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Alimentary > Icterus and Hepatic Encephalopathy in Small Animals > Flashcards

Icterus and Hepatic Encephalopathy in Small Animals Flashcards

1
Q

What are the clinical signs of hepatic disease?

A 
Inappetence/anorexia
V/D
Jaundice
Depression
PUPD
Neurological
Bleeding
GI ulceration
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2
Q

What is the problem with blood tests that confirm the presence of liver disease?

A

They will not usually indicate the type of lesion present

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3
Q

What does it indicate if the liver stops producing albumin?

A

It is severely damaged

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4
Q

What clinical pathology is helpful in diagnosing hepatic disease?

A 
Enzymes (ALT, ALP, GGT, AST)
Bilirubin
Bile acids
Albumin/globulin
Cholesterol
Glucose
Urea
Ammonia
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5
Q

What diagnostic aids are useful for hepatobillary disease?

A

CBC, biochem
Radiology
Ultrasound
Biopsy

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6
Q

What are the two main groups of hepatic disease?

A

Acute hepatopathy

Chronic hepatopathy

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7
Q

What is the prognosis like for patients with acute hepatopathies?

A

Prognosis is usually good because of the livers ability to regenerate

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8
Q

What are some causes of acute infectious hepatopathies in dogs?

A

Leptospira
Adenovirus
Bacterial endotoxaemia
Parasites - liver fluke

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9
Q

What are some acute toxic/drug induced causes of hepatopathies in dogs?

A 
Phenobarbitone
Carprofen
Potentiated sulphonamides
Fungi
Alfatoxins
Mycotoxins
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10
Q

Give some chronic inflammatory causes of hepatopathies in dogs…

A

Idiopathic
Chronic progression from acute injury
Eosinophilic and granulomatous hepatitis
Lobular dissecting hepatitis in standard poodles and GSDs

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11
Q

What drug can induce chronic hepatopathies in dogs?

A

Glucocorticoid hepatopathy

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12
Q

What are the congenital causes of hepatopathies in dogs?

A

PSS, portal vein hypoplasia

Copper storage disease (dobermans)

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13
Q

What are some inflammatory causes of acute hepatopathies in cats?

A

Acute suppurative/neutrophilic cholangitis (cats have common bile duct so more susceptible to bacterial coming from gut)

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14
Q

What are some causes of acute hepatopathies in cats other than inflammatory?

A

Neoplastic
Diffuse tumour infiltrate
+ Lymphoma

Hepatic lipidosis

Infectious
+ Bacterial endotoxaemia/septicaemia
+ Toxoplasmosis
+ FIP

Toxic/drug induced
+ Diazepam
+ Phenobarbitone
+ Potentiated sulphonamides

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15
Q

What are some chronic inflammatory causes of hepatopathies in cats?

A

Lymphocytic cholangitis
Chronic neutrophilic cholangitis

Both may involve pancreas and gut

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16
Q

What are some chronic causes of hepatopathies in cats other than inflammatoru?

A

Amyloidosis

Neoplasia
+ Primary and secondary
+ Lymphoma and biliary carcinoma

Infectious
+ FIP
+ Toxoplasmosis

Congenital
+ Vascular disorders

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17
Q

What is the treatment of hepatic disease?

A 
Supportive e.g. fluids
ABs
Dietary changes
Anti-oxidants
Anti-inflammatories
Specific tx e.g. copper chelators
18
Q

What is jaundice?

A

Yellow discolouration of body tissues caused by increased levels of bilirubin

19
Q

Where is jaundice most easily seen?

A

Sclera
MMs
Non-pigmented skin

20
Q

What is the physiology of jaundice?

A

Bilirubin primarily formed from breakdown of haemoglobin from aged red blood cells.

21
Q

How is bilirubin produced?

A

RBC breakdown > goes to kidney first but can’t go anywhere as unconjugated bilirubin isn’t water soluble.

22
Q

What would you see in faeces if you have problem excreting bilirubin?

A

White faeces because bilirubin gives faeces colour

23
Q

How can you differentiate prehepatic from hepatic jaundice?

A

Animals with RBC haemolysis that is severe enough to result in jaundice will have significant regenerative anaemia

24
Q

Give some causes of perhepatic jaundice

A

IMHA

Microanigopathic or RBC damage
+ Splenic torsion
+ Haemangiosarc
+ Caval syndrome

Congenital

Babesia infection

Toxins
+ Onions
+ Garlic
+ Zinc

25
Q

What are the most common causes of hepatic jaundic in dogs?

A

Chronic inflammatory hepatitis

Neoplasia

Toxic hepatitis

Infectious hepatitis
+ Adeno
+ Lepto

26
Q

Most common causes of hepatic jaundice in cats?

A

Cholangiohepatitis
+ Acute neutrophilic
+ Chronic neutrophilic
+ Chronic lymphocytic

FIP

Neoplasia

Hepatic lipidosis

27
Q

Most common causes of post-hepatic jaundice?

A

Toxic or infectious cholangitis

Pancreatic diease

Infiltrating or space occupying lesion
+ Abscess
+ Neoplasia

Bile duct rupture

28
Q

Why is it bad if bile gets into the peritoneum?

A

It is toxic, irritant and not sterile

29
Q

Non-hepatic/anaemia causes of increased bilirubin?

A

Fever
Starvation
Sepsis or significant inflammation

30
Q

What is the rate limiting step of bilirubin production?

A

Delivery of bilirubin into the intestines –> Levels of bilirubin can increased during fever because delivery into the intestines is slowed down.

31
Q

Why is mild biliruibinuria normal is dogs?

A

Dogs have a low renal threshold so renal enxyme systems produce and conjugate bilirubin to limited extent

32
Q

What does bilirubinuria indicate in cats?

A

Always pathological because cats have 9 times higher renal threshold than dogs

33
Q

What is hepatic encephalopathy?

A

Neurological dysfunction that occurs as a result of liver failure and increased ammonia in the blood stream

34
Q

What are the causes of hepatic encepahlopathy

A

PSS (acquired or congenital)

Fulminant hepatic failure

35
Q

Describe a portosystemic shunt

A

Portal vein is bypassed so toxins from the gut go into systemic circulation > liver is deprived of hepatotrophic substances which are important for liver growth and function

36
Q

What are the clinical pathological signs of hepatic encephalopathy?

A

Decreased serum alb/glob
Slight to moderate ALT/ALP increase
Increased fasting blood ammonia
Increased fasting and post prandial serum bile acids
Ammonium biurate crystalluria
Small RBCs (due to changes in iron metabolism)
Hypoglycaemia

37
Q

What are the clinical signs of HE?

A 
Intermittent neurological dysfunction
Headpressing
Intermittent GI signs 
Poor growth
PUPD
Prolonged recovery from anaesthesia
Hypersalviation
Behavioural changes
Seizures (cats)
38
Q

Are certain breeds more affected by hepatic encephalopathy?

A 
Dogs 
Cairn
Irish wolfhound
Yorkies
Maltese
Australian Cattle Dogs
39
Q

What are the different hepatic shunt types?

A

Intrahepatic
Extrahepatic
Multiple

40
Q

What is the treatment for HE?

A 
Surgical
Medical
- Medium protein diet
- Vegetable and white meat protein
- Avoid red meat
- Lactulose (forms ammonium ions rather than ammonia and decreased gut transit time for bacteria to produce ammonia)
- ABs to reduce gut flora

Alimentary (14 decks)

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