Icterus & Hepatic Encephalopathy Flashcards
1
Q
hyperbilirubinaemia
A
icterus
2
Q
where is 70% of bilirubin from
A
old erythrocytes
3
Q
what form is newly made bilirubin in
A
unconjugated and insoluble in water
4
Q
how does bilirubin travel to liver
A
bound to albumin
5
Q
what makes bilirubin soluble in water
A
in hepatocytes it is bound to glucuronic acid
6
Q
how is bilirubin excreted
A
in the urine
7
Q
bacteria in lower urinary tract change bilirubin into
A
urobilinogen
8
Q
icterus can be (3)
A
- prehepatic
- hepatic
- posthepatic
9
Q
cause of prehepatic icterus
A
increased haemolysis overwhelming the liver
10
Q
3 causes of increased haemolysis seen in prehepatic icterus
A
- immune haemolytic anaemia
- babesia infection
- toxins (lead and onions)
11
Q
6 causes of hepatic icterus in cat
A
- suppurative cholangiohepatitis (bacterial)
- lymphocytic plasmacytic hepatitis (immune mediated)
- hepatic lipidosis
- feline infectious peritonitis
- toxins
- neoplasia
12
Q
4 causes dog hepatic icterus
A
- acute liver disease
- leptospirosis
- chronic hepatitis
- neoplasia
13
Q
3 causes post hepatic icterus
A
- pancreatitis
- neoplasia
- cholelithiasis
14
Q
differentiate between rehepatic and hepatic icterus
A
look at PCV and total solids
15
Q
icterus with low PCV and normal total solids indicates
A
prehepatic
16
Q
in icterus if PCV is normal and total solids + albumin is low indicates
A
hepatic
17
Q
differentiating between hepatic and post hepatic icterus
A
ultrasound to look for obstruction or masses
18
Q
liver function tests fasting blood bile acid
A
- measure blood bile acid after a period of fasting
- measure blood bile acid after eating
- blood bile acid will increase if there is liver failure or a portosystemic shunt
19
Q
define hepatic encephalopathy
A
where NH3 and aromatic AA which are toxic to CNS bypass liver and expose themselves to CNS
20
Q
5 equine causes of haemolysis
A
- neonatal isoerythrolysis
- equine infectious anaemia
- drugs
- toxins
- autoimmune haemolytic anaemia
21
Q
photosensitisation and liver disease
A
uncommon
- increased phylloerythrin lodges in blood vessles close to skin
- UV light causes it to cause cell membrane damage and necrosis
22
Q
phylloerythrin produced by
A
bacteria in gut
23
Q
phylloerythrin is
A
a photogenic agent
24
Q
pyrrolizidine alkaloids are found in
A
plants like ragwort
25
pyrrolizidine alkaloids are metabolised in the liver to produce
toxic pyrrole derivatives
26
toxic pyrrole derivatives are
antimitotic (stop cell division)
27
age of tyzzers disease
7-42 days old foal
28
tyzzers disease prognosis
very bad
29
equine hyperlipaemia occurs due to
- negative energy balance due to stress etc
- hormone sensitive lipase cause release of fatty acids from adipose tissue
- taken up by liver which makes excessive triglycerides, ketones, and glucose
30
7 clinical signs of hyperlipaemia
- lethargy
- anorexia
- weakness
- icterus
- mild colic
- diarrhoea
- recumbency
31
enzymes indicating hepatocellular damage
- ALT - alanine aminotransferase
- AST - aspartate aminotransferase
- SDH - sorbitol dehydrogenase
- GLDH - glutamate dehydrogenase
32
2 ways in which liver enzymes leak
- necrosis
| - blebbing
33
blebbing can be
- reversible
| - irreversible
34
reversible blebbing
a blebosome is released and it all heals up normally
35
irreversible blebbing
blebosome is released leaving a hole in the cell surface membrane
36
blebosome
enzyme surrounded by cell surface membrane
37
most reliable enzyme for indicating liver damage in small animals
ALT
38
ALT will increase within how many hours post injury
12 hours
39
when will ALT levels peak
1-2 days
40
Large animal liver enzymes for indicating liver damage
- SDH
| - GLDH
41
where is AST found
- muscle
- RBC
- liver
42
muscle specific enzyme indicating muscle damage
CK - creatine kinase
43
persistently elevated CK indicates
ongoing muscle damage
44
enzymes that indicate biliary damage
- ALP - alkaline phosphatase
| - GGT - gammaglutamyl transferase
45
where ALP is derived from
- bile duct epithelium
- bone of young animal
- steroid induced isoform in dogs
46
GGT is found in
- bile duct epithelium
- colostrum so raised in nursing animals
- renal tubular cells
47
7 things indicating liver fnction
- bilirubin
- albumin
- urea
- glucose
- cholesterol
- ammonia
- bile acids
48
where is ammonia from
the gut
49
ammonia is turned into
urea in the liver
50
ammonia in hepatic disease
increased ammonia
| decreased urea
51
where cholesterol is synthesised
liver
52
where cholesterol is excreted
in bile
53
increased cholesterol indicates
- cholestasis
| - endocrine disorders
54
decreased cholesterol indicates
- hepatic failure as decreased synthesis
55
effusion define
increased amount of fluid in a cavity
56
3 different types of effusion
- exudate
- modified transudate
- transudate
57
normal fluid appearance
- low volume
| - clear/straw coloured
58
normal fluid total protein
25-30 g/L
59
nucleated cell count normal fluid
under 3x10 to the 9 per litre
60
2 cells in normal fluid
- mesothelial cells
| - macrophages
61
appearance transudate
- low cell/protein
| - clear
62
SG transudate
under 1.018
63
total protein transudate
under 25 g/L
64
total nucleated cell count transudate
under 0.5x10 to the 9 per litre
65
3 cells transudate
- mesothelial cells
- macrophages
- non degenerate neutrophils
66
appearance modified transudate
- yellow-serosanguinous
- cloudy
- variable protein
67
modified transudate SG
1.018-1.030
68
4 modified transudate cells
- mesothelial cells
- macrophages
- nondegenerate neutrophils
- small lymphocytes
69
3 causes of modified transudate
- cardiac disease
- chylous effusion
- lymphatic obstruction
70
exudate appearance
- high protein and cell
71
exudate SG
over 1.018
72
total protein exudate
over 30g/L
73
total nucleated cell count exudate
over 3x10 to the 9 per litre
74
4 cells exudate
- nondegenerate and degenerate neutrophils
- macrophages
- eosinophils
- lymphocytes
75
2 types of exudate
- septic
| - nonseptic
76
septic exudate cells
- degenerate neutrophils
| - intracellular bacteria
77
haemorrhage SG
1.025-1.040
78
haemorrhage total protein
over 30g/L
79
haemorrhage total nucleated cell count
1.5-10 x10 to the 9 per litre
80
cells haemorrhage
- WBC
- neutrophils
- macrophages
81
haemorrhage types
- iatrogenic/ongoing
- acute
- chronic
82
cells iatrogenic/ongoing haemorrhage
- platelet clumps
| - erythrocytes
83
acute haemorrhage cells
- erythrophagia
84
chronic haemorrhage cells
- siderophages
| - haematoidin
85
siderophages
macrophages that have eaten erythrocytes
86
chylous effusion 2 features
- creamy top made of chylomicrons when refrigerated
| - triglycerides
87
equine peritoneal fluid appearance
- pale yellow
| - clear
88
equine peritoneal fluid total nucleated cell count
0.5-9 x10 to the 9 per litre
89
equine peritoneal fluid protein
under 15g/L
90
SG equine peritoneal flid
1.000-1.010
91
cells equine peritoneal fluid
50% macrophage
| 50% nondegenerate neutrophil
92
equine peritoneal fluid classified as
modified transudate
93
nonseptic horse exudate appearance
- amber
| - slightly turbid
94
total nucleated cell count non-septic equine exudate
over 10x10 to the 9 per litre
95
protein equine nonseptic exudate
over 25g/L
96
cells non-septic exudate horse
more neutrophils than macrophages
97
septic exudate horse appearance
- yellow-brown
| - turbid
98
total nucleated cell count horse spetic exudate
over 10x10 to the 9 per litre
99
protein horse septic exudate
over 34g/L
100
cells horse septic exudate
- degenerate neutrophils
| - bacteria
