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SAM 2 > Liver 1 > Flashcards

Liver 1 Flashcards

1
Q

What is the liver responsible for?

A
  1. Clearance of gut-derived toxins
  2. Produces and acivates clotting factors
  3. Production of proteins, cholesterol, bile, glucose, BUN
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2
Q

What are the lobes of the liver?

A

Left- medial and lateral
Right- medial and lateral
Quadrate
Caudate- 2 processes: caudate and papillary

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3
Q

Which lobe is associated with the gall bladder?

A

Quadrate

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4
Q

What are the large blood vessels in the liver?

A

Portal vein, hepatic artery, hepatic vein/vena cava

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5
Q

What are the large biliary ducts?

A

Common bile duct and cystic duct

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6
Q

What are the components of the biliary system?

A
  1. Common hepatic duct
  2. Cystic duct
  3. Gall bladder
  4. Common bile duct

Many branches are intrahepatic

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7
Q

What is bile made up of?

A
  1. Water and electrolytes
  2. Bicarbonate
  3. Bile acids
  4. Cholesterol
  5. Phospholipids
  6. Bilirubin
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8
Q

What are bile acids for?

A

Absorption and digestion of fat and fat soluble vitamins

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9
Q

T/F: Bile is not the main elimination route of cholesterol.

A

False

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10
Q

What is bile release stimulated by?

A

CCK and secretin

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11
Q

What is the difference in the anatomy of the major duodenal papillae between the dog and the cat?

A

Dog: pancreatic duct and bile duct enter duodenum at separate places

Cat: pancreatic duct and bile duct join and enter the duodenum at the same place

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12
Q

What is a lobule?

A

Hexagonal plate of hepatocytes radiating out from a central vein

  • Portal triads are at the edges of lobules
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13
Q

What are portal triad?

A

Collection of the there major vessels surrounding lobules

  • Hepatic artery: oxygenated blood
  • Portal vein: venous blood from abdomen
  • Bile duct: carries bile away to larger intrahepatic ducts and then the GB
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14
Q

What is an acini?

A

A cone of tissue that runs for zone 1 to 3

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15
Q

What is a limiting plate?

A

Peri-portal hepatocytes

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16
Q

What is zone one and what kind of injury is it most prone to?

A

Area closest to the portal triads that is most prone to hepatotoxins

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17
Q

What is zone 2?

A

The area between zones 1 and 3

Nothing really special…..

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18
Q

What is zone three and what kind of injury is it most prone to?

A

Area around the central vein that is most prone to hypoxia

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19
Q

What is seen in the limiting plate in chronic hepatitis?

A

Inflammation and necrosis

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20
Q

How much of the blood supply to the liver passes through the portal vein?

A

75%

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21
Q

What organs drain into portal circulation?

A

Small intestine, pancreas, spleen, stomach

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22
Q

T/F: Anything that can effect blood flow can effect liver enzyme values even if there is no specific liver disease.

A

True- anemia, shock, heart failure, etc

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23
Q

How much of the blood supply to the liver passes through the hepatic artery?

A

25%

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24
Q

Where d the branches of the hepatic artery and portal veins empty into?

A

Sinusoids

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25
Q

What are sinusoids?

A

Vascular channels lined circumferentially by hepatocytes that empty into the central vein

  • Highly fenestrated endothelial cells
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26
Q

What is the space of disse and what does it do?

A

Area between the endothelial cells and hepatocytes

Site of plasma filtration and a large part of the lymph supply

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27
Q

Where do the central veins go?

A

Coalesce into larger hepatic veins and dump into vena cava

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28
Q

What are bile canaliculi made up of?

A

Basal aspect of hepatocytes joined together in junctional complexes- form the space of the bile canaliculi

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29
Q

What is contained within the bile ducts?

A

Products secreted by hepatocytes flow through canaliculi into bile ducts

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30
Q

What is the flow in he canaliculi relative to the blood flow in the liver?

A

Opposite

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31
Q

What is the flow from canaliculi to gall bladder?

A

Canaliculi– intrahepatic bile ducts– common bile duct– custic duct– gallbladder

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32
Q

What does the gall bladder do?

A

Storage and concentration of bile during fasting

Expulsion of bile when needed

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33
Q

What are kupffer cells, where are they found, and what do they do?

A
  • Liver macrophages
  • Located in sinusoids
  • Scavenge bacteria and other foreign materials
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34
Q

What are some clinical signs or presenting concerns of animals with liver disease?

A

Can be normal with labwork changes

Weight loss, vomiting, diarrhea, lethargy, icterus/jaundice, peritoneal effusion, acholic feces, hepatic encephalitis, abdominal pain, enlarged or small liver

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35
Q

What is acholic feces indicative of?

A

Bile duct obstruction or cholestasis

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36
Q

What are some CBC findings in patients with liver disease and what are they indicative of?

A
  • Regenerative anemia if toxin, GI bleed, coagulopathic
  • Normocytic normochromic anemia in chronic disease
  • Microcytosis in congenital/acquired shunts
  • Thrombocytopenia: lepto or coag issues
  • Thrombocytosis: chronic blood loss, Cushing’s disease
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37
Q

What are the serum chem findings in patients with liver disease and what are they indicative of?

A

Increased cholesterol: cholestatic disease
Decreases cholesterol: shunts and failure
Increased bilirubin: cholestatic disease, EHBDO, sepsis and hemolysis
Increased BUN: GI bleed
Decreased BUN: shunting or failure
Albumin: decreased with PSS and dysfunction
Hypoglycemia: dysfunction, shunts
Hyperglycemia: concurrent diabetes mellitus?

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38
Q

What are the UA findings in patients with liver disease and what are they indicative of?

A

Hyposthenura and isosthenuria common in extra and intra hepatic diseases

  • PSS often PU/PD
  • Glucoseuria: copper disease or lepto
  • Bilirubinuria: abnormal in CAT
  • Ammonium biurate crystals: shunts or failure
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39
Q

What can radiographs and US tell you when evaluating liver disease?

A

Radiographs: hepatic size, mineralization in liver or GB, mass lesions

US: masses, blood flow and shuntning, clots, gallbladder patency, shape, echogenicity, allows for aspirates/cultures of paranchyma and bile

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40
Q

T/F: Normal appearance of the liver on an ultrasound definitely rules out liver disease.

A

False

41
Q

What can be diagnosed on cytology of the parenchyma of the liver?

A
  • Hepatic lipidosis
  • Some neoplasias like lymphosarcoma
  • Vacuolar hepatopathy
42
Q

What are some additional lab tests that are useful in working up a liver disease patient?

A
  • Bile acids
  • Protein C
  • Coag profiles
  • Lepto and other infectious disease tests
  • Fecal analysis for parasites
43
Q

When should you biopsy the liver?

A

When other diseases have been ruled out non-invasively and you’re stuck

44
Q

T/F: Biopsy is not the best way to identify primary paranchymal diseases as most conditions can be diagnosed on cytology of FNA.

A

False- also helps guide treatments

45
Q

What should ALWAYS be run prior to performing an intestinal biopsy?

A

Coag profiles- usually within 1 day of procedure

46
Q

What are the pros/cons of needle biopsies of the liver?

A
  • Can be done percutaneously via US
  • Less invasive
  • Can’t monitor hemostasis directly

48% correlation to surgical biopsy

47
Q

What are the different types of surgical biopsies and what is the advantage?

A

Laparotomy and laparoscopy

Allows for direct hemostatic control and provides best diagnostic pieces

48
Q

When should you pursue laparotomy over laparoscopy?

A

When you need to assess or biopsy other organs

49
Q

What are the different stains you can use to evaluate liver histopathy and what are they diagnostic for?

A 
H&E- routine
Masson's trichrome- cirrhosis and fibrosis
PAS- ceroid lipofuscin/lipid
Rubeanic avid/Rhodanine- copper
Congo red- amyloid
Perl's stain- iron
50
Q

What cultures can you run on liver tissue and which is more diagnostic?

A

Anaerobic and aerobic cultures

Bile usually is more diagnostic than liver tissues so culture both if possible

51
Q

T/F: Liver enzyme elevations are often nonspecific clues and are not diagnostic for disease.

A

True- some have indications but mostly are not very useful on their own

52
Q

What are the three patterns of elevation in liver enzymes?

A

Hepatocellular, cholestatic, and mixed

53
Q

How is most liver disease caught?

A

On routine bloodwork of apparently healthy pets

54
Q

What is the half life of ALT (alanine aminotransferase) in the dog?

A

56 hours

55
Q

Where is ALT usually located and what is an elevated value indicative of?

A

Cytosol of hepatocytes

Elevations indicate inflammation or necrosis

56
Q

What should you suspect if ALT decreases or normalizes but you find other evidence of hepatic synthetic factor decreases?

A

Loss of functional liver mass

57
Q

Where is AST (aspartate aminotransferase) usually located?

A

Cytosol and mitochrondria of hepatocytes and myocytes

58
Q

What does an elevated AST mean?

Compare to ALT.

A

Hepatocellular or myocellular damage

Less specific than ALT

59
Q

How can you tell that an elevated ALT is associated with liver or muscle damage?

A

If muscular origin, CK will also rise

Hepatocellular will have a normal CK

60
Q

What is the half life of AST in the dog and cat?

A

12 hours in dog

77 min in cat

61
Q

What will the expected AST and ALT values be relative to each other with irreversible liver injury?

A

AST > ALT

62
Q

What conditions can effect hepatocellular enzymes?

A

Primary liver disease, infection, hepatotoxicity, reactive disease, hepatic abscess, liver lobe torsion, hyperthyroiidism

63
Q

What values are associated wtih cholestasis?

A

ALP, GGT, total bilirubin, increased cholesterol

64
Q

Which animal is ALP (alkaline phosphatase) cortisol induced?

A

Dogs ONLY

65
Q

What are other things that can contribute to increased ALP?

A

Bone growth and osteolytic disease

Small contributions from intestine kidney, liver, bone

66
Q

What are increased ALP usually induced by?

A

Hepatocellular injury to canalicular membranes of hepatocytes

67
Q

T/F: Increased ALP can be neoplasia induced.

A

True- hepatocellular carcinoma, LSA, osteosarcoma, mammary carcinoma

Increased ALP is a negative prognostic indicator for osterosarcoma patients

68
Q

T/F: ALP source should be differentiated as adds to clinical diagnosis.

A

False- supportive but does not add to clinical diagnosis

69
Q

What is the half life of ALP in the dog and cat?

A

70 hours in dogs

6 hours in cats

70
Q

T/F: ALP is very specific for hepatobiliary disease in the cat.

A

True

71
Q

Where is GGT (gamma-glutamyl transpeptidase) normally found?

A

Membrane bound on biliary surfaces

  • Pei-portal hepatocytes
  • Minimal contribution from kidney and pancreas
72
Q

T/F: GGT is more specific for cholestasis than ALP.

A

True

73
Q

What is the half life of GGT in the dog?

A

80 hours

74
Q

What are some conditions that can cause elevations in cholestatic values?

A 
Extrahepatic conditions- pancreatitis, IBD, masses, endocrine, sepsis
Breeds
Drug induced
Primary cholangitis/cholangiohepatitis
Benign nodular hyperplasia
75
Q

What enzymes elevate first in cholestasis, what enzymes elevate later?

A

AST and ALT first

ALK and GGT later

76
Q

What is bilirubin derived from?

A

Breakdown of hemoglobin from RBCs and myoglobin

77
Q

What is bilirubin a test of?

A

Hepatic function

78
Q

What is the difference between conjugated and unconjugated bilirubin?

A

Unconjugated- bound to albumin

Conjugated- made water soluble in bile for excretion into intestine and clearance in feces

79
Q

What levels of bilirubin will produce pigment change in the skin and the serum?

A
  1. 0-3.0 = skin

1. 0-2.0 = serum

80
Q

What does an increased bilirubin level support?

A

Diagnosis involving hemolysis or hepatobiliary disease

81
Q

How long does it take bilirubin to clear from the skin?

A

Depends on cause, usually takes several days once cause is resolved

82
Q

Where is bilirubin conjugated?

A

Liver

83
Q

What disease will present with higher amounts of unconjugated bilirubin versus conjugated?

A

Hemolytic disease or hepatic deficiencies

84
Q

What are other values associated with hepatic function?

A

Bile acids, ammonia, clotting factors, synthetic factors (BUN, albumin, cholesterol, glucose)

85
Q

What are bile acids derived from?

A

Cholesterol- cholic and chenodeoxycholic

86
Q

What are bile acids conjugated to for excretion?

A

Glycine, taurine, glucuronic acid, and sulfates

87
Q

T/F: Bile acids undergo enterohepatic recycling.

A

True- 96% that is excreted is reabsorbed and secreted back into bile canaliculi

88
Q

T/F: Enterohepatic recycling is impaired with disease and can result in inappropriate excretion of bile acids in the feces.

A

False

89
Q

Bile acids are useful to run to assess hepatic function in what kind of patients?

A

Non-icteric

90
Q

What is the procedure for testing bile acids?

A

Measure pre feeding and 2 hours post feeding

91
Q

What are increases in bile acids associated with?

A

Shunts, MVD, hepatic disease, failure, cholestatic disease

92
Q

What are normal bile acid values?

A

Pre

93
Q

What clotting factor does the liver NOT produce?

A

VIII

94
Q

What should you give prior to liver procedures to help clotting abilities?

A

vit K1

95
Q

What are clotting factor deficiency associated with?

A

Poor absorption of vit K and decreased activation associated with cholestasis or hepatic dysfunction

96
Q

What percentage depletion is needed to increased clotting times?

A

70%

97
Q

What values will you see with decreased hepatic function?

A

Prolonged: PT and PTT
Decreased: BUN, cholesterol, albumin, glucose

98
Q

What is protein C and what is it associated with?

A

Anticoagulant protein made in the liver

Deceased values associated with poor function or perfusion, synthetic failure, shunts

Can differentiate MVD and shunts

99
Q

What is the significance of ammonia?

A

Liver removes ammonia from circulation and enters urea cycle or consumed in synthesis of glutamine

Increases and be used to confirm hepatic encephalopathy but is not definitive for it

SAM 2 (21 decks)

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