Hepatobiliary Disease Flashcards
which enzymes are markers of parenchymal disease?
aminotransferases:
alanine aminotransferase (ALT)
aspartate aminotransferase (AST)
what is reactive hepatitis like?
mild to moderate portal hepatitis
no necrosis/apoptosis
no spillover into the hepatic parenchyma
what gastrointestinal diseases are associated with elevations in ALP?
inflammatory bowel disease
pancreatitis
which serum alkaline phosphatases are inducible?
liver
corticosteroid
which drugs induce ALP in dogs?
corticosteroids
phenobarbital
penicillamine
pesticides?
supplements: CBD
which breeds are predisposed to chronic hepatitis?
bedlington
dalmations
westie
labrado retrievers
doberman pinscher
cocker spaniel
english springer spaniel
which breeds are predisposed to idiopathic vacuolar hepatopathies?
scottish terrier
miniature schnauzer
what do total serum bile acids measure?
patency of enterohepatic circulation
hepatic function
what is benign nodular hyperplasia like on histopathology?
well circumscribed hyperplastic normal hepatocytes that often contain vacuoles and are organized into cord with discernible portal area, lipogranulomas, mild mixed inflammatory infiltrates
who is benign nodular hyperplasia common in?
old dogs
what is the signalment of gallbladder mucocele?
older dogs
median body weight 15 kg
strong breed predispositions
no sex predilection
what signs can dogs with gallbladder mucocele show?
vomiting
anorexia
lethargy
abdominal pain
icterus
fever
what can cause an increase in ALP?
benign nodular hyperplasia
gallbladder mucocele
hepatocellular cancer
cholecystitis/cholangitis/cholangiohepatitis
vacuolar hepatopathy
what is seen on bloodwork with hepatocellular carcinoma?
increased ALP and ALT
less common AST and GGT
what is the etiology of vacuolar hepatopathy?
likely a reactive pattern
which breeds are associated with idiopathic vacuolar hepatopathy?
scottie
miniature schnauzer
which dog breed is over-represented in cholangitis/cholangiohepatitis/cholecystitis?
doxies
what things on ultrasound with the gallbladder are associated with bacterial infection?
immobile bile
thick, mineralized or irregular gallbladder wall/duct
what endocrine diseases are associated with elevations in ALP?
hyperadrenocorticism
diabetes mellitus
hypothyroidism- rare
hyperthyroidism: cats
which ALPs are inducible?
liver
corticosteroid
not bone
what does steroid/vacuolar hepatopathy look like on histopathology?
intracytoplasmic vacuolation
degenerative changes: piecemeal necrosis and ballooning degeneration
which breeds are shown to be predisposed to copper heptatitis?
bedlington
dalmation
which breeds are thought to be predisposed to immune hepatitis?
labradors
dobermans
cocker spaniels
english springer spaniels
what are liver enzymes like in chronic hepatitis?
usually ALT»ALP
until late stage
what is likely to be high in congenital portosystemic shunts?
ALT
who is predisposed to idiopathic vacuolar hepatopathies?
scottish terrier
miniature schnauzer
what can be used to evaluate hepatic function?
bilirubin
albumin
BUN
cholesterol
glucose
total serum bile acids
blood ammonia
what do total serum bile acids test?
measure of patency of enterohepatic circulation
hepatic function
when are total serum bile acids elevated?
congenital or acquired portosystemic shunting: screen
hepatobiliary pathology: diagnostic
is liver size usually normal with benign nodular hyperplasia?
yes
what does benign nodular hyperplasia cause in bloodwork?
mild to moderate increase ALP
mild increase ALT, GGT
bilirubin normal
maybe mild increase TSBA
what are the risk factors for gallbladder mucocele?
endocrinopathy
hyperlipidemia
biliary infection?
environmental
diet: high fat, gluten
what is bloodwork like in a gallbladder mucocele?
normal
abnormal: inflammatory leukogram, elevated liver enzymes ALP»ALT, hyperbilirubinemia
hyperlipidemia
what is prognosis like of hepatocellular carcinoma?
resection associated with prolonged survival times with low local recurrence and metastatic rates in dogs
what are clinical signs of idiopathic vacuolar hepatopathy?
many have signs compatible with corticosteroid excess
what are the consequences of idiopathic vacuolar hepatopathy?
parenchymal loss and fibrosis
neoplastic transformation
gallbladder mucocele
hepatocutaneous syndrome
proteinuria?
hypertension?
what is the triad of clinical signs that is very suggestive of cholangitis/cholangiohepatitis/cholecystitis?
icterus
fever
abdominal pain
onlu 20-55% have this
