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SA Gastroenterology (Spring 2015) > L13: Canine and Feline Liver Disease > Flashcards

L13: Canine and Feline Liver Disease Flashcards

1
Q

causes of acute hepatitis

A

toxins
infections
drugs
idiopathic

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2
Q

CS of acute hepatitis

A 
inappetance
lethargy
vomiting
abd pain
\+/- icterus
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3
Q

biochem in acute hepatitis**

A

marked inc. ALT
ALP < ALT
inc. bilirubin

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4
Q

Tx of acute hepatitis**

A

supportive: fluids, glucose, HE
anti-emetics
antioxidant therapy

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5
Q

Extrahepatic Bile Duct Obstruction

A
  • impairment of bile flow in the biliary system b/w liver and duodenum
  • CS: inappetance, icterus, vomiting
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6
Q

Common causes of Extrahepatic Bile Duct Obstruction in DOGS

A

pancreatitis (common)

GB mucocele

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7
Q

Common causes of Extrahepatic Bile Duct Obstruction in CATS

A

neoplasia (common)

liver flukes

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8
Q

Dx of Extrahepatic Bile Duct Obstruction**

A 
marked inc. ALP
ALP usually > ALT
icterus
U/S
\+/- confirm w/ laparotomy
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9
Q

possible causes of chronic hepatitis

A

drug-induced
copper-associated (Bedlington, Dobies, Dalmatians, Labs, Westies)
familial (breed) related
idiopathic

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10
Q

CS of chronic hepatitis

A

-intermittent nonspecific signs

+/- icterus

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11
Q

biochem of chronic hepatitis**

A
  • inc. ALT and ALP
  • ALT > ALP
  • dec. albumin, urea nitrogen, cholesterol
  • hyperbilirubinemia
  • abn. bile acids
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12
Q

Dx of chronic hepatitis

A

BIOPSY: reveals mononuclear inflammation, necrosis, bile duct hyperplasia, +/- fibrosis

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13
Q

Dx of copper-associated chronic hepatitis

A
  • Biopsy - rhodanine stain

- quantitative tissue copper analysis

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14
Q

Tx of chronic hepatitis

A
  • immunosuppressive therapy (pred)
  • UDCA: dioxycolic acid (anti-oxidant, good alternative to steroid, few side effects/contraindications)
  • anti-oxidants
  • anti-fibrotics? (since chronic hepatitis can –> liver fibrosis)
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15
Q

Tx of copper-assoc. chronic hepatitis

A
  • dietary Cu restriction
  • chelator therapy (D-penacillamine, Trientine)
  • Zinc (helps chelate Cu in GIT)
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16
Q

response of the liver to injury

A

hepatocellular degeneration (apoptosis) –> regenerative nodules –> bile duct hyperplasia –> hepatic fibrosis –> portal hypertension

17
Q

chars. of cirrhosis

A
  • chronic diffuse process
  • end stage of chronic liver diseases
  • CS: inappetance, hepatic encephalopathy, weight loss, icterus, ascites and/or peripheral edema
  • secondary shunts often develop
18
Q

ascites in cirrhosis

A

cirrhosis –> portal hypertension –> dec. effective circulation volume –> sodium and water retention –> ascites

19
Q

tx of cirrhosis

A
  • address underlying disease
  • anti-fibrotics?
  • spironolactone +/- lasix for fluid retention (lasix may cause metabolic alkalosis)
20
Q

hepatic encephalopathy

A
  • results from hepatic detoxification fx –> accum. of toxic metabolites which are toxic to neurons/glia and act as “false NT”
  • CS: behavior change, blindness, pacing, seizure
21
Q

Dx/Tx of hepatic encephalopathy

A

Dx: presence of liver dysfx (ie. abn. BA, ammonia), known liver dz
Tx: lactulose (traps ammonia in colon for excretion), broad spec Abx (neomycin, amoxicillin), restricted protein diet

22
Q

Congenital Portal Systemic vascular anomalies (CPSS)

A
  • abn. devel. of hepatic portal circulation (shunt from portal v. to vena cava)
  • usually young dogs (Yorkies, mini schnauzer, maltese, Irish Wolfhound)
23
Q

small breeds usually have extra/intra hepatic shunt

A

extra

24
Q

large breeds usually have extra/intra hepatic shunt

A

intra

25
Q

CS of CPSS

A
  • Hepatic encephalopathy signs common
  • PU/PD, urate stones, ptyalism (excess saliva), small stature
  • cats: Cu irises
26
Q

Clin path of CPSS

A
  • may be normal
  • ALT, AST, ALP, GGT norm. to mild inc.
  • dec. albumin, urea nitrogen, +/- glucose
  • ammonium biurate crystals
  • microcytic anemia (50%)
  • abnormal LFT’s
27
Q

Dx imaging of CPSS

A
  • abd U/S: aortic to portal v. ratios, renomegaly, shunt
  • CT angiogram
  • transplenic scintigraphy
28
Q

Tx of CPSS

A 
Medical:
-restrict protein
-lactulose
\+/- abx
Surgical ligation of shunt
29
Q

Vacuolar Hepatopathy

A
  • glycogen accumulation w/n hepatocytes
  • can be due to steroids
  • CS: none or pu/pd, polyphagia
  • classic lesion = vacuolization
30
Q

Vacuolar Hepatopathy clin path

A
  • inc. ALP (may be dramatic)
  • N bilirubin
  • dx by liver aspirate/biopsy
31
Q

Tx of Vacuolar Hepatopathy

A
  • none if asymptomatic
  • mitotane, trilostane
  • melatonin

SA Gastroenterology (Spring 2015) (9 decks)

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