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Small Animal Med > Hepatobilliary > Flashcards

Hepatobilliary Flashcards

1
Q

Historical Problems Associated w/ Hepatobilliary Dz

A
  • vomiting
  • Ds
  • PU/PD
  • stranguria/pollakiuria/hematuria
  • icterus
  • seizures or abnormal mentation
  • abdominal distension / pain
  • excessive salivation
  • coagulopathy
  • acholic stools
  • anorexia / weight loss
  • lethargy
  • fever
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2
Q

Clinical Pathology Associated w/ Hepatobilliary Dz

A
  • anemia
  • target cells
  • low BUN
  • hypoalbuminemia
  • hypoglycemia
  • increased ALP, GGT, ALT
  • hyperbilirubinemia
  • isosthenuria
  • hematuria
  • bilirubinuria
  • ammonium birate or bilirubin crystals
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3
Q

Diagnosing Hepatobilliary Dz

A
  • abdominal rads
  • abdominal ultrasound
  • pre/post prandial bile acids
  • coag panel
  • liver fine needle aspirate or biopsy
  • bile or liver culture
  • abdominocentesis
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4
Q

Indications for Doing a Liver Biopsy or FNA

A

At least 2 lobes should be sampled
1) Unexplained, persistent increases in liver enzyme activities and/or abnormal hepatic function tests
2) determine cause of architectural abnormalities such as irregular contours, nodules or changes in echogenicity
3) stage neoplastic diseases (e.g. mast cell tumors in dogs, lymphoma)
4) assess response to therapy for previously diagnosed disorder
5) follow progression of previously diagnosed disease if not treated

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5
Q

Risks of a Liver Biopsy

A

bleeding
* try to do caog panel first

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6
Q

When to sample & culture
Bile

A
  • when obtaining liver biopsy in cats or dogs
  • cats that have ultrasonographic gallbladder abnormalities
  • dogs w/ unexplained liver enzyme increases,
  • maybe dogs w/ fever of unknown origin
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7
Q

Reasons for Pure Transudate abdominal effusion

A
  • portal hypertension
  • hypoalbuminemia <1
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8
Q

Antibiotics for bacterial hepatobiliary infection

A
  • ampicillin/ penicillin G,
  • cefazolin,
  • enrofloxacin,
  • amikacin/gentamicin,
  • tetracycline/doxycycline
  • metronidazole
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9
Q

Managing Liver Dz

A
  • treat underlying cause
  • low protein diet
  • Lactulose (encephalopathy)
  • antibiotics
  • glucocorticoids to suppress inflammation
  • H2 antagonists to reduce ulcers
  • diruetics
  • Ursodeoxycholic acid decreases viscocity of bile (don’t use in obstruction)
  • Colchicine to inhibit fibrin formation
  • Vit K
  • Vit E
  • SAMe
  • Silymarin
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10
Q

Portosystemic Shunts; Clinical Signs

A
  • Poor growth
  • Mental dullness, seizures or other neurologic abnormalities
  • Polyuria/polydipsia
  • Pollakiuria/stranguria/hematuria (from cystic calculi)
  • Poor anesthetic recovery
  • copper irises (cats)
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11
Q

Portosystemic Shunts; Clin Path, Imaging

A

Clin Path
* Mild microcytic anemia
* Hypoalbuminemia
* Low BUN
* Low urine specific gravity
* urate crystals
* Normal or mildly increased AP and ALT
* increased in pre- and post-prandial bile acids
* Hyperbilirubinemia (acquired shunts)

Imaging
* Small liver on rads
* visible shunt on ultrasound
* visible shunt on Contrast venous portograms or contrast CT (best)

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12
Q

Portal Vein Hypoplasia; Clinical Signs, Diagnosis

A

Clinical Signs
* Poor growth
* Mental dullness, seizures or other neurologic abnormalities
* Polyuria/polydipsia
* Pollakiuria/stranguria/hematuria (from cystic calculi)
* Poor anesthetic recovery
* abdominal effusion w/ portal hypertension

Diagnosis
* liver biopsy to exclude other shunting dz

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13
Q

Hepatic Cirrhosis; Cause, Clin Path

A

Cause
* end stage of many liver diseases due to persistent inflammation

Clin Path
* hyperbilirubinemia
* signs of portosystemic shunt

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14
Q

Copper Storage Dz; Pathophysiology, Diagnosis, Treatment

A

Pathophysiology
* abnormal excretion of copper from hepatocytes into the biliary system
* association w/ Bedlington terriers, West Highland white terriers, Doberman and Labs

Diagnosis
* Copper found in abnormal amounts in liver biopsy
* test for mutations in COMMD1 gene

Treatment
* Zinc acetate to impair copper absorption
* Penicillamine or tetramine to help excrete Cu

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15
Q

Hepatic Neoplasia in Dogs; Common neoplasms, Diagnosis

A
  • Primary - Carcinoma
  • Metastatic - Hemangiosarcoma & lymphoma

Diagnosis
* FNA
* biopsy

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16
Q

Vacuolar Hepatopathy; What is it

A

non-specific cytologic/histologic diagnosis that suggests underlying systemic or liver disease

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17
Q

Hepatic Lipidosis; Pathophysiology, Clinical Signs

A
  • obese cat quits eating for SOME reason (usually 2wks) ->
  • accumulation of lipid in liver ->
  • hepatobiliary dysfunction

Clinical SIgns
* anorexia / lethargy
* weight loss
* icterus
* vomiting
* coagulopathies
* hepatic encephalopathy
* hepatomegaly
* non-regenerative anemia
* increased ALT/ALP
* hyperbilirubinemia
* hypercholestrolemia

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18
Q

Hepatic Lipidosis; Diagnosis, Treatment

A

Diagnosis
* lipid vacuolation of hepatocytes on liver biopsies
* rule out underlying dz, such as cholangiohepatitis, pancreatitis, GI/other organ dz

Treatment
* high protein diet (unless encephalopathy)
* Vit K (coagulopathies)
* Vit E
* support

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19
Q

Inflammatory Liver Dz; Signalment, Clinical Signs, Diagnosis, Treatment

A

Cats

Clinical Signs
* Anorexia/weight loss/ lethargy
* Icterus
* Vomiting
* Fever (neutrophilic cholangitis)
* Increased ALT, ALP, GGT, bilirubin
* Hyperglobulinemia (lymphocytic cholangitis)
* Neutrophilic leukocytosis (neutrophilic cholangitis)

Diagnosis
* Histo
* bile cytology/culture

Treatment
* glucocorticoids (lymphocytic)
* antibiotics (neutrophilic)

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20
Q

Hepatic Neoplasia in Cats

A
  • uncommon

Metastatic
* lymphoma,
* myeloproliferative,
* mast cell,
* hemangiosarcoma

Primary
* bile duct adenoma
* adenocarcinoma

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21
Q

Extrahepatic Bile Duct Obstruction; Causes, Clinical Signs, Diagnosis, Treatment

A

Causes
* tumors of pancreas, duodenum, bile duct
* choleliths
* stricture or edema

Signs
* icterus
* signs of underlying disorder

Diagnosis
* rads, ultrasound, CT of gallbladder & biliary
* surgery to look at gallbladder & biliary

Treatment
* surgery to remove obstruction

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22
Q

Cholecystitis; Pathophysiology, Clinical Signs

A

Pathophysiology
* Ascension of bacteria from GI
* E coli, Enterococcus, Bacteroides, Strep, Clostridium
* Bacterial cholecystitis -> common causes of gallbladder rupture

Clinical Signs
* abdominal pain
* fever
* vomiting
* icterus
* poor appetite
* may be abdominal effusion (gallbladder rupture)
* leukocytosis
* hyperbilirubinemia,
* increased ALT, AST, and ALP

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23
Q

Cholecystitis; Diagnosis, Treatment

A

Diagnosis
* gas in biliary tree on rads
* sludge & wall thickening on ultrasound (cats)
* (+) bile culture
* presence of bacteria on bile cytology

Treatment
* Antibiotics
* maybe surgery to establish patency of bile duct or remove gall bladder

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24
Q

Gallbladder mucocele; Signalment, Diagnosis, Treatment

A

Signalment
* shetland sheepdogs
* dogs w/ hyperadrenocorticism

Diagnosis
* incidental on ultrasound
* signs of gallbladder rupture
* signs of biliary obstruction

Treatment
* surgery
* may resolve w/ ursodial but takes a LONG time

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25
Q

Diseases in Cats that Can Present w/ Stomatitis/Glossitis

A
  • Calicivirus & herpes
  • FELV/FIV
  • lymphocytic/plasmacytic stomatitis
  • feline eosinophilic granuloma complex
  • immune mediated dz
  • severe peridontal dz
  • physical trauma
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26
Q

Features that Differentiate Regurgitation from Vomiting

A
  • absence of abdominal effort
  • lack of prodromal signs of retching and nausea
  • appearance of undigested food that may have tubular form
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27
Q

Esophagitis; Causes, Clinical Signs, Diagnosis, Treatment

A

Causes
* injury from gastric reflux or chronic vomiting
* foreign body
* ingestion of caustic substance

Signs
* clinically silent
* signs of stricture

Diagnosis
* lesions on esophagoscopy

Treatment
* proton-pump inhibitors (omeprazole)
* metoclopramide and cisapride to enhance the tone of the LES
* crushed sucralfate suspended in water?

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28
Q

Esophageal Stricture; Diagnosis, Treatment

A

Diagnosis
* esophagoscopy (best)
* contrast rads

Treatment
* repeated dilation by balloon catheter or bougienage
* rarely sx due to sx causing stricture

29
Q

Megaesophagus; Causes, Diagnosis of Cause, Management

A

Causes
* Myasthenia Gravis!!
* esophagitis
* long-term obstruction
* congenital

Diagnosis
* CBC, Chem, Urinalysis
* Acetylcholine receptor Ab test
* neuro exam
* thyroid and adrenal function tests

Management
* sildenafil may help congenital
* find food form that works for individual
* feed upright
* maybe gastrotomy tube to avoid aspiration/pneumonia

30
Q

Diagnostic Approach to Regurgitation

A
  • physical exam of oral cavity, pharynx, esophagus, and thoracic cavity
  • rads to evaluate esophagus
  • contrast rads if no aspiration pneumonia
  • esophagram or esophagoscopy
  • fluoroscopic gastrogram to assess pyloric function
31
Q

Features that Distinguish Vomiting from Regurgitation

A
  • restlessness,
  • lip-licking,
  • hypersalivation,
  • retching,
  • frequent swallowing
  • strong and forceful abdominal contractions
32
Q

Foreign Body & Complete Obstruction; Clinical Signs

A
  • hypochloremia
  • increased T CO2 (metabolic alkalosis
33
Q

Gastric Neoplasia; Types, Clinical Signs, Diagnosis

A

Types
* gastric adenocarcinoma (dogs)
* gastric lymphosarcoma (cats)
* spindle cell tumors

Signs
* vomiting
* anorexia/weight loss
* hematemesis
* abdominal pain
* maybe anemia
* neutrophilia
* hypoproteinemia

Diagnosis
* thickened region of the stomach wall or mass on ultrasound or CT
* biopsy for definitive

34
Q

Acute Gastritis; Causes, Treatment

A

Causes
* dietary indiscretion
* forein material
* NSAIDs

Treatment
* NPO for 12-24hrs
* fluids
* maybe anti-emetics

35
Q

Food Hypersensitivity/Intolerance; Diagnosis

A
  • dietary exclusion trial
  • gastroscopic food testing
  • serum allergy test
36
Q

Erosive/Ulcerative Gastritis; Causes, Clinical Signs, Treatment

A

Causes
* chronic corticosterids
* chronic NSAIDs
* gastrinoma
* mast cell tumor
* gastric neoplasia
* kidney dz
* hepatic failure
* pancreatitis
* hypoadrenocorticism
* hypovolemia / septic shock

Signs
* vomiting
* hematemesis
* melena
* maybe anemia

Treatment
* proton pump inhibitors
* misoprostol
* sucralfate

37
Q

Acute Pancreatitis; Causes, Pathogenesis

A

Causes
* nutritional: high fat, other sources of canine dietary indiscretion
* trauma/ hypovolemia/ ischemia
* hypercalcemia
* drugs: corticosteroids, maybe azathioprine
* hyperlipidemia
* toxo and FIP (cats)

Pathogenesis
* activation of trypsin and other enzymes ->
* autodigestive process ->
* disrupts cells and leads to production/release of inflammatory mediators & activated pancreatic enzymes->
* local and systemic inflammation and organ dysfunction ->
* clinical signs of pancreatitis

38
Q

Acute Pancreatitis; Clinical Signs

A

Signs
* abdominal pain,
* maybe effusion
* dehydration/shock
* icterus
* fever
* inflammatory leukogram
* thrombocytopenia
* increased amylase / lipase
* increased ALT /ALP
* hyperbilirubinemia
* bilirubinuria
* hypocalcemia
* hypercholesterolemia/ triglyceridemia
* increased TLI & PLI

39
Q

Acute Pancreatitis; Diagnosis, Treatment

A

Diagnosis
* rads w/ lost detail in R cranial quadrant
* ultrasound w/ pancreatic enlargement
* peritoneal lavage (not often)
* exploratory sx (not often)

Treatment
* IV fluids
* NPO or slow feeding
* tube feeding for cats
* buprenorphine for pain
* antibiotics (???)
* maybe plasma
* maropitant

40
Q

Association between Renal Dz & Vomiting

A
  • uremia
  • acute urinary tract obstruction causes stretch of renal capsule
  • acute nephritis/pyelonephritis causes stretch of renal capsule
41
Q

Diagnostic Approach to Vomiting

A
  • history & PE ->

if in-depth diagnostics not needed ->
* NPO,
* fluids,
* antiemetics
* antibiotics
* monitor

Diagnostics
* CBC / Chem
* PLI
* T4 (especially cats)
* urinalysis
* basal cortisol
* rads
* test for infectious dz

  • look for non-GI cause
  • food trial
42
Q

Small Vs Large Bowel Ds

A

Small
* maybe melena
* normal - increased volume
* normal - increased frequency
* weightloss w/ chronicity
* often vomit
* fat or undigetsed food

Large
* tenesmus
* mucus
* hematochezia
* normal - decreased volume
* increased frequency
* urgency

43
Q

Acute Hemorrhagic Diarrhea Syndrome; Signalment, Clinical Signs, Diagnosis, Treatment

A

Signalment
* young adult dogs
* mini schnauzers

Clinical Signs
* Ds
* depression
* shock
* fever
* abdominal pain
* hematemesis

Diagnosis
* PCV 65-70%
* lower than expected TP/albumin

Treatment
* fluids
* broad spectrum Abs (??)

44
Q

Canine Parvovirus; Transmission, Signalment, Clinical Signs

A

Transmission
* fecal-oral

Signalment
* 6-12wks old
* rottweilers & dobermen up to 6mo

Signs
* fever
* vomiting
* abdominal pain
* depression
* shock
* bloody Ds

45
Q

Canine Parvovirus; Diagnosis, Treatment

A

Diagnosis
* lymphopenia
* anemia
* hypoproteinemia
* increased BUN/creat
* ELISA sanp

Treatment
* IV fluids (may supplement Vit K)
* broad-spectrum Abs
* maropitant
* maybe enteral nutrition
* blood transfusion if anemic
* equine antiserum
* maybe stool transplant

46
Q

Feline Panleukopenia Virus; Transmission, Signalment, Clinical Signs, Diagnosis, Treatment

A

Transmission
* fecal oral
Signalment
* 12-20 wks old

Clinical Signs
* silent, acute, or sudden death
* fever, depression, anorexia
* vomiting
* uncommonly Ds
* abdominal pain
* thickened intestinal loops
* mesenteric lymphadenopathy

Diagnosis
* canine ELISA snap

Treatment
* IV fluids (may supplement Vit K)
* broad-spectrum Abs
* maropitant

47
Q

Salmon Poisoning; Clinical Signs, Diagnosis, Treatment

A

Signs
* fever, anorexia, lethargy
* Ds (often hemorrhagic)
* vomiting
* lymph node enlargement

Diagnosis
* fluke eggs in stool
* organisms in macrophages from lymph node aspirate
* thrombocytopenia

Treatment
* oxytetracycline or doxycyclinefor 3d
* support

48
Q

Hookworms; Signalment, Clinical Signs, Diagnosis, Treatment

A

Signalment
* worse in puppies

Signs
* bloody Ds
* profound anemia / iron deficiency

Diagnosis
* ova in fecal float

Treatment
* antithelmentics
* transfusion or iron supp

49
Q

Roundworms; Signalment, Clinical Signs, Diagnosis, Treatment

A

Signalment
* worse in puppies

Signs
* Ds
* maybe intestinal obstruction

Diagnosis
* ova in fecal float

Treatment
* antithelmentics

50
Q

Cystoisospora; Signalment, Clinical Signs, Diagnosis, Treatment, Prevention

A

Signalment
* clinical signs in young pups

Signs
* Ds

Diagnosis
* oocysts in fecal float

Treatment
* sulfonamides

Prevention
* treat bitches around whelping

51
Q

Giardia; Clinical Signs, Diagnosis, Treatment

A

Signs
* Ds

Diagnosis
* observation of organisms in fecal smear
* zinc sulfate fecal float
* ELISA snap

Treatment
* metronidazole
* fenbendazole
* albendazole
* febantel/pyrantel/praziquantel
* bathing

52
Q

Lymphocytic/Plasmacytic Enteritis; Clinical Signs, Diagnosis, Treatment

A

Clinical Signs
* chronic small bowel Ds
* ascites
* thickened SI loops
* mesenteric lymph node enlargement

Diagnosis
* exclusion of other causes
* biopsy of SI
* difficult to distinguish from lymphosarcoma

Treatment
* maybe be antibiotics
* restricted fat diet w/ novel protein & carb
* corticosteroids
* cobalamin

53
Q

Protein Losing Enteropathy; Clinical Signs

A
  • chronic Small bowel Ds
  • weight loss
  • abdominal and/or pleural effusion
  • peripheral edema
  • panhypoprteinemia (or just hyoalbuminemia)
54
Q

Intestinal Lymphangiectasia; Causes, Clinical Signs,

A

Causes
* inflammation of mesenteric/serosal lymphatics -> lymphatic obstruction
* neoplasia -> lymphatic obstruction
* idiopathic
* R side heart failure
* pericardial dz

Signs
* looks like PLE
* anemia
* thrombocytosis
* neutrophelia
* maybe lymphopenia
* hypoalbuminemia
* hypoglobulinemia
* hypocholesterolemia
* effusions

55
Q

Small Cell Intestinal Lymphoma; Species, lesions, Diagnosis

A

most common in cats

Lesions
* diffuse mucosal invasion,
* intestinal wall thickening,
* loss of wall layering on ultrasound

Diagnosis
o homogenous lymphocytes on Immunohistochemistry of GI biopsy
o PARR detect clonal expansion of T or B cells

56
Q

Small Cell Intestinal Lymphoma; lesions, Diagnosis

A

Lesions
o focal thickenings or masses in any segment of the GI tract
o markedly enlarged mesenteric lymph nodes

Diagnosis
o aspiration of lymph nodes & cytology

57
Q

Antibiotic Responsive Diarrhea; Clinical Signs

A

Clinical Signs
o small intestinal diarrhea,
o weight loss w/ normal, or increased appetite
o little to nothing of interest on CBC, Chem, imaging, etc

58
Q

Small Intestinal Dysbiosis; Predisposing Factors, Clinical Signs, Diagnosis, Treatment

A

Predisposing Factors
o luminal stasis
o exocrine pancreatic insufficiency

Clinical Signs
o small bowel Ds that respond to antibiotics but recur at completion of meds

Treatment
o correction of cause
o ampicillin, amoxicillin, tetracycline

59
Q

Histiocytic Colitis of Boxers & French Bulldogs; Cause, Clinical Signs, Diagnosis, Treatment

A

Cause
o enteroinvasive E. coli

Clinical SIgns
o large bowel Ds

Diagnosis
o demonstration in tissue by fluorescence i-situ hybridization

Treatment
o enrofloxacin

60
Q

Tritrichomonas foetus; Clinical Signs, Diagnosis, Treatment

A

Clinical Signs
o large bowel Ds in cats

Diagnosis
o wet mount stool sample
o fecal culture
o fecal PCR

Treatment
o difficult
o Ronidazole (not on market)
o may spontaneously resolve after 2 yrs

61
Q

Trichuris vulpis; Clinical Signs, Diagnosis, Treatment

A

Clinical Signs
o large bowel Ds in dogs in endemic areas

Diagnosis
o fecal float
o (-) fecal does not rule out

Treatment
o anthelmintic active against whipworms

62
Q

Idiopathic Inflammatory Colitis; Types, Clinical Signs, Treatment

A

Types
o lymphocytic/plasmacytic
o suppurative
o eosinophilic

Clinical SIgns
o large bowel Ds

Treatment
o increase fiber
o feed hypoallergenic diet
o feed low residue diet
o sulfasalazine
o corticosteroids

63
Q

Exocrine Pancreatic Insufficiency; Clinical Signs Dogs Vs Cats, Diagnosis, Treatment

A

Signs in Dogs
o small bowel Ds
o greasy voluminous stools
o poor weight gain/weight loss w/ normal or ravenous appetite

Signs in Cats
o weight loss w/ normal or increased appetite OR anorexia
o Ds
o vomiting
o lethargy

Diagnosis
o low TLI
o often low cobalamin

Treatment
o pancreatic enzyme supps
o high carb / low fat diet
o broad spectrum antibiotics if concurrent SI dysbiosis

64
Q

Diagnostic Approach to General Diarrhea

A

o thorough physical including rectal
o fecal analysis for parasites
o fecal analysis for infectious dz
o pursue further diagnostics dependent on small or larger bowel

65
Q

Diagnostic Approach to Small Bowel Diarrhea

A

o after parasites and exam abnormalities ruled out
o GI panel for TLI, Cobalamin, Folate
o imaging
o diet trial
o antibiotic trial
o glucocorticoid trial

66
Q

Diagnostic Approach to Large Bowel Diarrhea

A

o after parasites and exam abnormalities ruled out
o dietary trial
o stool culture
o endoscopy & biopsy of colon

67
Q

Perianal Fistula; Signalment, Pathogenesis, Diagnosis, Treatment

A

Signalment
o commonly German Shepherds

Pathogenesis
o diet, or bacterial flora of the large intestine, or the anal sacs produce antigens ->
o inflammation ->
o fistula

Diagnosis
o visible on physical exam

Treatment
o cyclosporine (or other immunosuppressant)
o hypoallergenic diet
o sacculectomy

68
Q

Anal Sac Disease; Predisposing Factors, Types, Signs, Diagnosis, Treatment

A

Predisposing Factors
o obesity
o Ds

Types
o sacculitis
o abscess
o adenocarcinoma of apocrine glands

Diagnosis
o rectal exam
o aspiration cytology if nodules are hard/non-painful

Treatment
o expression of anal gland content
o instillation of antibiotics or glucocorticoids in anal sacs
o sacculectomy
o tumor removal

Small Animal Med (10 decks)

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