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SA Gastroenterology > Liver > Flashcards

Liver Flashcards

1
Q

What are the functions of the liver?

A

Metabolism: carbohydrate, lipid, protein, vitamin

Immunologic functions

Detoxification and Excretion: bilirubin, steroids, ammonia, drugs

Digestive: bile acids

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2
Q

What are the 4 anatomic units of the liver?

A

1) hepatocytes
2) the biliary network
3) the vascular system
4) the Kupffer cells

These are all integrated into a lobule, the functional unit of the liver.

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3
Q

What are the signs of liver disease?

A 
Decreased appetite
Lethargy 
Swollen abdomen (ascites or hepatomegaly) 
Jaundice 
Ptyalism 
Vomiting 
Neurologic signs (encephalopathy) 
Weight loss
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4
Q

What are the liver enzyme tests?

A

Indicators of cell damage: ALT and AST

Indicators of cholestasis/drugs: ALP and GGT

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5
Q

What are liver function tests?

A 
Pseudofunction: 
Bilirubin (serum and urine)
Albumin
BUN
Cholesterol
Glucose

True function:
Ammonia
Bile Acids

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6
Q

What additional tests can you use to assess liver function (besides enzymes and function tests)?

A 
CBC
Clotting function tests (PT/PTT)
Fecal
Abdominocentesis
Radiographs
Ultrasound
Cytology
Biopsy
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7
Q

What are the causes of acute hepatitis?

A

Toxins
Infections
Drugs
Idiopathic

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8
Q

How do you diagnose acute hepatitis?

A

Increased ALT and AST
ALP much lower than ALT
Bilirubin may be increased

*biopsy is rarely indicated/useful

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9
Q

How do you treat acute hepatitis?

A

Supportive care- fluids, glucose, nutritional support
Anti-emetics
Antioxidant therapy (N-acetylcysteine, silymarin)

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10
Q

What are causes of chronic hepatitis?

A

Drug-induced
Copper-associated
Breed related (bedlington terriers, doberman, westie, Dalmatian, labs)

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11
Q

How do you diagnose chronic hepatitis?

A

BIOPSY

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12
Q

How do you treat chronic hepatitis?

A

Immunosuppressive therapy
UDCA
Anti-oxidants
Anti-fibrotics

For copper-associated hepatitis:
Dietary copper restirction, chelator therapy, zinc

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13
Q

How can you treat cirrhosis?

A

Address underlying disease
Anti-fribrotics
Spironolactone +/- lasix

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14
Q

How do you treat hepatic encephalopathy?

A

Lactulose
Antibiotics
Restricted protein diet

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15
Q

What are the two forms of cholangitis in the cat and what causes each?

A

Neutrophilic (ascending infection, E.coli)

Lymphocytic (immune-mediated, triaditis)

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16
Q

What do you treat cholangitis in the cat?

A

General supportive therapy
Depends on biopsy results

Neutrophilic- flluoroquinolone and metronidazole, clavamox

Lymphocytic- prednisolone, ursodeoxycholic acid, chlorambucil

17
Q

What causes feline hepatic lipidosis?

A

Rapid weightloss in short time with decreased caloric intake

18
Q

How do you diagnose feline hepatic lipidosis?

A

History of anorexia
Fat cat with muscle wasting
Increased ALP with normal GGT

Laparoscopy
Cytology

19
Q

How do you treat feline hepatic lipidosis?

A 
Treat underlying cause
Nutritional support
Appetite stimulants (oxazepram, mirtazipine)
Anti-emetics (maropitant)
Prokinetics (cisapride)
20
Q

What causes extra-hepatic biliary obstruction in dogs? Cats?

A

Dogs: pancreatitis, GB mucocele

Cats: neoplasia, liver flukes

21
Q

How do you treat extra-hepatic biliary obstruction?

A

If caused by pancreatitis, can be managed medically

For other causes: surgical correction

22
Q

What are the forms and breed dispositions of portosystemic shunts?

A

Intrahepatic- large breed dogs (irish wolfhound, old english sheep dogs)

Extrahepatic- cats and small breed dogs (yorkies, min schnauzers, maltese)

23
Q

What is the clinical presentation for portosystemic shunts?

A

Young dogs, less active, “don’t do well”

Hepatic encephalopathy signs are common

PU/PD, urate stones, ptyalism, small stature

Cats- small stature, ptyalism, copper irises

24
Q

How do you diagnose portosystemic shunts?

A

Lab tests: increase in liver enzymes, decrease in albumin and BUN, urate crystals in urine, microcytic anemia
Lab values may be normal

Ultrasound
CT angiogram
Transplenic scintigraphy

25
Q

How do you treat portosystemic shunts?

A

Medical: restricted protein diet, lactulose, +/- neomycin, amoxicillin

Surgical: ligation of shunt (ameroid constrictor, cellophane banding, interventional)

26
Q

What is the causes hepatic encephalopathy?

A

Loss of hepatic detoxification function and accumulation of toxic metabolites

27
Q

What are the clinical signs of hepatic encephalopathy?

A 
Behavior changes
Learning difficulties
head pressing
Blindness
Pacing
Seizures
28
Q

How do you diagnose haptic encephalopathy?

A

Presence of liver dysfunction (bile acids, ammonia)

29
Q

How do you treat hepatic encephalopathy?

A

Lactulose
Antibiotics (neomycin, amoxicillin)
Restricted protein diet

30
Q

How does hepatology in the cat differ from the dog?

A

You may want to just read the SCAVMA notes (pg 134-135)

Anatomy: cat has a common bile and pancreatic duct that join before entering the duodenal papilla. Some cats may also have a second pancreatic duct. Pancreatitis causes cholestasis much more readily in the cat than in the dog.

Excretion: cats are glucoronyltransferase deficient compared to dog (slower to metabolize some drugs, slower to excrete bilirubin)

Energy requirements: gluconeogenesis pathway in cats never shuts down during fasting as it does in dogs. This predisposes cats to hepatic lipidosis. Cats need arginine, taurine, and glutathione supplementation for proper liver function.

Liver enzymes: AST more difficult to interpret in cat (fasting cat breaks down muscle). Increases in ALP strongly suggest hepatic disease in cats (has a very short half-life).

Bilirubin: Catsdevelop jaundice earlier than dogs (due to decreased glutathione). Renal threshold for bilirubin is nine times higher in cat than dog so bilirubinuria in cat is a reliable sign of hepatic disease

Clotting function: Prolonged PT may be reversed with Vit K in cats

Liver function: Bile acids are very sensitive in cats, hypoalbuminemia is rare in cats with liver diseae

SA Gastroenterology (6 decks)

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