Internal Medicine: Gastroenterology: Liver Disease Flashcards
What are hepatic functions?
- Intermediate metabolism
- Storage
- Protein synthesis
- Production of bile
- Detoxification
What are the three types of jaundice and causes?
Pre-hepatic
* Haemolysis
Hepatic
* Hepatocyte dysfunction
* Intrahepatic cholestasis
Post hepatic
* Extra-hepatic cholestasis
What are signs of metabolic dysfunction of the liver?
- Non-specific- loss of condition, weight loss
- Hypoglycaemia
- Hypoalbuminaemia
What circulatory distrurbances can affect the liver?
What do they cause?
- Hypoalbuminaemia
- Portal hypertension
- Sodium and water retention
- PSS- congential, acquired
Ascites
What is hepatic encephalopathy?
Defective urea formation from NH3
* Decreased functional liver mass
* PSS
Increases blood NH3
Leads to altered CNS function
What are CNS signs of hepatic encephalopathy?
- Anorexia
- Vomiting and diarrhoea
- PUPD
- Dullness
- Agression
- Staggering
- Blindness
- Head-pressing
- Seizures
What causes copper-coloured irises in cats?
Porto-systemic shunts
How can liver disease cause haemorrhage?
- Defective production and storage of clotting factors
- Vitamin K malabsorption
- Portal hypertension- GI bleeding
How are hepatopathies classified?
- Primary- infectious/non-infectious
- Secondary- non-specific reversible
What are examples of secondary liver diasease?
- Anoxia
- Toxaemia
- Nutritional imbalance
- Metabolic changes
- Infection
What are reactive hepatopathies?
Name examples?
Most common liver abnormality- little loss of function, reversible
- IBD
- Bacterial infections
- Pancreatitis
- Shock
- Septicaemia
What bacteria and virus can cause primary hepatic disease?
Bacterial
* leptospirosis
* Bacterial cholangiohepatitis
Viral
* Infectious canine hepatitis
* Canine herpes virus
* FIP
Protozoal
* Toxoplasma
What are non-infectious causes of primary hepatic disease?
- Toxic hepatic disease
- Drug-induced hepatic disease
- All forms of chronic hepatitis
What are causes of non-inflammatory liver disease?
- Congenital portosystemic shunt
- Juvenile hepatic fibrosis
- Feline hepatic lipidosis
- Neoplasia
- Telangiectasis and Peliosis
- Surgical- trauma, liver lobe torsion- entrapment
What is feline hepatic idiosyncrasies?
- Relative deficiency of glucuronyl transferase
- Difficulty in conjugating toxins
Reasons for susceptibility to asprin, paracetamol etc
What causes paracetamol toxicity in cats?
Why does it cause death
- Relative deficiency of glucuronidation, and gluthione
- Produced methaemoglobinaemia
- Haemolytic anaemia- depression, dyspnoea
- Facial odema
- Hepatocellular damage- liver failure and icterus
How can paracetamol toxicity in cats be treated?
- N-acetlycystine
- Vitamin C
- Supportive- IV fluids
- Activated charcoal if recent ingestion
How do cats clinical signs of liver disease differ to dogs?
Cats
* Anorexia/weight loss less common
* Icterus relatively common
* PUPD- less severe
* Hepatoencephalopathy- increased hypersalivation
* Microhepatica and cirrhosis rarely seen
* Pyrexia common in supp cholangitis
* Chorioretinitis or uveitis
What are DDxs for feline icterus?
- Cholangitis complex
- Dry FIP
- Lymphoma
- Neoplasia
- Lipidosis
- Toxoplasmosis
- Haemolytic anaemia
- Toxic hepatopathy
- Pancreatitis
- Panleucopenia
- Biliary obstruction
