Liver

Question 1

Which statement is NOT true for lymphocytic cholangitis in cat?

o The most common form of the cholangitis in cat
o The cause and pathogenesis are not really clear. Suspected immune-mediated procedure
o The Persian cat is predisposed
o The result of bile culture obtained by cholecystocentesis adherens invasive E coli (AIEC)

Answer 1

The result of bile culture obtained by cholecystocentesis adherens invasive E coli (AIEC)

Question 2

Which statement if NOT true?

o Antiepileptic therapy could cause elevated ALP, ALT and GGT level in dog
o The potentiated sulphonamide therapy can cause a destructive cholangitis in dog
o The glucocorticoid therapy always lead an irreversible necrosis in the liver
o The antidote of the acetaminophen toxicosis is the N-acetylcystine

Answer 2

The glucocorticoid therapy always lead an irreversible necrosis in the liver

Question 3

The upper limit of total bilirubin in the dog is 
o	10 mikromol/l 
o	40 mikromol/l 
o	10 mmol/l
o	40 mmol/l

Answer 3

10 mikromol/l (umol)

Question 4

Which statement is true?

o The acute liver failure regardless of cause can be classified by activation of Stellate cells, fibrosis
o The blood level of the hepatocellular enzymes (ALT, AST) is elevated primarily in case of necrosis, inflammation, increased permeability of the hepatocyte membrane
o The bilirubinuria is always pathologic in dog, associated always with bilirubinuria
o In cholestasis mostly the ALT and AST are elevated

Answer 4

The blood level of the hepatocellular enzymes (ALT, AST) is elevated primarily in case of necrosis, inflammation, increased permeability of the hepatocyte membrane

Question 5

Hepatitis caused by viruses/dog and cat

o Canine distemper (CAV-1), Calicivirus, FIV
o Rubarth disease (CAV-1), panleukopenia, FeLV
o Rubarth disease (CAV-1), herpesvirus caused hepatitis, FIP
o FIP, Calicivirus, Mycoplasmosis

Answer 5

Rubarth disease (CAV-1), herpesvirus caused hepatitis, FIP

Question 6

Which statement is not typical for cat?

o The common bile duct joins the major pancreatic duct before entering the duodenum
o The acute neutrophil cholangitis is the consequence of ascending bacterial infection
o The hepatic encephalopathy is a common consequence of the feline hepatic lipidosis due to the arginine deficiency
o The portal hypertension, ascites and PU/PD are common signs in hepatopathies of the cat

Answer 6

The portal hypertension, ascites and PU/PD are common signs in hepatopathies of the cat

Question 7

What is responsible for the signs suffering from hepatopathy?

o Ammonia
o Scatole
o Intracranial haemorrhage
o Hypoglycaemia

Answer 7

Ammonia

Question 8

Which disease is accompanied by ascites in cat?

o Hepatic lipidosis
o Lymphocytic cholangitis
o Neutrophilic cholangitis
o Congenital portosystemic shunt

Answer 8

Lymphocytic cholangitis

Question 9

Which statement is FALSE? feline hepatic lipidosis

o It is increased by intrahepatic cholestasis
o Bile acid, bilirubin, ALT and ALP were elevated, while GGT was disproportionaly low
o Clinical symptoms: obese cat losing weight, jaundice, salivation, coagulopathy and hepatomegaly.
o Increased lipoprotein synthesis due to starvation, resulting in decreased triglyceride levels in liver

Answer 9

Increased lipoprotein synthesis due to starvation, resulting in decreased triglyceride levels in liver

Question 10

What sickness causes portal hypertension?

Answer 10

Connected to hepatic arterio-venosus fistula (AVF) (also hepatic venous outflow obstruction)

Question 11

Which IS associated with portal hypertension?

o Hepatic microvascular hypoplasia
o Arterioportal/arterio-venosus fistula
o Congenital portosystemic shunt
o Hepatic lipidosis

Answer 11

Arterioportal/arterio-venosus fistula

Question 12

Which statement is NOT true?

o The bilirubinuria is always pathologic in cats associated with hyperbilirubinaemia
o The ALP-isoenzymes in the cat: liver, bone, steroid induced isoenzymes
o The ALT and AST are hepatocellular enzymes
o The bile acid, ALP, GGT levels are elevated in cholestasis

Answer 12

o The ALP-isoenzymes in the cat: liver, bone, steroid induced isoenzymes

Question 13

Which disease is associated with ascites in cats?

o Neutrophilic cholangitis
o Portosystemic shunt
o Lymphocytic cholangitis and biliary cirrhosis
o Hepatic lipidosis

Answer 13

Lymphocytic cholangitis and biliary cirrhosis

Question 14

Which statement is NOT characteristic for the primer Cu accumulation?

o Progressive, life-long Cu accumulation
o Centrolobular zona
o Beddlington terrier, Labrador and Dalmatian have primer Cu accumulation
o The Cu accumulation is caused by cholestasis

Answer 14

The Cu accumulation is caused by cholestasis

Question 15

Which statement is NOT characteristic for the seconder Cu accumulation?

o The liver damage is not proportional with the Cu level of the liver
o Periportal
o Dobermann, Labrador, and Dalmatian have seconder Cu accumulation
o The Cu accumulation is caused by cholestasis

Answer 15

Dobermann, Labrador, and Dalmatian have seconder Cu accumulation

Question 16

Which statement is false EOGC (eosinophil granuloma complex)

o Eosinphilia is possible in the blood
o Allergy plays a role in pathogenesis
o Can only be diagnosed with RTG
o Cyclosporine is possible theraphy method

Answer 16

Can only be diagnosed with RTG

Question 17

Which is the first-choice drug in the treatment of primary Copper storage disease?

o D-penicillamine
o Glucocorticoid
o Omeprazole
o Zn and cholagogue drugs

Answer 17

D-penicillamine

Question 18

Characteristic of lymphangiectasia

Answer 18

Ascites, hydrothoravx, weight loss, emaciation

Question 19

Lymphangiectasia/characteristics/dog, cat?

o Severe disorder of colon
o Leads to protein losing enteropathy in severe case
o Specific diagnosis established with measurement of serum concentration of folate & cobalamine
o High fat diet is suggested because of severe malnutrition

Answer 19

Leads to protein losing enteropathy in severe case

Question 20

In what kind of disease is this breed predisposed? (Doberman picture)

o Familiary, chronic hepatitis
o Epulis
o Congenital aortic stenosis
o Tracheal hypoplasia

Answer 20

Familiary, chronic hepatitis

Question 21

Which statement is NOT true for chronic hepatitis in dog?

o Periportal mononuclear cell infiltration, inflammation, periportal necrosis, fibrosis
o Centrolobular mononuclear cell infiltration, inflammation, centrolobular necrosis, fibrosis
o Chronic procedure, no improvement for 4-6 weeks
o The histopathology is independent from the cause

Answer 21

Centrolobular mononuclear cell infiltration, inflammation, centrolobular necrosis, fibrosis

Question 22

Which is NOT a form of vena portae hypoplasia?

o Hepatic microvascular hypoplasia
o Arterioportal / arteriovenosus fistula
o Idiopathic noncirrhotic portale hypoplasie
o Hepatiportal fibrosis

Answer 22

Arterioportal / arteriovenosus fistula

Question 23

Which statement is NOT true?

o In hepatic encephalopathy the blood level of ammonia is elevated
o The lactulose and diet with high biologic values protein are an important part of the treatment of the hepatic encephalopathy
o Precipitating factors in hepatic encephalopathy are the obstipation, alkalosis, hypokalaemia and GI bleeding
o In microvascular dysplasia the abnormal blood vessels can be detected by colour doppler ultrasound

Answer 23

In microvascular dysplasia the abnormal blood vessels can be detected by colour doppler ultrasound

Question 24

What are the lesions on this picture?

o Fusobacteria induced hepatic necrosis
o Hepatocellular carcinoma
o Chronic fibrinous perihepatitis
o Signs of Ascaris larval migration

Answer 24

Signs of Ascaris larval migration

Question 25

Portosystemic shunt. Diagnosis?

o Icterus, ascites, anorexia, vomiting, hepatomegaly
o Intermittent clinical symptoms, neural/digestive/urinary symptoms, plasma azotaemia, increase bile acids (PPBA), doppler ultrasonography
o Ultrasonography, hepatomegaly, AST, ALT increased, biopsy
o Ascites, hypoproteinaemia, haematuria, ALT increased

Answer 25

Intermittent clinical symptoms, neural/digestive/urinary symptoms, plasma azotaemia, increase bile acids (PPBA), doppler ultrasonography

Question 26

Which statement is NOT true/PSS/dog?

o The symptoms of portosystemic shunt can worsen after feeding of protein rich food
o The postprandial bile acid level of blood is higher than normal in portosystemic shunts
o The extrahepatic portosystemic shunt occurs in large breed dog
o In congenital portosystemic shunt the nervous symptoms are episodic

Answer 26

The extrahepatic portosystemic shunt occurs in large breed dog

Question 27

What is your opinion based on the picture?

o	Hepatic icterus 
o	Posthepatic icterus 
o	Bile peritonitis
o	Haemolytic icterus
o	Methemoglobinuria

Answer 27

Haemolytic icterus

Question 28

Congenital portosystemic shunt- Diagnosis?

o icterus, ascites, anorexia, wasting, hepatomegaly
o intermittent clinical symptoms, neural-, digestive-, urinary symptoms, plasma ammonia-, FBA-PP bile acid ↑, doppler ultrasonography
o ultrasonography-hepatomegaly, AST/ALT ↑, biopsy
o Ascites, hypoproteinaemia, haematuria, ALT ↑

Answer 28

intermittent clinical symptoms, neural-, digestive-, urinary symptoms, plasma ammonia-, FBA-PP bile acid ↑, doppler ultrasonography