Hepatobiliary Flashcards
How long due puppies and kittens have elevated ALP after birth due to rapid growth?
15 wk
What two enzymes are mostly IN hepatocytes and leak out?
ALT and AST
Where else is AST found?
Muscle so correlate with CK findings.
Is how marked liver enzymes are elevated relate to prognosis?
NO
What two enzymes are membrane associated?
ALP and GGT
Where else is ALP found?
Osteoblasts
INtestinal mucosa
Renal Cortex
Placenta
ALP is shorter in what animal, cat or dog?
Cat
Are mild elevations in ALP significant in cats? dogs?
Cats yes due to the half life
Dogs no
Siberian huskies can have elevated ALP due to?
Juvenile familial reasons
Cat with high ALP and less strikingly GGT is most consistent with?
Hepatic lipidosis.
Do you have to have concurrent decrease of globlins with hypoalbuminemia with GI disease (PLE)?
No becasue increase gamma globulins can mask losses
Hypoalbuminemia indicates what type of hepatic insufficiency in cat?
Chronic because albumin has a half life of 8-10 days.
What is the most common cause for low BUN?
Restricted protein intake
High Cholesterol is observed in cats and dogs with?
Severe intrahepatic cholestasis
Extra hepatic biliary duct obstruction
Why do you get hypoglycemia in hepatobiliary disease?
Loss of gluconeogenesis
Impaired hepatic degradation of insulin.
What are differentials for hypoglycemia?
Functional hypoglycemia Sepsis Insulinoma Paraneoplastic PSS Hepatic disease Addisons
Biopsy can cause what in cats…of the liver or spleen?
Fatal shock.
What are weird causes for hyperbilirubinemia in aniamls?
Septic
Hyperthyroid in cats
Most common hepatobiliary disease in cats?
Hepatobiliary or acute hepatic lipidosis
What is the least common cause in cats for liver disease?
Chronic parenchymal disease
What is the most common hepatic disease in N. America in cats?
Primary/idiopathic hepatic lipidosis.
What is the diffference between primary and secondary hepatic lipidosis?
Primary = fat cat that is starved Secondary = skinny cat commonly DKA
Most common primary hepatobiliary diseases in cats?
Idiopathic lipdosis
Neurtophilic cholangitis
Lymphocytic cholangitis.
Cats do not produce what when it comes to ALP?
Steroid-induced isoenzyme so ALP will not go up on blood work
ALP has a short half life in what species?
Cat (6 hours) - This means any elevation of this enzyme is bad news.. because it is consistently being metabolized away.
Lipidosis can have a preliminary diagnosis from?
cytology
Primary idiopathic lipidosis can commonly see what mismatch in enzymes?
GGT normal or mildly elevated
ALP high elevation
What is the most common liver disease in Europe for cats?
Cholangitis
Three categories of cholangitis in cats?
Lymphocytic
Neuttrophilic
Liver Flukes
Quick pathophys of Neutrophilic cholangitis?
Ascending bacteriall infection
Quick pathophys of Lymhocytic cholangitis?
Unknown- maybe immune-mediated
Where can you find liver fluke eggs?
Feces or bile aspirates
What cat is over represented for lymphocytic cholangitis?
Persians
What is the difference in clinical presentation between lymphocytic and neutrophilic cholangitis in cats?
Lymphocytic is usually chronic clinical signs. Waxing and Wanning.
Neutrophilic is usually more acute
Lymphocytic cholangitis is commonly seen with protein rich ascites and its main ddx is?
FIP
Common US findings with lymphocytic cholangitis in cats?
Dilated CBD
Dilated Gall bladder
Sludge in gallbladder
Are bile aspirates warranted in lymphocytic cholangitis in cats?
No.. this is for more acute disease.
Sclerosing cholangitis can cause a liver to look like what on rads in a cat?
Big.. not small. Likely due to dilation of the bile duct.
Where are liver flukes commonly seen?
Florida and Hawaii
Liver flukes can also affect what other organ?
Pancreas
Cholecystitis in cats is commonly associated to what kind of cholangitis?
Neutrophilic
Common US signs of cholecystitis in cats?
Thickened gallbladder wall/irregular
Sludge in gallbladder
What cats are predisposed to liver cysts?
Persian
What are the common causes for Extrahepatic bile duct obstruction in cats?
Inflammation of the duodenum, pancreas, or biliary tree
Neoplasia of the biliary tree or pancreas
Choleliths are common or uncommon in cats?
Uncommon
Cats that are predisposed to amyloidosis?
Siames and Abyssinians
What other organ is commonly affected in amyloidosis besides the liver?
Kidneys
What is the quick pathophys of amyloidosis?
Some underlying chronic inflammatory process in another organ… chronic gingivitis.
Cats with hepatic amyloidosis commonly present how?
Anemia and hypotension secondary to hepatic capsule ruture and hemoabdomen.
What enzyme is commonly normal in hepatic amyloidosis cats?
ALP… this helps you differentiate them from Cholangioheps and lipidosis.
Liver tumors make up what percentage of tumors in a cat?
1-3%
Myelolipoma in a liver is suggested to be associated with>
Chronic hypoxia
Hepatic involvemnt in a diaphragmatic hernia
What is the most common malignant liver tumor in a cat?
Biliary carcinomas >50%
Aggressive behavior with diffuse intrperitoneal mets in 70-80%
Cats rarely get nodular hyperplasia T/F
True.. this is rare so a bad differential in cats
Odd diseases that cause liver tumors in cats?
FIP
Lipidosis
Amyloidosis
Toxoplasmosis commonly affects what organs in the cat?
Lungs
Liver
CNS - Eyes
Do forget about these causes for hepatitis in cats?
Toxin
Idiosyncratic
Hyperthyroid (High Liver enzymes and maybe hyperbilirubinemia)
DM - some may have high bilirubin
What happens to the liver with Cushings disease in cats?
Nothing.. they don’t have steroid response ALP and shit.
Left sided intrahepatic shunt is believed to be from what?
Patent ductus venosus
What cats are predisposed to PSS?
Persians and Himalayans
In one study, half the cats with intrahepatic PSS were what breed?
Siamese
Dogs present in acute or chronic liver disease more commonly and how does this differ from cats?
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
What is the common cause of chronic hepatitis in a dog?
Usually unknown
Who gets copper accumulation hepatitis in dogs?
Doberman Pinschers Westies White terrier Bedlington Terrier Labs in the US
Who gets copper accumulation hepatitis in dogs?
Doberman Pinschers Westies White terrier Bedlington Terrier***** Labs in the US Dalmations
How does RAAS play a role in ascites in portal hypertension?
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.
Triad of clinical signs of liver disease in dogs?
Ascites
GI ulcers
Hepatic encephalopathy
What are two prognostic indicators in chronic liver disease in dogs?
Ascites
Jaundice
Difference in radiographic ffindings of chronic liver disease in dogs vs cats?
Cats - large liver
Dogs - small
Where is copper excreted?
Bile
What breed of dog is the only one known to have true copper storage disease.. what is true copper storage disease?
Bedlington Terrier
Genetic defect is copper transport or storage
True copper storage in Bedlington terriers is commonly seen at what age?
Young to mid-age
At what age should breeders test dogs for copper storage disease?
12 months
What is secondary copper storage?
Seen in labs, dalmations and dobies… likely secondary to cholestasis.
Is infectious chronic canine hepatitis common?
No.. rare. Viral and bacterial etiologies have been reported but not common. lepto and bartonella is exception
What lepto serovar causes hepatitis in young dogs with the abscence of azotemia?
Leptospira grippotyphosa.
What chemo causes liver disease?
CCNU
Can drugs cause chronic hep in dogs?
Yes.
What is the most common cuase of acute hepatitis in dogs?
Infectious or toxic
What dog breed is predisposed to gall bladder mucoceles?
Shetland sheepdogs
Like lack of phsophatidylcholine that is a detergent of bile acids.
Number one reason for extrahepatic bile duct obstruction in a dog?
Extraluminal panc. - #1
Other differentials include: FB, Diaphragmatic hernia, strictures from previous trauma, neoplasia
When do you go to surgery and when do you not?
Go to surgery when you have something to cut.. meaning when you see an obvious mechanical obstruction.
What large breed dog usually has extrahepatic shunts rather than intrahepatic?
Collies
What breed comomonly has left intrahepatic shunts?
Irish wolf hounds
What stone is commonly seen in PSS dogs?
Urates - can’t see on rads.
Differentials for high bile acids?
PSS
Acquired PSS
Early cholestasis
Can some breeds have idiopathic postprandal bile acid concentration increases?
Yes
Maltese and Irish wolfhound puppies
Shunting anomaly with low portal pressure?
EHPSS
Shuntin anomaly with high portal pressure?
Primary portal hypoplasia
Microvascular dysplasia
Noncirrhotic portal hypertension
Arterioportal fistulas
What breed is at risk of microvasular dysplasia in a dog?
Cairn Terriers
Yorkies.
What are the typical signs of portal hypertension?
Ascites
Hepatic encephalopathy
GI ulcers
Out of the shuntin anomalies with high portal pressure does not have much clinical signs?
microvascular dysplasia
Most common cause of liver abscesses in dogs…adults vs puppies?
Puppies = navel infection Dogs = pancreatits or hepatobiliary.
What endocrinopathies put dogs at risk for liver abscesses?
Diabetes mellitus
Cushings
Prevalence of nodular hyperplasia in dogs over 14 years old?
100%
Can there be liver enzyme elevation with nodular hyperplasia?
Yes ALP (2.5-14 fold elevation)
What type of cancer is most common in the liver?
Metastatic - 2.5x more than primary
What is a common paraneoplastic disease in hepatocellular carcinoma?
Hypoglycemia due to insulin like growth factor.
Pathophysiology of hepatocutaneous syndrome?
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
Three groups of secondary hepatopathies?
Hepatocyte vacuolation
Hepatic congestion and edema
Nonspecific reactive hepatitis
Example of nonspecific reactive hepatitis?
Inflammation in the splanchnic bed… such as pancreatitis or IBD
What are the differentials for hepatosplenomegaly?
Infectious (rickettsial, fungal)
Inflammatory (SLE)
Neoplasia
Benign
