Hepatology 4

Question 1

If chronic hepatitis is suspected, what is the purpose of a liver biopsy?

Answer 1

To prove the diagnosis of chronic hepatitis.
To identify of the trigger for the chronic hepatitis is still present and see if anything can be done to be able to improve the patient’s prognosis.

Question 2

What is required on biopsy in order to make the diagnosis of chronic hepatitis?

Answer 2

Mixed inflammatory infiltrate.
+/- fibrosis.
+/- regenerative nodules.

Question 3

Causes of chronic hepatitis.

Answer 3

Idiopathic - most cases, diagnosis of exclusion.
Cooper associated (one of the most reversible causes):
- breed/genetic basis e.g. Bedlington Terriers.
- other breeds incl. labs are predisposed.
Secondary to prior insult (may have been sub-clinical).
- e.g. infectious – known (e.g. CAV-1, lepto, vs. other pathogens).
- e.g. previous toxin exposure.
- previous acute hepatitis insut.
Immune-mediated - likely in some breeds.

Question 4

Treatment of copper associated chronic hepatitis.

Answer 4

De-coppering therapy:
- chelator – D-penicillamine (others less commonly used).
- dietary copper restriction – avoid red meat/offal/eggs, cereals, drinking water from copper pipes.
- zinc supplementation / maintenance – NOT with de-coppering agents.
– a much gradual therapy.
Hepatoprotective therapies
- e.g. SAMe.
Management of complications.

Question 5

The longer term plan for patients with copper associated hepatopathy?

Answer 5

De-coppering take 6-9 months.
Monitor liver enzymes every 1-2m.
Re-biopsy 1m after normalisation to re-quantify copper.
Copper remains elevated
- continue and re-evaluate.
Copper normal:
- stop D-penicillamine.
- maintain on copper restricted diet (+/- transition to zinc).
- continue hepatoprotective therapies.

Question 6

Pyrexic, obese cat with renal pain…
diagnostics?

Answer 6

Haematology.
Serum biochemistry.
Abdominal imaging.
- renal ultrasound.
Urinalysis.