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SA Gastroenterology (Spring 2015) > L13: Concepts of Liver Disease > Flashcards

L13: Concepts of Liver Disease Flashcards

1
Q

portal vascular system**

A
  • blood flows from all digestive organs to the liver via portal v.
  • liver acts as metabolic filter and removes translocated intestinal bacteria
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2
Q

hepatic vascular anatomy

A
  • portal v., hepatic aa., bile duct feed into liver
  • hepatic v. feeds into CVC
  • biliary system circulates countercurrent to blood supply and eventually heads to intestines
  • liver lobule is radially arranged around a central hepatic venule w/ portal triads at the periphery
  • portal triad = portal v, hepatic a., bile duct
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3
Q

zones in hepatic vascular anatomy

A

1: periportal region
2: intermediate zone b/w portal triads and central v.
3: around central v.

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4
Q

components of acinus

A
  • sinusoids lined by fenestrated endothelium
  • Kupffer cells part of reticuloendothelial system (liver’s “immune system”)
  • stellate cells provide support
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5
Q

anatomy of hepatocyte

A
  • very metabolically active
  • tight junctions between
  • sinusoids on top and bottom
  • bile canuliculi connect to form bile ducts
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6
Q

hepatic functions

A
  • carb/lipid/protein/vitamin metabolism
  • immunologic functions
  • detoxification and excretion of bilirubin, steroids, ammonia, drugs
  • synthesis, regulation, enterohepatic circulation of bile acids
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7
Q

slide 11

A

:)

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8
Q

Q: what % of liver can be removed before evidence of dysfunction?

A

A: 75%

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9
Q

breed disposition to liver dz

A

dobies
spaniels
labs
bedlingtons

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10
Q

what CS most specific for liver dz?

A

jaundice

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11
Q

low protein ascites indicative of:

A

portal hypertension

hypoalbuminemia

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12
Q

high protein ascites indicative of:

A 
R-sided heart failure
caval syndrome (due to backflow into portal system)
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13
Q

general principles of liver dz in cats

A
  • ascites uncommon
  • palpate thyroid gland and measure T4
  • copper colored iris in 60% of feline shunts
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14
Q

what is often 1st sign of liver disorder?**

A

clinicopathologic abnormalities

-often secondary to other disorder like reactive hepatopathies*

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15
Q

do liver enzymes indicate function?

A

NO

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16
Q

liver enzyme indicators of cell damage**

A

ALT

AST

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17
Q

liver enzyme indicators of cholestasis/drugs

A

ALP

GGT

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18
Q

where ALT found?

A
  • cytoplasm

- liver specific*

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19
Q

where AST found?

A
  • cytoplasm and mitochondria

- can be in liver, muscle, RBCs

20
Q

greatest increases of ALT/AST seen with:

A

necrosis

21
Q

T/F: poor correlation b/w magnitude of increase of ALT/AST and severity of disease

A

T

22
Q

where ALP found?

A

bone, liver, steroid inducible (dogs only)

-membrane bound

23
Q

why is elevation of ALP significant?

A

-usually indicates a more chronic problem b/c minor disturbances that cause cholestasis usually don’t cause rise in ALP

24
Q

where GGT found?

A

mainly liver

-membrane bound

25
Q

ALP/GGT induced by:

A
  • cholestasis

- drugs

26
Q

“Pseudofunction” liver function tests

A
  • bilirubin
  • albumin
  • BUN
  • cholesterol
  • Glucose
27
Q

“True function” liver function tests

A
  • ammonia

- serum bile acids

28
Q

Q: ALT greatly increased, ALKP mildly increased. Hepatocellular or cholestatic origin?

A

hepatocellular

29
Q

3 categories of causes for icterus

A

pre-hepatic
hepatic
post-hepatic

30
Q

pre-hepatic causes of icterus

A

-hemolysis (rule out by doing PCV or Hct)

31
Q

hepatic causes of icterus

A
  • hepatitis
  • hepatic lipidosis
  • neoplasia
  • cirrhosis
  • toxins/drugs
  • sepsis
32
Q

post-hepatic causes of icterus

A 
pancreatitis
cholangitis
cholecystitis
choleliths
biliary neoplasia
GB mucocele
duodenal disease
33
Q

bilirubinuria always significant in cats!!**

A

:)

34
Q

albumin produced by:

A

liver

35
Q

when is albumin decreased

A

liver disease, PLE, PLN, effusions, maldig/malab. disease

36
Q

does albumin decrease under anorexia?

A

barely

37
Q

Blood Urea Nitrogen (BUN) test

A
  • related to ammonia and metabolism

- low BUN suggests dysfyunction such as dec. appetite, low protein diet, diuresis

38
Q

causes of hypoglycemia

A
  • liver dysfx
  • insulinoma
  • fasting in puppies
  • Addison’s
  • etc.
39
Q

when is cholesterol increased? dec?

A

inc: cholestatic disease
dec: liver dysfx
(uptake and synthesis in the liver)

40
Q

Blood ammonia test

A
  • ammonia converted to urea in liver
  • can test fasting ammonia (if high, suggests liver dysfx)
  • lvls change based on pH of sample, which changes as sample ages!
41
Q

ammonia goes where is PSS?

A

brain

42
Q

ammonia goes where in hepatitis?

A

peripheral circulation

43
Q

Serum bile acids test

A
  • give yes or no answer on whether liver functioning normally or not, but doesn’t differentiate between TYPE of liver disease
  • bile acids don’t contribute to hepatic encephalopathy
  • stable in serum
  • don’t need to run if patient icteric (u already know elevated!)
44
Q

slide 32-33

A

:)

45
Q

what can cause inc. in bile acids

A

PSS

parenchymal disease

46
Q

additional diagnostics in liver dz

A
  • CBC
  • Clotting function
  • Fecal exam to look for GI bleeding
  • rads
  • abdominocentesis
  • U/S
  • aspiration cytology
  • biopsy

SA Gastroenterology (Spring 2015) (9 decks)

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