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Alimentary > Icterus & Hepatic Encephalopathy > Flashcards

Icterus & Hepatic Encephalopathy Flashcards

1
Q

hyperbilirubinaemia

A

icterus

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2
Q

where is 70% of bilirubin from

A

old erythrocytes

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3
Q

what form is newly made bilirubin in

A

unconjugated and insoluble in water

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4
Q

how does bilirubin travel to liver

A

bound to albumin

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5
Q

what makes bilirubin soluble in water

A

in hepatocytes it is bound to glucuronic acid

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6
Q

how is bilirubin excreted

A

in the urine

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7
Q

bacteria in lower urinary tract change bilirubin into

A

urobilinogen

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8
Q

icterus can be (3)

A
  • prehepatic
  • hepatic
  • posthepatic
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9
Q

cause of prehepatic icterus

A

increased haemolysis overwhelming the liver

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10
Q

3 causes of increased haemolysis seen in prehepatic icterus

A
  • immune haemolytic anaemia
  • babesia infection
  • toxins (lead and onions)
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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
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12
Q

4 causes dog hepatic icterus

A
  • acute liver disease
  • leptospirosis
  • chronic hepatitis
  • neoplasia
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13
Q

3 causes post hepatic icterus

A
  • pancreatitis
  • neoplasia
  • cholelithiasis
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14
Q

differentiate between rehepatic and hepatic icterus

A

look at PCV and total solids

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15
Q

icterus with low PCV and normal total solids indicates

A

prehepatic

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16
Q

in icterus if PCV is normal and total solids + albumin is low indicates

A

hepatic

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17
Q

differentiating between hepatic and post hepatic icterus

A

ultrasound to look for obstruction or masses

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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
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19
Q

define hepatic encephalopathy

A

where NH3 and aromatic AA which are toxic to CNS bypass liver and expose themselves to CNS

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20
Q

5 equine causes of haemolysis

A
  • neonatal isoerythrolysis
  • equine infectious anaemia
  • drugs
  • toxins
  • autoimmune haemolytic anaemia
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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
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22
Q

phylloerythrin produced by

A

bacteria in gut

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23
Q

phylloerythrin is

A

a photogenic agent

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24
Q

pyrrolizidine alkaloids are found in

A

plants like ragwort

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25
Q

pyrrolizidine alkaloids are metabolised in the liver to produce

A

toxic pyrrole derivatives

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26
Q

toxic pyrrole derivatives are

A

antimitotic (stop cell division)

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27
Q

age of tyzzers disease

A

7-42 days old foal

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28
Q

tyzzers disease prognosis

A

very bad

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29
Q

equine hyperlipaemia occurs due to

A
  • 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
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30
Q

7 clinical signs of hyperlipaemia

A
  • lethargy
  • anorexia
  • weakness
  • icterus
  • mild colic
  • diarrhoea
  • recumbency
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31
Q

enzymes indicating hepatocellular damage

A
  • ALT - alanine aminotransferase
  • AST - aspartate aminotransferase
  • SDH - sorbitol dehydrogenase
  • GLDH - glutamate dehydrogenase
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32
Q

2 ways in which liver enzymes leak

A
  • necrosis

- blebbing

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33
Q

blebbing can be

A
  • reversible

- irreversible

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34
Q

reversible blebbing

A

a blebosome is released and it all heals up normally

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35
Q

irreversible blebbing

A

blebosome is released leaving a hole in the cell surface membrane

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36
Q

blebosome

A

enzyme surrounded by cell surface membrane

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37
Q

most reliable enzyme for indicating liver damage in small animals

A

ALT

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38
Q

ALT will increase within how many hours post injury

A

12 hours

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39
Q

when will ALT levels peak

A

1-2 days

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40
Q

Large animal liver enzymes for indicating liver damage

A
  • SDH

- GLDH

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41
Q

where is AST found

A
  • muscle
  • RBC
  • liver
42
Q

muscle specific enzyme indicating muscle damage

A

CK - creatine kinase

43
Q

persistently elevated CK indicates

A

ongoing muscle damage

44
Q

enzymes that indicate biliary damage

A
  • ALP - alkaline phosphatase

- GGT - gammaglutamyl transferase

45
Q

where ALP is derived from

A
  • bile duct epithelium
  • bone of young animal
  • steroid induced isoform in dogs
46
Q

GGT is found in

A
  • bile duct epithelium
  • colostrum so raised in nursing animals
  • renal tubular cells
47
Q

7 things indicating liver fnction

A
  • bilirubin
  • albumin
  • urea
  • glucose
  • cholesterol
  • ammonia
  • bile acids
48
Q

where is ammonia from

A

the gut

49
Q

ammonia is turned into

A

urea in the liver

50
Q

ammonia in hepatic disease

A

increased ammonia

decreased urea

51
Q

where cholesterol is synthesised

A

liver

52
Q

where cholesterol is excreted

A

in bile

53
Q

increased cholesterol indicates

A
  • cholestasis

- endocrine disorders

54
Q

decreased cholesterol indicates

A
  • hepatic failure as decreased synthesis
55
Q

effusion define

A

increased amount of fluid in a cavity

56
Q

3 different types of effusion

A
  • exudate
  • modified transudate
  • transudate
57
Q

normal fluid appearance

A
  • low volume

- clear/straw coloured

58
Q

normal fluid total protein

A

25-30 g/L

59
Q

nucleated cell count normal fluid

A

under 3x10 to the 9 per litre

60
Q

2 cells in normal fluid

A
  • mesothelial cells

- macrophages

61
Q

appearance transudate

A
  • low cell/protein

- clear

62
Q

SG transudate

A

under 1.018

63
Q

total protein transudate

A

under 25 g/L

64
Q

total nucleated cell count transudate

A

under 0.5x10 to the 9 per litre

65
Q

3 cells transudate

A
  • mesothelial cells
  • macrophages
  • non degenerate neutrophils
66
Q

appearance modified transudate

A
  • yellow-serosanguinous
  • cloudy
  • variable protein
67
Q

modified transudate SG

A

1.018-1.030

68
Q

4 modified transudate cells

A
  • mesothelial cells
  • macrophages
  • nondegenerate neutrophils
  • small lymphocytes
69
Q

3 causes of modified transudate

A
  • cardiac disease
  • chylous effusion
  • lymphatic obstruction
70
Q

exudate appearance

A
  • high protein and cell
71
Q

exudate SG

A

over 1.018

72
Q

total protein exudate

A

over 30g/L

73
Q

total nucleated cell count exudate

A

over 3x10 to the 9 per litre

74
Q

4 cells exudate

A
  • nondegenerate and degenerate neutrophils
  • macrophages
  • eosinophils
  • lymphocytes
75
Q

2 types of exudate

A
  • septic

- nonseptic

76
Q

septic exudate cells

A
  • degenerate neutrophils

- intracellular bacteria

77
Q

haemorrhage SG

A

1.025-1.040

78
Q

haemorrhage total protein

A

over 30g/L

79
Q

haemorrhage total nucleated cell count

A

1.5-10 x10 to the 9 per litre

80
Q

cells haemorrhage

A
  • WBC
  • neutrophils
  • macrophages
81
Q

haemorrhage types

A
  • iatrogenic/ongoing
  • acute
  • chronic
82
Q

cells iatrogenic/ongoing haemorrhage

A
  • platelet clumps

- erythrocytes

83
Q

acute haemorrhage cells

A
  • erythrophagia
84
Q

chronic haemorrhage cells

A
  • siderophages

- haematoidin

85
Q

siderophages

A

macrophages that have eaten erythrocytes

86
Q

chylous effusion 2 features

A
  • creamy top made of chylomicrons when refrigerated

- triglycerides

87
Q

equine peritoneal fluid appearance

A
  • pale yellow

- clear

88
Q

equine peritoneal fluid total nucleated cell count

A

0.5-9 x10 to the 9 per litre

89
Q

equine peritoneal fluid protein

A

under 15g/L

90
Q

SG equine peritoneal flid

A

1.000-1.010

91
Q

cells equine peritoneal fluid

A

50% macrophage

50% nondegenerate neutrophil

92
Q

equine peritoneal fluid classified as

A

modified transudate

93
Q

nonseptic horse exudate appearance

A
  • amber

- slightly turbid

94
Q

total nucleated cell count non-septic equine exudate

A

over 10x10 to the 9 per litre

95
Q

protein equine nonseptic exudate

A

over 25g/L

96
Q

cells non-septic exudate horse

A

more neutrophils than macrophages

97
Q

septic exudate horse appearance

A
  • yellow-brown

- turbid

98
Q

total nucleated cell count horse spetic exudate

A

over 10x10 to the 9 per litre

99
Q

protein horse septic exudate

A

over 34g/L

100
Q

cells horse septic exudate

A
  • degenerate neutrophils

- bacteria

Alimentary (5 decks)

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