Icterus & Hepatic Encephalopathy Flashcards
hyperbilirubinaemia
icterus
where is 70% of bilirubin from
old erythrocytes
what form is newly made bilirubin in
unconjugated and insoluble in water
how does bilirubin travel to liver
bound to albumin
what makes bilirubin soluble in water
in hepatocytes it is bound to glucuronic acid
how is bilirubin excreted
in the urine
bacteria in lower urinary tract change bilirubin into
urobilinogen
icterus can be (3)
- prehepatic
- hepatic
- posthepatic
cause of prehepatic icterus
increased haemolysis overwhelming the liver
3 causes of increased haemolysis seen in prehepatic icterus
- immune haemolytic anaemia
- babesia infection
- toxins (lead and onions)
6 causes of hepatic icterus in cat
- suppurative cholangiohepatitis (bacterial)
- lymphocytic plasmacytic hepatitis (immune mediated)
- hepatic lipidosis
- feline infectious peritonitis
- toxins
- neoplasia
4 causes dog hepatic icterus
- acute liver disease
- leptospirosis
- chronic hepatitis
- neoplasia
3 causes post hepatic icterus
- pancreatitis
- neoplasia
- cholelithiasis
differentiate between rehepatic and hepatic icterus
look at PCV and total solids
icterus with low PCV and normal total solids indicates
prehepatic
in icterus if PCV is normal and total solids + albumin is low indicates
hepatic
differentiating between hepatic and post hepatic icterus
ultrasound to look for obstruction or masses
liver function tests fasting blood bile acid
- 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
define hepatic encephalopathy
where NH3 and aromatic AA which are toxic to CNS bypass liver and expose themselves to CNS
5 equine causes of haemolysis
- neonatal isoerythrolysis
- equine infectious anaemia
- drugs
- toxins
- autoimmune haemolytic anaemia
photosensitisation and liver disease
uncommon
- increased phylloerythrin lodges in blood vessles close to skin
- UV light causes it to cause cell membrane damage and necrosis
phylloerythrin produced by
bacteria in gut
phylloerythrin is
a photogenic agent
pyrrolizidine alkaloids are found in
plants like ragwort
pyrrolizidine alkaloids are metabolised in the liver to produce
toxic pyrrole derivatives
toxic pyrrole derivatives are
antimitotic (stop cell division)
age of tyzzers disease
7-42 days old foal
tyzzers disease prognosis
very bad
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
7 clinical signs of hyperlipaemia
- lethargy
- anorexia
- weakness
- icterus
- mild colic
- diarrhoea
- recumbency
enzymes indicating hepatocellular damage
- ALT - alanine aminotransferase
- AST - aspartate aminotransferase
- SDH - sorbitol dehydrogenase
- GLDH - glutamate dehydrogenase
2 ways in which liver enzymes leak
- necrosis
- blebbing
blebbing can be
- reversible
- irreversible
reversible blebbing
a blebosome is released and it all heals up normally
irreversible blebbing
blebosome is released leaving a hole in the cell surface membrane
blebosome
enzyme surrounded by cell surface membrane
most reliable enzyme for indicating liver damage in small animals
ALT
ALT will increase within how many hours post injury
12 hours
when will ALT levels peak
1-2 days
Large animal liver enzymes for indicating liver damage
- SDH
- GLDH
where is AST found
- muscle
- RBC
- liver
muscle specific enzyme indicating muscle damage
CK - creatine kinase
persistently elevated CK indicates
ongoing muscle damage
enzymes that indicate biliary damage
- ALP - alkaline phosphatase
- GGT - gammaglutamyl transferase
where ALP is derived from
- bile duct epithelium
- bone of young animal
- steroid induced isoform in dogs
GGT is found in
- bile duct epithelium
- colostrum so raised in nursing animals
- renal tubular cells
7 things indicating liver fnction
- bilirubin
- albumin
- urea
- glucose
- cholesterol
- ammonia
- bile acids
where is ammonia from
the gut
ammonia is turned into
urea in the liver
ammonia in hepatic disease
increased ammonia
decreased urea
where cholesterol is synthesised
liver
where cholesterol is excreted
in bile
increased cholesterol indicates
- cholestasis
- endocrine disorders
decreased cholesterol indicates
- hepatic failure as decreased synthesis
effusion define
increased amount of fluid in a cavity
3 different types of effusion
- exudate
- modified transudate
- transudate
normal fluid appearance
- low volume
- clear/straw coloured
normal fluid total protein
25-30 g/L
nucleated cell count normal fluid
under 3x10 to the 9 per litre
2 cells in normal fluid
- mesothelial cells
- macrophages
appearance transudate
- low cell/protein
- clear
SG transudate
under 1.018
total protein transudate
under 25 g/L
total nucleated cell count transudate
under 0.5x10 to the 9 per litre
3 cells transudate
- mesothelial cells
- macrophages
- non degenerate neutrophils
appearance modified transudate
- yellow-serosanguinous
- cloudy
- variable protein
modified transudate SG
1.018-1.030
4 modified transudate cells
- mesothelial cells
- macrophages
- nondegenerate neutrophils
- small lymphocytes
3 causes of modified transudate
- cardiac disease
- chylous effusion
- lymphatic obstruction
exudate appearance
- high protein and cell
exudate SG
over 1.018
total protein exudate
over 30g/L
total nucleated cell count exudate
over 3x10 to the 9 per litre
4 cells exudate
- nondegenerate and degenerate neutrophils
- macrophages
- eosinophils
- lymphocytes
2 types of exudate
- septic
- nonseptic
septic exudate cells
- degenerate neutrophils
- intracellular bacteria
haemorrhage SG
1.025-1.040
haemorrhage total protein
over 30g/L
haemorrhage total nucleated cell count
1.5-10 x10 to the 9 per litre
cells haemorrhage
- WBC
- neutrophils
- macrophages
haemorrhage types
- iatrogenic/ongoing
- acute
- chronic
cells iatrogenic/ongoing haemorrhage
- platelet clumps
- erythrocytes
acute haemorrhage cells
- erythrophagia
chronic haemorrhage cells
- siderophages
- haematoidin
siderophages
macrophages that have eaten erythrocytes
chylous effusion 2 features
- creamy top made of chylomicrons when refrigerated
- triglycerides
equine peritoneal fluid appearance
- pale yellow
- clear
equine peritoneal fluid total nucleated cell count
0.5-9 x10 to the 9 per litre
equine peritoneal fluid protein
under 15g/L
SG equine peritoneal flid
1.000-1.010
cells equine peritoneal fluid
50% macrophage
50% nondegenerate neutrophil
equine peritoneal fluid classified as
modified transudate
nonseptic horse exudate appearance
- amber
- slightly turbid
total nucleated cell count non-septic equine exudate
over 10x10 to the 9 per litre
protein equine nonseptic exudate
over 25g/L
cells non-septic exudate horse
more neutrophils than macrophages
septic exudate horse appearance
- yellow-brown
- turbid
total nucleated cell count horse spetic exudate
over 10x10 to the 9 per litre
protein horse septic exudate
over 34g/L
cells horse septic exudate
- degenerate neutrophils
- bacteria
