Lecture 11 2/10/25 Flashcards
What are the early, non-specific signs of liver disease?
-hyporexia
-vomiting
-lethargy
-weight loss
-diarrhea
-PU/PD
What are the late stage, more specific signs of liver disease?
-icterus
-hepatic encephalopathy
-hypoglycemia
-ascites
-bleeding tendencies
How does the development time of liver disease impact the clinical signs seen?
-chronic/slowly developing dz gives the liver time to adapt, which can reduce clinical sign severity
-acute/acute on chronic damage leaves no time for adaptation and can result in more severe clinical signs
What are the clinical signs of acute hepatopathy in dogs and cats?
-anorexia
-hepatic encephalopathy
-vomiting
-polydipsia
-dehydration
-jaundice
-fever
-cranial abdominal pain
-coagulopathy/petechiae/melena/hematemesis
-ascites
-splenomegaly
-acute kidney injury
What are the clinical signs of chronic hepatopathy in dogs and cats?
-vomiting and/or diarrhea
-hematemesis/melena
-inappetence
-weight loss
-PU/PD
-ascites
-jaundice
-hepatic encephalopathy
-bleeding tendencies
What is icterus?
yellow discoloration of tissues and body fluids secondary to hyperbilirubinemia and bile pigment deposition
Where are the most sensitive places to identify icterus?
-sclera
-conjunctiva
-soft palate
-below the tongue
What are the clin path findings in a patient with prehepatic/hemolytic icterus?
-moderate or marked decrease in hematocrit
-possible spherocytes
-possible auto-agglutination
-possible positive Coombs test
-possible hemoglobinemia and/or hemoglobinuria
What are the clin path findings in a patient with hepatic icterus?
-normal hematocrit or mildly decreased hematocrit
-high increases in ALT and AST
-increases in ALP and GGT
-decreases in albumin, cholesterol, glucose, and urea
What are the clin path findings in a patient with posthepatic icterus?
-normal hematocrit or mildly decreased hematocrit
-increases in ALT, AST, and cholesterol
-high increases in ALP and GGT
-WNL albumin, glucose, and urea
What is ascites?
accumulation of free fluid within the abdominal cavity
How is ascites detected?
-abdominal distention (severe)
-positive ballottement (severe)
-radiography
-abdominal ultrasound
What are the causes of ascites that are related to the hepatobiliary system?
-portal hypertension
-hypoalbuminemia
-gallbladder rupture
What causes portal hypertension?
increased resistance and/or blood flow in portal circulation
What is hepatic encephalopathy?
neurologic dysfunction in patients with liver dz
What is the general etiology of hepatic encephalopathy?
dysmetabolism of toxins due to liver dysfunction and/or portosystemic bypass
What are the most common causes of hepatic encephalopathy in dogs?
-congenital portosystemic shunts
-acquired portosystemic shunts due to portal hypertension
-acute liver failure without shunting
What are the most common causes of hepatic encephalopathy in cats?
-congenital portosystemic shunts
-arginine deficiency secondary to hepatic lipidosis
-acute liver failure without shunting
What is the pathogenesis of portosystemic shunt/liver dysfunction?
ammonia-rich blood from portal circulation “bypasses” the liver and flows directly into systemic circulation
What percent of dogs and cats with congenital portosystemic shunt develop hepatic encephalopathy?
around 70%
Which brain neurotoxins/neuroinhibitors are implicated in hepatic encephalopathy pathogenesis?
-ammonia***
-glutamine
-gamma-aminobutyric acid
-benzos/benzo-like substances
-tryptophan/serotonin
-aromatic amino acids
-manganese
-opioids
What are the early clinical signs of hepatic encephalopathy?
-mild confusion
-inappetance
-dullness
-irritability
What are the advanced clinical signs of hepatic encephalopathy?
-ataxia
-circling
-head pressing
-salivation
-seizures
-stupor
-coma
How is hepatic encephalopathy diagnosed?
-evidence of liver dysfunction in patient with neurological signs
-exclusion of other known brain diseases
-episodic signs of encephalopathy that may worsen after eating
-hyperammonemia