Lecture 14 2/12/25 Flashcards

1
Q

What is feline hepatic lipidosis?

A

metabolic syndrome characterized by hepatic lipid accumulation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is the etiology of feline hepatic lipidosis?

A

-consequence of negative energy balance in over-conditioned cats
-hyporexia/anorexia is usually secondary to another disease; GI dz, pancreatitis, cholangitis
-can be idiopathic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is the pathophysiology of feline hepatic lipidosis?

A

-negative energy balance leads to peripheral fat mobilization
-delivery to liver exceeding mitochondrial beta-oxidation leads to triglyceride accumulation in the hepatocytes
-cytosolic distension with triglycerides leads to intracellular dysfunction and extracellular compression of canaliculi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is the clinical presentation of feline hepatic lipidosis?

A

-middle-aged cats
-often over-conditioned
-history of hyporexia/anorexia, lethargy, weight loss, vomiting, diarrhea
-dehydration, hepatomegaly, and icterus seen on PE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the findings on biochemical testing in cats with hepatic lipidosis?

A

-marked increase in ALP that is almost always greater than the increase in GGT
-hyperbilirubinemia
-increased ALT and AST
-electrolyte derangements
-mild hyperglycemia
-increased beta-hydroxybutyrate due to ketogenesis in the liver
-underlying disease can cause increased GGT, hypoalbuminemia, and hyperglobulinemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the findings on CBC in cats with hepatic lipidosis?

A

-mild nonregenerative anemia
-poikilocytosis (abnormal shape)
-heinz bodies
-possibility of mature neutrophilic leukocytosis (underlying dz)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the findings on UA in cats with hepatic lipidosis?

A

lipid droplets

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the findings on coagulation testing in cats with hepatic lipidosis?

A

often abnormal PT and PTT

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the findings on abdominal ultrasound in cats with hepatic lipidosis?

A

-diffusely hyperechoic liver
-hepatomegaly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

How is hepatic lipidosis diagnosed?

A

-consistent signs
-bloodwork changes
-hepatic cytology
-hepatic biopsy ONLY if suspicious of another hepatobiliary dz

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What are the differential diagnoses for hepatic lipidosis?

A

-cholangitis
-extrahepatic bile duct obstruction
-hepatocellular neoplasia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the goals of hepatic lipidosis management?

A

-correct dehydration
-correct electrolyte changes
-reverse the negative energy balance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the characteristics of fluid therapy for hepatic lipidosis patients?

A

-use isotonic crystalloids without lactate buffer
-replace volume based on lean body mass
-supplement with potassium, phosphorus, and B-vitamin
-avoid dextrose supplementation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the characteristics of nutritional support for hepatic lipidosis patients?

A

-enteral feeding starts once hydration and electrolytes are normal
-can use nasoesophageal or nasogastric feeding tubes
-feed a protein enriched diet
-begin feeding at 1/4 or 1/3 RER and gradually increase over 2 to 3 days
-can do CRI or 4 to 6 small bolus feedings throughout day

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the characteristics of esophageal tubes for hepatic lipidosis patients?

A

-can be placed once patient is stable and has received 2 to 3 doses of vitamin K1
-can be used to provide medication and allow for increased food options
-can be managed by owners
-antiemetics used to prevent vomiting/expulsion of the tube

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What other supportive care can be done in hepatic lipidosis patients?

A

-vitamin K1 supplementation
-antioxidants
-metabolic supplements

17
Q

What is the prognosis for hepatic lipidosis?

A

-good if diagnosed early, treated proactively, and underlying problem is identified and addressed
-good prognostic indicators include reduction in beta-hydroxybutyrate during hospitalization and reduction in bilirubin within 1 to 2 weeks of therapy
-poor prognostic indicators include hypotension, effusions, and progressive hypoalbuminemia and hyperbilirubinemia

18
Q

What are the characteristics of feline cholangitis?

A

-inflammatory process targeting the bile ducts/ductules expanding within the portal tract
-classification is based on the predominant cellular infiltrate and duration of illness
-common comorbidities include pancreatitis and IBD

19
Q

What are the 3 main subtypes of feline cholangitis?

A

-neutrophilic (acute and chronic)
-lymphocytic
-chronic (fluke associated)

20
Q

What is the etiology of acute and chronic neutrophilic cholangitis?

A

-most commonly bacterial infection
-rarely protozoal infection

21
Q

What is the etiology of lymphocytic cholangitis?

22
Q

Which fluke is most commonly the cause of chronic cholangitis?

A

Platynosomum concinnum

23
Q

What is the pathophysiology of neutrophilic and chronic/fluke cholangitis?

A

-infectious organisms cause direct injury to biliary epithelium
-secondary induction of innate and adaptive immune responses targeted at clearing dead cells and infection leads to maintained inflammation and tissue damage
-extrahepatic bile duct obstruction can occur due to fluke obstruction, thickened bile, or cholelithiasis

24
Q

What is the pathophysiology of lymphocytic cholangitis?

A

-immune-mediated disease targeting the biliary epithelium leads to periductal and intraductal lymphocyte infiltration and myofibroblast activation
-cell infiltration/activation leads to extracellular matrix deposition and potentially bile duct destruction

25
What is the clinical presentation of acute neutrophilic cholangitis?
-young cats -short duration of illness -signs including abdominal pain, dehydration, fever, GI signs, and icterus
26
What is the clinical presentation of chronic neutrophilic cholangitis?
-cats of any age -waxing and waning signs
27
What is the clinical presentation of lymphocytic cholangitis?
-middle-aged to older cats -no breed or gender predisposition -signs including intermittent vomiting, diarrhea, anorexia, and icterus
28
What is the clinical presentation of fluke-associated cholangitis?
-free-roaming cats in tropical/subtropical regions -acute phase patients can be asymptomatic or present with anorexia and lethargy -chronic infection presents with cyclic abdominal pain, chronic mucoid diarrhea, and icterus -high fluke burden can lead to severe inflammation, extrahepatic bile duct obstruction, or death
29
What are the differential diagnoses for neutrophilic and fluke-associated cholangitis?
-hepatic abscess -pancreatitis -extrahepatic bile duct obstruction -stricture -neoplasia
30
What are the differential diagnoses for lymphocytic cholangitis?
-hepatobiliary neoplasia -chronic pancreatitis -reactive hepatopathy -FIP
31
What are the clin path findings in acute neutrophilic cholangitis?
-neutrophilia with left shift and toxic changes -hyperbilirubinemia -increases in GGT and ALP; GGT > ALP -marked increase in ALP if concurrent with lipidosis -moderate to severe ALT and AST increases -hyperglobulinemia -electrolyte derangements -coagulopathy -pre-renal and/or renal azotemia
32
What are the clin path findings in lymphocytic cholangitis?
-regenerative/nonregenerative anemia with poikilocytosis -moderate to severe increase in ALT and AST -relatively higher GGT/ALP ratios -mild hyperglobulinemia -hyperbilirubinemia
33
What are the clin path findings in fluke-associated cholangitis?
-mild non-regenerative anemia -hypereosinophilia -lymphocytosis -hyperbilirubinemia -increased ALT and AST
34
How is cholangitis diagnosed?
-fecal float (fluke-associated) -abdominal ultrasound -cholecystocentesis and bile analysis -liver FNA -histology (definitive)
35
What are the management steps for neutrophilic cholangitis?
-correction of dehydration and electrolyte abnormalities -vitamin K1 prior to invasive procedures -antioxidants -nutritional support -antibiotic therapy
36
What are the management steps for lymphocytic cholangitis?
-immunosuppression with prednisolone -ursodeoxycholic acid in cats without ductopenia -antioxidants -modulation of gut flora -close monitoring of ductopenic cats
37
What are the management steps for fluke-associated cholangitis?
-praziquantel -repeat fecals to assure clearance
38
What is the prognosis for cholangitis?
-often have comorbidities; should be identified and treated appropriately -good prognosis for fluke-associated and neutrophilic cholangitis if identified early -lymphocytic cholangitis requires chronic therapy and monitoring; remission possible before inevitable relapse/progression to lymphoma -ductopenic cats have poorer prognosis in lymphocytic cholangitis