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3.16 Alimentary > Investigating Canine and Feline Liver Disease > Flashcards

Investigating Canine and Feline Liver Disease Flashcards

1
Q

List functions of liver

A

Metabolism carbohydrates
Drug metabolism and excretion
Production of urea from ammonia
Production of coagulation factor
Production of albumin
Immune functions
Metabolism of lipids
Storage of minerals (Fe, Cu, Vitamins)
Bile acid synthesis

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2
Q

Liver failure does not develop until >…? functional capacity is lost

A

70

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3
Q

List some Causes of Secondary Hepatopathies

A

Hypoxia / hypotension
Congestion
Non hepatic inflammatory diseases
Drugs
Metastatic Neoplasia
Endocrinopathies

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4
Q

List hypoxic/hypotension causes of secondary hepatopathy

A

Shock
Surgery
Seizures
Anaemia

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5
Q

List cardiogenic Congestion causes of secondary hepatopathy

A

Right-sided CHF
Pericardial effusion

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6
Q

List Non hepatic inflammatory diseases causes of secondary hepatopathy

A

GI disease
Pancreatitis
Sepsis
Toxaemia

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7
Q

List iatrogenic causes of secondary hepatopathy

A

Glucocorticoids
Phenobarbital

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8
Q

List Endocrinopathies causes of secondary hepatopathy

A

Hyperadrenocorticism
Hypoadrenocorticism
Diabetes mellitus
Hyperthyroidism (cats)
Hypothyroidism (dogs)
Hyperlipidaemia (Min. Schnauzers)

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9
Q

Breeds predisposed to chronic hepatitis

A

Springer spaniel
Doberman
Cocker spaniel
Labrador

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10
Q

Breeds predisposed to copper storage disease

A

Bedlington terriers
Labradors

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11
Q

Breeds predisposed to Gall bladder mucoceles

A

Shetland Sheepdogs, Border Terriers

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12
Q

Feline hepatic lipidosis risk factors/history

A

Overweight cats with recent history of anorexia

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13
Q

Hepatotoxic drugs

A

NSAIDs (Carprofen)
Paracetamol (cats)
Azathioprine
TMPS antibiotics (dogs)
Diazepam (oral, cats)
Lomustine
Carbimazole/methimazole
Phenobarbitone

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14
Q

Infectious causes of acute hepatic disease

A

CAV-1
Leptospirosis
Clostridium
Acute neutrophilic cholangitis/cholangiohepatitis

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15
Q

Metabolic causes of acute hepatic disease

A

Hepatic lipidosis (cats)

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16
Q

Toxic causes of acute hepatic disease

A

Xylitol (chewing gum)
Mycotoxins, aflatoxicosis
Amanita mushrooms
Cyanobacteria- microcystin toxicosis (blue green algae)
Sago palm

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17
Q

Biochemistry of Indicators of liver damage

A

Liver enzymes – ALT, AST

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18
Q

Biochemistry of Indicators of cholestasis

A

Liver enzymes – ALP, GGT
Bilirubin
Bile acids

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19
Q

Indicators of liver function

A

Bile acids
Ammonia
Bilirubin
Glucose, urea, albumin, cholesterol, fibrinogen

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20
Q

ALT

A

Liver specific enzyme
Alanine AminoTransferase

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21
Q

AST

A

Liver enzyme
Aspartate aminotransferase (AST)
Liver, skeletal muscle, cardiac myocytes and kidneys

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22
Q

ALP or ALKP

A

Alkaline phosphatase

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23
Q

GGT

A

Gamma glutamyl transferase (GGT)

24
Q

…? is least specific of all markers

A

ALP

25
Q

Summarise how billirubin is produced in the body

A

erythrocytes Transported to the liver and conjugated, secreted into bile, stored in gall bladder and excreted via ducts

26
Q

How to classify jaundice?

A

Prehepatic
- Haemolysis
- Increased production exceeds capacity of hepatic excretion

Hepatic
- Abnormal uptake, defective conjugation or abnormal excretion of bilirubin by hepatocytes

Post hepatic
- Impaired excretion of bilirubin

27
Q

Investigating Pre hepatic Jaundice

A

Increased PCV

28
Q

Investigating Post hepatic Jaundice

A

ALP, GGT > ALT, AST
Hypercholesterolaemia?
Ultrasound biliary system - Assess for obstruction of bile duct, GB rupture
Pancreatic assessment- cPLI

29
Q

Investigating Hepatic Jaundice

A

Rule out pre and post hepatic aetiology
Consider biopsy

30
Q

Cause of Hypocholesterolaemia

A

Liver failure

31
Q

Cause of Hypercholesterolaemia

A

Extrahepatic bile duct obstruction
Intrahepatic cholestatic diseases
Marked hepatic regeneration

32
Q

How is cholesterol excreted

A

Derived from diet and made in the liver
Undergoes enterohepatic recycling
Bile provides the major excretory pathway

33
Q

Will urea levels increase or decrease in liver failure

A

Decreases with severe liver dysfunction due to failure to convert ammonia to urea

34
Q

Will glucose levels increase or decrease in liver failure

A

Occasionally hypoglycaemia seen with severe hepatic compromise (<30% hepatic function)

35
Q

Most specific test of liver dysfunction are …?

A

bile acids

36
Q

Contraindications of Bile acid stim test

A

Jaundiced

37
Q

Describe the anemia that could be seen in liver failure

A

Mild anaemia
Microcytic, hypochromic anaemia with portosystemic shunts

38
Q

Ascites

A

Accumulation of free fluid within the abdominal cavity

39
Q

Causes of ascites

A

Decreased oncotic pressure- Hypoalbuminaemia
Increased hydrostatic pressure - Portal Hypertension
Leakage from organs (bile)
Inflammation (peritonitis)
Leakage from vessels (blood)

40
Q

Size of needle used for FNA for liver

A

23

41
Q

Pros of FNA

A

Minimally invasive procedure
Little equipment
Sedation
Useful for lymphoma, mast cell tumours and hepatic lipidosis
Bile samples

42
Q

Cons of FNA

A

Accuracy of cytology limited (30-50% agreement with histology)
Does not evaluate hepatic architecture
Only cytology
Iatrogenic damage gall bladder

43
Q

Name of needle used for Percutaneous biopsy

A

Cutting Needle (Tru-Cut)

44
Q

Pros of Biopsy: Cutting Needle

A

Larger sample size allows examination of hepatic architecture
Avoids laparotomy
Sample focal disease

45
Q

Cons of Biopsy: Cutting Needle

A

General anaesthesia
Specialist equipment
Less accurate than surgical biopsies
Difficult with small livers or ascites
Haemorrhage

46
Q

Pros of Biopsy: Surgical

A

Better diagnostic samples. Larger sample size allows better examination of hepatic architecture
Can get samples form multiple liver lobes and bile aspirate
Can visualise haemorrhage

47
Q

Cons of Biopsy: Surgical

A

General anaesthesia
More invasive procedure
Risks of haemorrhage

48
Q

List hepatic disease

A

Chronic Hepatitis
Cholangitis
- Neutrophilic Cholangitis
- Lymphocytic Cholangitis
- Vacuolar Hepatopathies
Hepatobiliary Neoplasia

49
Q

What is Chronic Hepatitis

A

Inflammation of the hepatic parenchyma
Often present later stages of chronic hepatitis
Treat with immunosuppressives

50
Q

What is Cholangitis

A

Inflammation of the biliary duct
More common in cats +/- duodenitis, pancreatitis, cholangitis (“triaditis”)

51
Q

What is Neutrophilic Cholangitis

A

Suppurative inflammation on histology
Ascending infection from intestines – anatomical problem in cats
Treat with AB

52
Q

What is Lymphocytic Cholangitis

A

Suspected immune mediated disease
Chronic history of vague illness
Systemically well – normothermic
Treat with immunosuppressive

53
Q

What is Vacuolar Hepatopathies

A

Histopathology diagnosis
Hepatocytes become markedly distended with cytosolic glycogen
Associated with glucocorticoid excess:
- Glucocorticoid administration
- Hyperadrenocorticism
Endogenous release of corticosteroids in response to chronic stress, illness, inflammation or neoplasia
ALP often increased (dogs)

54
Q

What is Gall Bladder Mucocele

A

Distention of gallbladder by an inappropriate accumulation of mucus

55
Q

U/S apperance of gall bladder with gall bladder mucocele

A

“Kiwi” appearance

56
Q

What is Bile Peritonitis

A

Inflammatory response of the lining of the abdominal cavity to the presence of free bile

3.16 Alimentary (15 decks)

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