Hepatology 2 Flashcards
- What does a low creatinine suggest?
- Either very good GFR or very poor muscle mass
- do not worry unless of a poor body condition.
- What would be the next dx step after establishing that there is a mixed liver disease based on blood work?
- What % liver cells would be damaged before seeing a decrease in liver functioning?
- Hepatic imaging.
- 75-80%
- Why do we test bile acids and run BAST?
- What if resting vile acids are normal?
- What if resting bile acids are high?
- To establish the extent of liver damage.
- Stimulate them with BAST.
- No need to stimulate them.
- What liver disease is likely to make the liver small?
- Other minimally invasive diagnostics?
- Chronic hepatitis.
- Abdominal effusion analysis:
- transudate – hypoalbuminaemia.
- modified transudate – portal hypertension.
- bile - biliary rupture.
- others are possible.
Other specific infectious disease testing:
- e.g. leptospirosis – serology, PCR.
- e.g. FIP – PCR, immunocyto/histochemistry.
- other, rare.
Hepatic sampling.
Required for definitive diagnosis of many diseases - neoplasia cannot be diagnosed on appearance alone!
Rarely used in acute setting - except for toxins.
Indicated for:
- persistent/progressive enzyme elevations.
– exclude extrahepatic causes first.
- structural parenchymal patholohy.
- monitoring response to therapy.
– e.g. infection response to ABX.
– e.g. copper hepatitis.
- breed screening.
– e.g. Bedlingtons prone to copper storage in the liver.
Ultrasound-guided hepatic sampling.
Liver cytology - FNA.
– e.g. round cell tumours e.g. lymphoma, hepatic lipidosis in cats (diffusely affecting the liver).
Liver histology - percutaneous (‘tru-cut’) biopsy.
– take from left and right.
Cholecystocentesis - bile cytoogy (EDTA), culture (plain).
Other types of hepatic sampling?
Laparoscopy.
Laparotomy.
Always check platelets, PT, aPTT before sampling the liver.
+/- pre-treat with vitamin K.
Hepatic biopsy specimen processing.
Lobar variation.
Formalin - histopatgology.
Fresh:
- culture.
- copper quantification.
- spare fresh in case e.g. PCRs needed e.g. fungal diseases etc.
– saline-soaked swab at the bottom of a plain sample pot and place sample on top, and send to lab who usually freeze this.
Hepatic sampling complications.
Haemorrhage.
Ascites.
Bile peritonitis.
Clinical deterioration (esp. if end-stage) (associated with ascites).
Unnecessary (e.g. reactive hepatopathy) sample.
Non-diagnostic sample - discuss with owners beforehand.
When NOT to sample.
In acute disease.
End-stage liver dysfunction (to extent of being encephalopathic).
– diagnostics unlikely to help to treat these patients any better.
Why can you not measure bile acids in the presence of jaundice?
Bile acids test is a colorimetric assay so cannot get accurate result.
A waste of time and money in cases where there is jaundice.
Acute inflammatory leukogram.
Large neutrophilia of more than double the reference range which is more than would be seen with a stress leukogram.
Rapid production of neutrophils suggests acute toxic change.
- What are the 3 most common feline liver diseases in the UK?
- Common and important cause of jaundice in cats?
- Another important cause of jaundice in cats (rarely in dogs)?
- Multisystemic diseases that the liver can also be involved in?
- Neutrophilic cholangitis.
Lymphocytic cholangitis.
Hepatic lipidosis. - FIP.
- Sepsis (‘cholestasis of sepsis’).
- Lymphoma, toxoplasma, FIP.
Neutrophilic cholangitis.
(Cholangiohepatitis in dogs).
Ascending bacterial biliary infection.
Acute disease.
Often sick/pyrexic.
Dx by bile cytology/culture.
Chronic/mixed cholangitis possible.
May accompany pancreatitis and/or inflammatory enteropathies ‘triaditis’.
Lymphocytic cholangitis.
Immune-mediated biliary disease.
Chronic disease.
May have hepatomegaly, abdominal effusion, jaundice and hyperglobulinaemia - ddx FIP.
Dx - liver biopsy.
Chronic/mixed cholangitis possible.
May accompany pancreatitis and/or inflammatory enteropathies ‘triaditis’.
