Icterus and Hepatic Encephalopathy in Small Animals Flashcards by Adam Northwood

What are the clinical signs of hepatic disease?

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

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

They will not usually indicate the type of lesion present

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What does it indicate if the liver stops producing albumin?

It is severely damaged

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What clinical pathology is helpful in diagnosing hepatic disease?

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

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What diagnostic aids are useful for hepatobillary disease?

CBC, biochem
Radiology
Ultrasound
Biopsy

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What are the two main groups of hepatic disease?

Acute hepatopathy

Chronic hepatopathy

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What is the prognosis like for patients with acute hepatopathies?

Prognosis is usually good because of the livers ability to regenerate

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What are some causes of acute infectious hepatopathies in dogs?

Leptospira
Adenovirus
Bacterial endotoxaemia
Parasites - liver fluke

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

Phenobarbitone
Carprofen
Potentiated sulphonamides
Fungi
Alfatoxins
Mycotoxins

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Give some chronic inflammatory causes of hepatopathies in dogs…

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

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What drug can induce chronic hepatopathies in dogs?

Glucocorticoid hepatopathy

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What are the congenital causes of hepatopathies in dogs?

PSS, portal vein hypoplasia

Copper storage disease (dobermans)

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What are some inflammatory causes of acute hepatopathies in cats?

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

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

Neoplastic
Diffuse tumour infiltrate
+ Lymphoma

Hepatic lipidosis

Infectious
+ Bacterial endotoxaemia/septicaemia
+ Toxoplasmosis
+ FIP

Toxic/drug induced
+ Diazepam
+ Phenobarbitone
+ Potentiated sulphonamides

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What are some chronic inflammatory causes of hepatopathies in cats?

Lymphocytic cholangitis
Chronic neutrophilic cholangitis

Both may involve pancreas and gut

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

Amyloidosis

Neoplasia
+ Primary and secondary
+ Lymphoma and biliary carcinoma

Infectious
+ FIP
+ Toxoplasmosis

Congenital
+ Vascular disorders

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What is the treatment of hepatic disease?

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

What is jaundice?

Yellow discolouration of body tissues caused by increased levels of bilirubin

Where is jaundice most easily seen?

Sclera
MMs
Non-pigmented skin

What is the physiology of jaundice?

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

How is bilirubin produced?

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

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

White faeces because bilirubin gives faeces colour

How can you differentiate prehepatic from hepatic jaundice?

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

Give some causes of perhepatic jaundice

IMHA

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

Congenital

Babesia infection

Toxins
+ Onions
+ Garlic
+ Zinc

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

Chronic inflammatory hepatitis Neoplasia Toxic hepatitis Infectious hepatitis + Adeno + Lepto

Most common causes of hepatic jaundice in cats?

Cholangiohepatitis + Acute neutrophilic + Chronic neutrophilic + Chronic lymphocytic FIP Neoplasia Hepatic lipidosis

Most common causes of post-hepatic jaundice?

Toxic or infectious cholangitis Pancreatic diease Infiltrating or space occupying lesion + Abscess + Neoplasia Bile duct rupture

Why is it bad if bile gets into the peritoneum?

It is toxic, irritant and not sterile

Non-hepatic/anaemia causes of increased bilirubin?

Fever Starvation Sepsis or significant inflammation

What is the rate limiting step of bilirubin production?

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

Why is mild biliruibinuria normal is dogs?

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

What does bilirubinuria indicate in cats?

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

What is hepatic encephalopathy?

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

What are the causes of hepatic encepahlopathy

PSS (acquired or congenital) | Fulminant hepatic failure

Describe a portosystemic shunt

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

What are the clinical pathological signs of hepatic encephalopathy?

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

What are the clinical signs of HE?

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

Are certain breeds more affected by hepatic encephalopathy?

``` Dogs Cairn Irish wolfhound Yorkies Maltese Australian Cattle Dogs ```

What are the different hepatic shunt types?

Intrahepatic Extrahepatic Multiple

What is the treatment for HE?

``` 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 ```