Liver 2 Flashcards
What is hepatopathy?
An abnormal or diseased state of the liver
What is icterus or jaundice?
Increased bilirubin in the blood steam and extracellular fluid causing yellow pigment of skin, sclera, and other mucous membranes
What is hepatitis?
Inflammation affecting of the hepatocytes
What is cholangitis?
Inflammation affecting the bile ducts?
What is cholangiohepatitis?
Inflammation affecting the bile ducts and hepatocytes
What is cirrhosis?
Scarring of the liver
What conditions can lead to an acute hepatopathy?
Toxins, drugs, infections, pancreatitis
May be idiopathic
What conditions can lead to a chronic hepatopathy?
Inflammatory disease, abscesses, granulomas, metabolic storage disease, neoplasia, infectious organisms, endocrine disease, congenital abnormalities
What are some general treatments of hepatopathies?
Initially supportive- fluids, vomiting/diarrhea control, coag treatment, antibiotics if indicated
- Drug cessation
- Toxin removal
- Infectious disease treatment
- Nutritional support
Which medications offer specific liver support?
Silymarin- milk thistle
N-acetylcysteine or S-adenosylmethionine
Vit-K supplementation in icterus
T/F: Acute hepatopathies usually resolve with time.
True- primary causes is not always found but enzymes will return to normal with supportive care
What percentage of acute hepatopathies progress to chronic hepatitis?
25%
Fibrosis, inflammation, necrosis
What is extrahepatic liver disease?
Non-primary hepatic diseases which affect the liver and cause liver values to increase
What are some common extrahepatic diseases?
- Toxin or drug induced
- Breed related (huskies)
- Enodcrinopaties (most common)
- Hypoxia and hypotension (HBC, seizure, AHDS)
- Muscler injury
- Neoplasia
- Bone disorders
- GI disease
- Pancreatitis
- Systemic infection
- Pregnancy in cats
Which endocrinopathies have liver effects?
Diabetes mellitus
Cushing’s Disease
Hypothyroidism
Hyperthyroidism
What liver value will raise in pregnant cats?
ALP
What are some common hepatotoxins?
Plants- cycad palms, aminita Xylitol Supplements and nutraceuticals Aflatoxin Drugs
What can xylitol cause?
Acute hypoglycemia and liver failure
What are the main drugs that are known to cause liver issues?
Diazepam, methimazole, acetaminophen
Sulfonamides, phenobarbitol, NSAIDS, prednisone, azathioprine, oxibendazole
What infectious agents effect the liver?
Bacteria, lepto, tick born infections, canine adenovirus, heartworm, neospora, leshmania, toxoplamsa. hepatozoon, histoplasmosis, heterobilharzia, flukes, abscesses
What are the liver flukes of small animals?
Platynosomum fastosum, Heterobilharzia americanum, Eurytrema procyonis, Amphimerus pseudofelis, Metrochis conjuctus
What are chronic hepatopathies usually associated with and what is the chronicity?
Inflammatory infiltrates that can progress to fibrosis and cirrhosis
Weeks to months in duration
What conditions are classified as chronic hepatopathies?
Copper stoage disease, drug induced disease, infectious induced, immune mediated, result of toxin
What are some canine breed associated hepatopathies?
Immune mediated/inflammatory- cocker spaniel, doberman, poodle
Copper storage disease- bedlington, lab, westie, dalmation, skye, doberman, german shepherd
Amyloid- sharpei, abyssinian, siamese, can lead to hemoabdomen if fractures
Benign hyperphosphastasemia- scotties, huskies
Gallbladder mucocele- shelti, pug
What is copper hepatopathy?
Aka wilsons disease in humans
Chronic disease associated with errors of copper metabolism
What are some clin path findings associated with copper hepatopathy?
Glucosuria in advanced disease
Elevated ALT first with other values follow
What are some causes of copper hepatopathy?
Bedlingtons- deletion of exon 2 in commd1 gene (prevention of copper excretion in bile)
Increased copper uptake, defect in copper metabolism, altered excretion of copper
T/F: Clinical signs may not be apparent until the disease is very severe with copper hepatopathy?
True- severe accumulation leading to inflammation can take a long time before it causes any clinical signs
How do you diagnose copper hepatopathy?
Liver biopsy and copper quantification
How do you treat copper hepatopathy?
Copper restricted diets
Chelation therapies
- D-penicillamine: copper mobilization and increased binding, must supplement B6 and do NOT give with zinc
- Zinc- increases binding, more mild effect than D-pen
- Trientine HCl- increases urine excretion of copper and decrease GI absorbtion, EXPENSIVE
What is the prognosis of copper hepatopathy?
Good if found before a crisis
What is lymphocytic plasmacytic liver disease?
Chronic inflammatory hepatitis with a suspected immune mediated etioloty
How do you treat chronic inflammatory hepatitis?
Prenisone/prednisolone or other imune modulated medications
Liver and other supportive care as needed
What is the prognosis of chronic inflammatory hepatitis?
Can go into remission but may lead to fibrosis and cirrhosis
What animal is chalangitis/cholangiohepatitis syndrome (CCHS) more common in?
Cats- most common acquired inflammatory liver disease
Does CCHS have a more chronic or acute presentation?
Can be either
Usually has concurrent inflammatory disease in GI or pancreas and may be icteric
What are the categories of CCHS and how are they diagnosed?
Dx via biopsy
Suppurative- often associated with bacterial infection and more acute clinical disease
Lymphocytic without destructive cholangitis
Lymphocytic with destructive cholangitis- permanent icterus
What are some primary feline hepatopathies?
Small cell lymphoma
Lymphoproliferative disease
Lymphocytic portal hepatitis
