L13: Canine and Feline Liver Disease

Question 1

causes of acute hepatitis

Answer 1

toxins
infections
drugs
idiopathic

Question 2

CS of acute hepatitis

Answer 2

inappetance
lethargy
vomiting
abd pain
\+/- icterus

Question 3

biochem in acute hepatitis**

Answer 3

marked inc. ALT
ALP < ALT
inc. bilirubin

Question 4

Tx of acute hepatitis**

Answer 4

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

Question 5

Extrahepatic Bile Duct Obstruction

Answer 5

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

Question 6

Common causes of Extrahepatic Bile Duct Obstruction in DOGS

Answer 6

pancreatitis (common)

GB mucocele

Question 7

Common causes of Extrahepatic Bile Duct Obstruction in CATS

Answer 7

neoplasia (common)

liver flukes

Question 8

Dx of Extrahepatic Bile Duct Obstruction**

Answer 8

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

Question 9

possible causes of chronic hepatitis

Answer 9

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

Question 10

CS of chronic hepatitis

Answer 10

-intermittent nonspecific signs

+/- icterus

Question 11

biochem of chronic hepatitis**

Answer 11

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

Question 12

Dx of chronic hepatitis

Answer 12

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

Question 13

Dx of copper-associated chronic hepatitis

Answer 13

• Biopsy - rhodanine stain

- quantitative tissue copper analysis

Question 14

Tx of chronic hepatitis

Answer 14

• 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)

Question 15

Tx of copper-assoc. chronic hepatitis

Answer 15

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

Question 16

response of the liver to injury

Answer 16

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

Question 17

chars. of cirrhosis

Answer 17

• 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

Question 18

ascites in cirrhosis

Answer 18

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

Question 19

tx of cirrhosis

Answer 19

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

Question 20

hepatic encephalopathy

Answer 20

• 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

Question 21

Dx/Tx of hepatic encephalopathy

Answer 21

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

Question 22

Congenital Portal Systemic vascular anomalies (CPSS)

Answer 22

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

Question 23

small breeds usually have extra/intra hepatic shunt

Answer 23

extra

Question 24

large breeds usually have extra/intra hepatic shunt

Answer 24

intra

Question 25

CS of CPSS

Answer 25

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

Question 26

Clin path of CPSS

Answer 26

- 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

Question 27

Dx imaging of CPSS

Answer 27

- abd U/S: aortic to portal v. ratios, renomegaly, shunt - CT angiogram - transplenic scintigraphy

Question 28

Tx of CPSS

Answer 28

``` Medical: -restrict protein -lactulose +/- abx Surgical ligation of shunt ```

Question 29

Vacuolar Hepatopathy

Answer 29

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

Question 30

Vacuolar Hepatopathy clin path

Answer 30

- inc. ALP (may be dramatic) - N bilirubin - dx by liver aspirate/biopsy

Question 31

Tx of Vacuolar Hepatopathy

Answer 31

- none if asymptomatic - mitotane, trilostane - melatonin