliary carcinomas >50%

Aggressive behavior with diffuse intrperitoneal mets in 70-80%

54
Q

Cats rarely get nodular hyperplasia T/F

A

True.. this is rare so a bad differential in cats

55
Q

Odd diseases that cause liver tumors in cats?

A

FIP
Lipidosis
Amyloidosis

56
Q

Toxoplasmosis commonly affects what organs in the cat?

A

Lungs
Liver
CNS - Eyes

57
Q

Do forget about these causes for hepatitis in cats?

A

Toxin
Idiosyncratic
Hyperthyroid (High Liver enzymes and maybe hyperbilirubinemia)
DM - some may have high bilirubin

58
Q

What happens to the liver with Cushings disease in cats?

A

Nothing.. they don’t have steroid response ALP and shit.

59
Q

Left sided intrahepatic shunt is believed to be from what?

A

Patent ductus venosus

60
Q

What cats are predisposed to PSS?

A

Persians and Himalayans

61
Q

In one study, half the cats with intrahepatic PSS were what breed?

A

Siamese

62
Q

Dogs present in acute or chronic liver disease more commonly and how does this differ from cats?

A

Chronic that progresses to fibrosis and is parenchymal— this is commonly progresses to portal hypertension

Cats are acute and hepatobiliary with no fibrosis or portal hypertension

63
Q

What is the common cause of chronic hepatitis in a dog?

A

Usually unknown

64
Q

Who gets copper accumulation hepatitis in dogs?

A 
Doberman Pinschers
Westies
White terrier
Bedlington Terrier
Labs in the US
65
Q

Who gets copper accumulation hepatitis in dogs?

A 
Doberman Pinschers
Westies
White terrier
Bedlington Terrier*****
Labs in the US
Dalmations
66
Q

How does RAAS play a role in ascites in portal hypertension?

A

Lack of organ perfusion… RAAS is activated. Pooling of blood in the splanchnic region… RAAS cause retention of water by retention causing increased pressure and therefore edema.

67
Q

Triad of clinical signs of liver disease in dogs?

A

Ascites
GI ulcers
Hepatic encephalopathy

68
Q

What are two prognostic indicators in chronic liver disease in dogs?

A

Ascites

Jaundice

69
Q

Difference in radiographic ffindings of chronic liver disease in dogs vs cats?

A

Cats - large liver

Dogs - small

70
Q

Where is copper excreted?

A

Bile

71
Q

What breed of dog is the only one known to have true copper storage disease.. what is true copper storage disease?

A

Bedlington Terrier

Genetic defect is copper transport or storage

72
Q

True copper storage in Bedlington terriers is commonly seen at what age?

A

Young to mid-age

73
Q

At what age should breeders test dogs for copper storage disease?

A

12 months

74
Q

What is secondary copper storage?

A

Seen in labs, dalmations and dobies… likely secondary to cholestasis.

75
Q

Is infectious chronic canine hepatitis common?

A

No.. rare. Viral and bacterial etiologies have been reported but not common. lepto and bartonella is exception

76
Q

What lepto serovar causes hepatitis in young dogs with the abscence of azotemia?

A

Leptospira grippotyphosa.

77
Q

What chemo causes liver disease?

A

CCNU

78
Q

Can drugs cause chronic hep in dogs?

A

Yes.

79
Q

What is the most common cuase of acute hepatitis in dogs?

A

Infectious or toxic

80
Q

What dog breed is predisposed to gall bladder mucoceles?

A

Shetland sheepdogs

Like lack of phsophatidylcholine that is a detergent of bile acids.

81
Q

Number one reason for extrahepatic bile duct obstruction in a dog?

A

Extraluminal panc. - #1

Other differentials include: FB, Diaphragmatic hernia, strictures from previous trauma, neoplasia

82
Q

When do you go to surgery and when do you not?

A

Go to surgery when you have something to cut.. meaning when you see an obvious mechanical obstruction.

83
Q

What large breed dog usually has extrahepatic shunts rather than intrahepatic?

A

Collies

84
Q

What breed comomonly has left intrahepatic shunts?

A

Irish wolf hounds

85
Q

What stone is commonly seen in PSS dogs?

A

Urates - can’t see on rads.

86
Q

Differentials for high bile acids?

A

PSS
Acquired PSS
Early cholestasis

87
Q

Can some breeds have idiopathic postprandal bile acid concentration increases?

A

Yes

Maltese and Irish wolfhound puppies

88
Q

Shunting anomaly with low portal pressure?

A

EHPSS

89
Q

Shuntin anomaly with high portal pressure?

A

Primary portal hypoplasia
Microvascular dysplasia
Noncirrhotic portal hypertension

Arterioportal fistulas

90
Q

What breed is at risk of microvasular dysplasia in a dog?

A

Cairn Terriers

Yorkies.

91
Q

What are the typical signs of portal hypertension?

A

Ascites
Hepatic encephalopathy
GI ulcers

92
Q

Out of the shuntin anomalies with high portal pressure does not have much clinical signs?

A

microvascular dysplasia

93
Q

Most common cause of liver abscesses in dogs…adults vs puppies?

A 
Puppies = navel infection
Dogs = pancreatits or hepatobiliary.
94
Q

What endocrinopathies put dogs at risk for liver abscesses?

A

Diabetes mellitus

Cushings

95
Q

Prevalence of nodular hyperplasia in dogs over 14 years old?

A

100%

96
Q

Can there be liver enzyme elevation with nodular hyperplasia?

A

Yes ALP (2.5-14 fold elevation)

97
Q

What type of cancer is most common in the liver?

A

Metastatic - 2.5x more than primary

98
Q

What is a common paraneoplastic disease in hepatocellular carcinoma?

A

Hypoglycemia due to insulin like growth factor.

99
Q

Pathophysiology of hepatocutaneous syndrome?

A

Disorder of the liver that is causing a metabolic hepatopathy (thought to be from glucagonomas in the pancreas) with increasing hepatic catabolism of amino acids with decreases their peripheral availability causing malnutrition of the skin, particularly in areas of poor blood supply like the extremities.

Been reported secondary to phenobarbital.

Common endocrine disease associated with hepatocutaneous syndrome… DM

100
Q

Three groups of secondary hepatopathies?

A

Hepatocyte vacuolation
Hepatic congestion and edema
Nonspecific reactive hepatitis

101
Q

Example of nonspecific reactive hepatitis?

A

Inflammation in the splanchnic bed… such as pancreatitis or IBD

102
Q

What are the differentials for hepatosplenomegaly?

A

Infectious (rickettsial, fungal)
Inflammatory (SLE)
Neoplasia
Benign

Internal Medicine (12 decks)

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