Hepatobiliary Disease Flashcards
Ascites
abnormal accumulationof serous fluid within the peritoneal cavity. the fluid is typically of moderate to low protein and cellularity (pure or modified transudate), and is a consequence of serious hepatic disease (that causes portal hypertension) or RHF
Cirrhosis
Progressive disease of the liver characterized by diffuse and progressive loss of hepatocytes and their replacement with fibrous tissue. Frequently results in portal hypertension, multiple acquired PSS, ascites, and ultimately liver failure
Icterus (Jaundice)
Yellow discoloration of serum/plasma and tissue (skin, sclera, mucous membranes), and excretions due to hyperbilirubinemia. Tissue discoloration is commonly seen once serum bilirubin is >2.0 mg/dl
Hepatic encephalopathy
a potentially reversible neurologic syndrome (behavioral abnormalities, mental dullness, ataxia, circling, head pressing, ptyalism(cats), cortical blindness, seizures, coma) that occurs in animals with liver failure
Acholic feces
grey-white colored feces resulting from an absence of bilirubin pigments (stercobilin) in the GI tract due to complete bile duct obstruction. This phenomenon is rare because very small amounts of bilirubin impart color to feces
Screening test for liver disease
serum biochemistry profile
Liver function test
pre & post-prandial serum bile acids
What are the most common CBC changes with hepatobiliary disease?
- Microcytosis (low MCV): common in dogs with congenital PSS
- RBC membrane abnormalities (acanthocytes, leptocytes, target cells): seen with hepatobiliary disorders due to alterations in lipoprotein metabolism
- Inflammatory leukogram: consider inflammatory hepatic disease
- Anemia: helps in your diagnostic approach to icterus (rule out hemolysis)
What are some of the more common causes of reactive hepatopathy?
- endocrinopathies
- hyperadrenocorticism, DM, hyperthyroidism
- pancreatitis
- GI disease
Three key parts of history to focus on when hepatobiliary disease is suspect and examples of specific concerns
- Diet
- new bag or recalled dog food: aflatoxin
- artificially sweetened human food: xylitol
- dietary indiscretion: pancreatitis
- Environment
- access to water: Lepto, blue-green algae
- mushroom ingestion: amanita
- ornamental plant: cycad
- Drugs
- NSAIDs
- Steroids(induction of ALP)
- Anticonvulsants(phenobarb-dogs, valium-cats)
- Antibiotics (Sulfas, tetracyclines, ketaconazole)
ALP > ALT sugggests damage to what?
biliary system (ALP is expressed in the endothelial cells that line the biliary tree)
ALT>ALP suggests what type of damage?
hepatocellular
What are the major causes of increased serum ALP?
- cholestatic liver disease
- rapid growth of bone in young animal
- drug induced (steroids, phenobarbital)
- NOT in cats
How are ALP and GGT different in cats vs. dogs?
ALP and GGT in the cat have lower liver concentrations and shorter half lives
this means ANY elevation in serum ALP & GGT is considered significant in cats
What are ddx for increased bilirubin?
- hepatic & post hepatic causes of cholestasis
- sepsis
Cholesterol decreases with _________, or may increase with ________
decreased cholesterol if liver function deteriorates
increased cholesterol in the case of cholestasis
What are the four parameters that decrease with decreased liver function?
- cholesterol
- BUN
- albumin
- glucose
USG with liver fnction is commonly _______
dilute
Some bilirubinuria may occur in _________
dogs (esp. males)
Bilirubinuria is always concerning in _____
cats
Common UA finding with congenital PSS
ammonium biurate crystals
When to collect blood for SBA test
after a 12h fast and 2h following a small meal
Differentials for increased SBA (from clin path)
Decreased clearance from portal blood
- PSS
- loss of functional mass
Decreased excretion into bile
- cholestasis (hepatic or post-hepatic
Physiologic
- gallbladder contraction may elevate fasting bile acids
When is SBA not indicated?
if patient is icteric and cannot differentiate hepatic from post-hepatic causes
