Increased Serum Transaminases in the Dog

Question 1

what are the bacterial hepatobiliary infectious diseases?

Answer 1

leptospirosis
opportunistic: enteric organisms

Question 2

what is a hepatic and/or bile FNA good for?

Answer 2

neoplasia especially round cell
vacuolar change
identify/culture infectious organisms

Question 3

is bile or liver better to culture?

Answer 3

bile

Question 4

what are the contraindications for a hepatic biopsy?

Answer 4

high probability of hemorrhage
suspicious of an abscess
severe ascites- to percutaneous only

Question 5

what is the presentation of chronic hepatitis?

Answer 5

many asymptomatic
vague signs
clinical pathology and imaging changes

Question 6

how are bedlington terriers predisposed to primary copper hepatopathy?

Answer 6

autosomal recessive
DNA test available

Question 7

what can you stain with for copper?

Answer 7

rhodamine

Question 8

what are the causes of primary copper hepatopathy?

Answer 8

genetic
increased intake
decreased excretion from cholestatic disease: not in dogs

Question 9

how can you treat hepatic copper toxicosis?

Answer 9

limit copper intake
anti-oxidants: SAMe, vitamin E
chelate copper
decrease absorption of copper
monitor

Question 10

when should you use immunosuppressive therapy in immune chronic hepatitis?

Answer 10

hepatic biopsy shows chronic hepatitis with significant lymphoplasmacytic or granulomatous inflammation
evidence of extrahepatic immune disease- raree
elimination of infectious/toxic etiologies

Question 11

what are the pros of using corticosteroids for immunosuppressive therapy?

Answer 11

anti-inflammatory
mild choleretic
appetite stimulant

Question 12

what are some hepatoprotectants?

Answer 12

N-acetylcysteine
S-adenosylmethionine
ursodeoxycholate
vitamin E
silymarin

Question 13

what is the most significant finding for diagnosing a congenital portosystemic shunt?

Answer 13

elevated serum total bile acids

Question 14

what drugs can be associated with acute liver failure?

Answer 14

diazepam in cat
potentiated sulfonamides in dog
carprofen in dog
acetaminophen when overdosed in dog and cat

Question 15

what are some environmental toxins?

Answer 15

cycad seeds
amanita mushrooms
blue green algae
xylitol
alfatoxin
copper

Question 16

which endocrinopathies can cause an elevated ALT?

Answer 16

diabetes mellitus
hyperadrenocorticism
hyperthyroidism: cats

Question 17

what GI diseases can cause ALT to be elevated?

Answer 17

pancreatitis
inflammatory bowel disease

Question 18

what viral disease can cause hepatobiliary disease in dogs?

Answer 18

canine adenovirus

Question 19

what is a hepatic and/or bile FNA bad for?

Answer 19

inflammation
fibrosis
bile cytology typically normal with primary hepatic disorders

Question 20

what size needles should you use for hepatic biopsies?

Answer 20

canine: 16G
feline: 18G

Question 21

what should you expect from a hepatic biopsy?

Answer 21

identify category
identify extend and severity
provide material for special testing
not etiology in every case

Question 22

what would indicate your animal is at increased risk for bleeding?

Answer 22

PT and PTT >1.5xprolonged
platelet count <80,000/ul

Question 23

what are the etiologies of canine chronic hepatitis?

Answer 23

idiopathic: most
toxic
immune
infectious: rare

Question 24

how can you eliminate the causative agent of chronic hepatitis?

Answer 24

stop all hepatotoxic drugs
test for copper and chelate
test for autoimmune disease: no good tests
test for infectious disease

Question 25

where is copper seen in copper hepatopathy?

Answer 25

high grade
centrilobular

Question 26

what are the cons of azathioprine?

Answer 26

maintenance not induction of remission
bone marrow suppression
hepatotoxic

Question 27

what are the hepatic vascular diseases?

Answer 27

congenital portosystemic shunts
microvascular dysplasia

Question 28

what are the clinical signs of congenital portosystemic shunts due to?

Answer 28

hepatic encephalopathy
hepatic atrophy

Question 29

who is predisposed to microvascular dysplasia?

Answer 29

yorkies
cairns
other small breeds

Question 30

what are clinical signs of microvascular dysplasia?

Answer 30

usually none
no treatment necessary

Question 31

what is acute liver failure?

Answer 31

recent onset of hepatic disease with hyperbilirubinemia and coagulopathy
+/- development of encephalopathy