Liver 2 Flashcards by Fiona Lair

What is hepatopathy?

An abnormal or diseased state of the liver

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What is icterus or jaundice?

Increased bilirubin in the blood steam and extracellular fluid causing yellow pigment of skin, sclera, and other mucous membranes

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What is hepatitis?

Inflammation affecting of the hepatocytes

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What is cholangitis?

Inflammation affecting the bile ducts?

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What is cholangiohepatitis?

Inflammation affecting the bile ducts and hepatocytes

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What is cirrhosis?

Scarring of the liver

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What conditions can lead to an acute hepatopathy?

Toxins, drugs, infections, pancreatitis

May be idiopathic

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What conditions can lead to a chronic hepatopathy?

Inflammatory disease, abscesses, granulomas, metabolic storage disease, neoplasia, infectious organisms, endocrine disease, congenital abnormalities

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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

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Which medications offer specific liver support?

Silymarin- milk thistle
N-acetylcysteine or S-adenosylmethionine
Vit-K supplementation in icterus

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T/F: Acute hepatopathies usually resolve with time.

True- primary causes is not always found but enzymes will return to normal with supportive care

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What percentage of acute hepatopathies progress to chronic hepatitis?

25%

Fibrosis, inflammation, necrosis

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What is extrahepatic liver disease?

Non-primary hepatic diseases which affect the liver and cause liver values to increase

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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

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Which endocrinopathies have liver effects?

Diabetes mellitus
Cushing’s Disease
Hypothyroidism
Hyperthyroidism

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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