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Companion Animal Med & Surgery > Hepatobiliary Disease > Flashcards

Hepatobiliary Disease Flashcards

1
Q

Ascites

A

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

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2
Q

Cirrhosis

A

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

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3
Q

Icterus (Jaundice)

A

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

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4
Q

Hepatic encephalopathy

A

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

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5
Q

Acholic feces

A

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

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6
Q

Screening test for liver disease

A

serum biochemistry profile

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7
Q

Liver function test

A

pre & post-prandial serum bile acids

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8
Q

What are the most common CBC changes with hepatobiliary disease?

A
  • 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)
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9
Q

What are some of the more common causes of reactive hepatopathy?

A
  • endocrinopathies
    • hyperadrenocorticism, DM, hyperthyroidism
  • pancreatitis
  • GI disease
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10
Q

Three key parts of history to focus on when hepatobiliary disease is suspect and examples of specific concerns

A
  • 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)
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11
Q

ALP > ALT sugggests damage to what?

A

biliary system (ALP is expressed in the endothelial cells that line the biliary tree)

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12
Q

ALT>ALP suggests what type of damage?

A

hepatocellular

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13
Q

What are the major causes of increased serum ALP?

A
  • cholestatic liver disease
  • rapid growth of bone in young animal
  • drug induced (steroids, phenobarbital)
    • NOT in cats
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14
Q

How are ALP and GGT different in cats vs. dogs?

A

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

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15
Q

What are ddx for increased bilirubin?

A
  • hepatic & post hepatic causes of cholestasis
  • sepsis
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16
Q

Cholesterol decreases with _________, or may increase with ________

A

decreased cholesterol if liver function deteriorates

increased cholesterol in the case of cholestasis

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17
Q

What are the four parameters that decrease with decreased liver function?

A
  • cholesterol
  • BUN
  • albumin
  • glucose
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18
Q

USG with liver fnction is commonly _______

A

dilute

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19
Q

Some bilirubinuria may occur in _________

A

dogs (esp. males)

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20
Q

Bilirubinuria is always concerning in _____

A

cats

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21
Q

Common UA finding with congenital PSS

A

ammonium biurate crystals

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22
Q

When to collect blood for SBA test

A

after a 12h fast and 2h following a small meal

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23
Q

Differentials for increased SBA (from clin path)

A

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
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24
Q

When is SBA not indicated?

A

if patient is icteric and cannot differentiate hepatic from post-hepatic causes

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25
Q

Breeds predisposed to copper storage hepatopathy

A
  • Bedlington terrier
  • Doberman pinscher
  • Dalmation
  • Labrador retriever
  • West highlan white terrier
  • Skye terrier
  • Cocker spaniel
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26
Q

Breeds predisposed to biliary disease

A
  • Shetland sheepdogs
  • Cocker spaniels
  • Chihuahua
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27
Q

Breeds predisposed to liver vascular anomalies (PSS, portal v. hypoplasia)

A
  • yorkie
  • maltese
  • lhasa apso
  • cairn
  • schnauzer
  • pug
  • shih tzu
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28
Q

List some secondary hepatopathies and the associated serum chem findings that may tip you off to them

A

DM-hyperglycemia

Hypotheyroidism-hypercholesterolemia

Hyperlipidemia-hypertriglyceridemia

Lymphoma-hypercalcemia

Pancreatitis-elevated amylase/lipase

PLE-panhypoproteinemia

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29
Q

What should you do if serum chem is normal but patient has signs of encephalopathy?

A

Liver function tests

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30
Q

What are two instances where liver failure may be present & patient has signs of encephalopathy, but the serum chem is normal?

A
  • congenital PSS
  • late-stage fibrosis
31
Q

Pre-hepatic hyperbilirubinemia is due to _________

A

increased hemolysis of RBCs

32
Q

Ddx for hepatic causes of hyperbilirubinemia

A
  • cholangitis
  • diffuse hepatocellular disease
    • ​hepatic lipidosis
    • infectious (lepto) or idiopathic cholangiohepatitis
    • neoplastic (e.g. lymphoma)
  • drug or toxin - induced injury
33
Q

Differentials for post-hepatic hyperbilirubinemia

A
  • pancreatitis
  • cholecystitis/mucocele
  • liver flukes, choleliths
  • pancreatic or biliary neoplasia
34
Q

3 ddx for increased cholesterol besides liver

A
  • hyperlipidemia disorders
  • hypothyroidism
  • nephrotic syndrome
35
Q

Ddx for decreased cholesterol besides decreased liver function

A

PLE

36
Q

Differentials for decreased glucose besides decreased liver function

A
  • insulinoma
  • Addison’s disease
  • Toy breed glycogen storage defect
  • sepsis
37
Q

What are some differentials for decreased albumin besides decreased liver function?

A
  • PLN
  • PLE
  • vasculitis
  • blood loss
38
Q

Feline-tests for dx reactive hepatopathy

A
  • fPLE/abdominal ultrasound (pancreatitis)
  • T4 (hyperthyroid)
  • fecal sedimentation (liver flukes; SE US)
  • Infectious dz titers/PCR (Cytaux, Toxo, Histo, etc)
39
Q

Canine-tests for dx of reactive hepatopathy

A
  • cPLI/abdominal ultrasound (pancreatitis)
  • ACTH stim/LDDST (Cushing’s)
  • infectious disease titers/PCR (Lepto)
40
Q

SBA and secondary hepatopathies?

A

most secondary hepatopathies will have normal SBA

41
Q

Liver synthesizes what clotting factors?

A

II, VII, IX, X

(vitamin K dependent)

42
Q

Liver size is best evaluated with ______

A

abdominal rads

43
Q

Ddx for hepatomegaly

A

Infiltrative disease

  • round cell neoplasia
  • extramedullary hematopoeisis
  • acute inflammation

Storage (vacuolar) disorder

  • lipid
  • glycogen
  • congenital
  • amyloid

Congestion

  • RHF
44
Q

What should you always do if you have an abdominal effusion?

A

fluid analysis & cytology

45
Q

What are some potential gallbladder/biliary problems?

A

sludge, edema, mucoceole, calcification, choleliths, neoplasia

46
Q

What are some vascular problems with the liver?

A
  • intra-hepatic shunt
  • congenital single PSS
  • multiple acquired extrahepatic shunts
  • portal vein hypoplasia
  • portal hypertension
  • arteriovenous fistula
47
Q

Diagnostic procedure for gallbladder/biliary issues

A

percutaneous ultrasound - guided cholecystocentesis

48
Q

What type of biopsy is needed for copper quantification?

A

laparoscopic/surgical biopsy

49
Q

Potential causes of canine chronic hepatitis

A
  • familial (includes copper storage disorders)
  • drug associated, aflatoxins
  • infectious
    • chronic bacterial cholangitis, lepto, infectious canine hepatitis
  • idiopathic/immune-mediated
50
Q

What does D-penicillamine do?

A

chelates copper

51
Q

Dietary considerations for dog with chronic hepatitis

A
  • high quality protein (only restrict if signs of hepatic encephalopathy)
  • Copper restricted diet if excess copper identified
  • anti-oxidant rich
  • highly palatable
52
Q

What are the signs associated with hepatic encephalopathy?

A

Behavioral

  • personality change (aggression)
  • staring, pacing
  • psychogenic PU/PD

Neurologic

  • cortical signs (head-pressing, seizures, coma)
  • vestibular (staggering, ataxia, circling)

Gastrointestinal

  • vomiting (+/- hematemesis; e.g. if GI ulcers)
  • hypersalivation (esp. cats)
  • diarrhea (+/- melena)
  • inappetence/anorexia
53
Q

Liver fluke-scientific name

A

Platynosomum concinnum

54
Q

Very abnormal coag profiles are most likely in what cases?

A
  • acute liver failure
  • complete bile duct obstruction
  • DIC
55
Q

Contrast radiographs aren’t usually used to evaluate hepatobiliary disease with the exception of _______________

A

portosystemic shunts, in which case portal venography is sometimes used to confirm presence or location of a shunt vessel.

56
Q

What is the use of splenoportal scintigraphy?

A

to look for portosystemic shunting when it is suspected but cannot be confirmed with ultrasound

57
Q

Liver biopsy-why and when?

A
  • determine a diagnosis and prognosis of a suspected hepatobiliary disorder (e.g. unknown cause of hepatomegaly, persistently elevated liver enzymes, abnormal liver function test, or hepatic icterus)
  • stage neoplastic disease
  • determine hepatic involvement of a systemic disease
  • assess response of hepatobiliary disease to therapy
58
Q

S-adenosylmethionine (SAMe) mechanism of action

A

provides methionine in support of glutathione synthesis->defense against oxidative injury

59
Q

Considerations when giving SAMe

A
  • give on empty stomach
  • be particular about the source/ Denosyl-SD4 has proven bioavailability
60
Q

Treatment for amanita mushroom

A

Silibinin/Silymarin (Milk thistle)

61
Q

Potential side effects of colchicince

A
  • hemorrhagic gastroenteritis
  • bone marrow suppression
  • renal injury
  • peripheral neuropathies
  • potential teratogenic and abortifacient effects-warn owners
62
Q

Colchicine can be used concurrently with what drugs?

A
  • UDCA
  • glucocorticoids
  • antioxidants
63
Q

Colchicine is NOT recommended to use concurrently with what drugs?

A
  • azathioprine
  • methotrexate
  • chlorambucil
64
Q

Most important non-inflammatory liver disease in cats

A

hepatic lipidosis

65
Q

Two type of inflammatory liver diseases seen in cats. which is most common?

A
  • neutrophilic cholangitis (most common)
  • lymphocytic cholangitis
66
Q

What breed of cat tends to get lymphocytic cholangitis more?

A

persians

67
Q

____% of cats with cholangitis also have pancreatitis

A

50%

68
Q

___% of cats with cholangitis also have IBD

A

83%

69
Q

Histologic findings-canine chronic hepatitis

A
  • mixed inflammation
  • hepatocyte apoptosis/necrosis
  • fibrosis
  • biliary hyperplasia
  • nodular regeneration
70
Q

Diagnostic test for hepatic icterus

A

liver biopsy

71
Q

Diagnostic test for posthepatic icterus

A

abdominal ultrasound

72
Q

Diagnostic test for prehepatic icterus

A

PVC and TS

73
Q
A

Companion Animal Med & Surgery (12 decks)

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