Internal Medicine: Gastroenterology: Liver Disease Diagnosis Flashcards
What may be found on clinical exam of liver disease?
- Icterus/Jaundice- can be severe without
- Ascites
- Hepatomegaly/microhepatica
- Pain
What can serum biochemistry show for liver disease?
What are its limitations?
- Can suggest primary liver disease
- Can show reactive changes to disease elsewhere
Do not show liver function
Serum Biochem
- What liver enzymes are hepatocellular markers?
- What liver enzymes are cholestatic markers?
- What can be used for function tests?
- Liver enzymes- ALT, AST
- Cholestatic- ALP, GGT
- Serum proteins (albumin), glucose, urea, cholesterol, billirubin, ammonia, bile acids
How do serum biochem tests change in order?
- ALT, ALP increase first
- Bile acids increase
- Albumin decreases- cirrhosis
- Bilirubin increases- cirrhosis
- Clotting factors- endstage
- Glucose- endstage
What special radiographs can be done of the liver?
Portovenography
What can ben assessed on ultrasound?
- Liver size
- Heterogenous parenchymal disease
- Biliary obstruction
- Biliary calculi
- Masses
- Vasculature- PSS, arteriovenous fistulas
When is liver biopsy indicated?
- Persistent increase in liver enzymes
- Altered liver size
- Monitoring progressive liver disease
- To evaluate response to treatment
- What is done before liver biopsy?
- What are the different techniques?
- Percutaneous- blind, US
- Laparoscopy
- Coeliotomy
What are contraindications of percutaneous liver biopsy?
- Lack of operator experience
- Small liver, unless US
- Focal disease
- Extrahepatic cholestasis
- Bleeding disorder
- Severe anaemia
What is the pathology of juvenile hepatic fibrosis?
P
- Progressive fibrosis
- Minimal inflammatory reaction
- Central vein fibrosis and occlusion most common
Secondary acquired shunts following hepatic fibrosis
GSD, Rottweiler
- What causes acquired shunts?
- What do they develop from?
- Juvenile fibrosis, cirrhosis
- Redundant vessels- portal vein and cranial vena cava, portal hypertension
What are the main causes of canine chronic hepatitis?
- Idiopathic chronic hepatitis
- Lobular dissecting hepatitis
- Drug-induced hepatitis
- Copper-associated hepatitis
What is cirrhosis?
- End stage liver disease
- Shrunken liver from fibrosis
What is hepatic portal hypoplasia?
How does it present?
AKA microvascular dysplasia
Microscopic intra-hepatic shunting
Often have no clinical signs or like PSS
Small terrier breeds
Increased bile acids
Feline cholangitis can be supprative or lymphocytic?
What immune cells are in each?
Supprative- neutrophils
Lymphocytic- lymphocytes and plasma cells
