Liver Flashcards
___________ enzymes detect hepatocellular injury
Leakage
_____________ enzymes detect cholestasis
Induced
If ALT is increased in middle aged dogs, you might suspect _____________ but in a young dog _____________ is more likely
Chronic hepatitis; protocaval shunt
T/F: AST is liver specific
False
Also from muscle - assay with CK to determine muscle or liver disease
What is used in large animals to detect hepatocellular damage?
SDH
GLDH - liver specific, more stable than SDH but assay is difficult
Alkaline phosphatase (ALP) is membrane bound at ??
Bile canalicular surface
Gamma glutamic transferase (GGT) is associated with ???
Epithelial cells in bile duct system
What are important isoenzymes of ALP?
Bone - young animals
Liver- cholestasis
Corticosteroid induced
T/F: ALP in cats can be increased due to steroid induction
False
Hyperthyroidism may increase ALP
If ALP is increased WITHOUT hyperbilibrubenemia, what should you suspect?
Steroids or anticonvulsant medication
Gamma glutamyl transferase can be induced with???
Cholestasis
Steroid
GGT is a better indicator of cholestasis in cats, except for in what disease
Hepatic lipidosis
ALT and AST - mild increase
ASP and GGT- markedly increased
Bile acids - increased
What is it? What can cause this?
Cholestasis
- cholangitis
- cholangiohepatitis
- bile duct obstruction
- hepatic lipidosis
What mild diseases can cause a reactive and secondary hepatopathy, increasing serum enzyme level?
Hypoxia Infectious disease Metabolic disease GI disease Neoplasia Cardiovascular disease Nutritional abnormalities Inflammatory disorders Benign nodular hyperplasia in old dogs
ALT and ALP may increase, but not bile acids
What are secondary hepatopathies
Intrahepatic cholestitis assoc. with bacterial infection
Chronic intestinal inflammatory disease
Pancreatitis
Metabolic and endocrine disease
Nodular hyperplasia
What substances removed by the liver can be tested in a liver function test?
Bilirubin Bile acid Cholesterol Ammonia Exogenous substances
What substances synthesized by the liver can be measured in a liver function test?
Albumin Urea Cholesterol Glucose Coagulation factors
An increased bilirubin can be seen due to?
Increased production due to RBC destruction
Decreased uptake my liver
Blockage of bile flow (cholestasis)
Bile acid increase can be due to?
Deviation of portal circulation (shunt or cirrhosis)
Decreased hepatocyte uptake
Decreased bile excretion
If fasting, bile acids >25 umol/L indicates
Liver lesions!
In chronic liver disease, what occurs to levels of albumin and globulin
Alb - synthesized in liver and will decrease
Glob - only some synthesized in liver (decrease) but most made in lymphoid tissue (increase)
If both albumin and globulin are decreased what should you consider?
Blood loss
PLE
Exudative skin lesions
If albumin is decreased but globulin in normal, what should you suspect?
Glomerular disease
Liver failure
If albumin and cholesterol are decreased, what do you suspect
PLE
Liver failure
If albumin in decreased and cholesterol is increased, you should suspect?
Nephrotic syndrome
In liver failure, what is the serum glucose level?
Normal to decreased
What occurs to ammonia and BUN in liver failure?
Ammonia increase
BUN decrease
In a PPT and PT, what would you expect to see in liver disease
Normal to prolonged
Usually the last thing to go in liver disease
ALT and AST - mod inc
ALP and GGT- mod/mark inc
Serum bilirubin- mod/mark inc
Bile acid- inc
Ammonia - inc
BUN, albumin, cholesterol - dec
What is this?
Liver failure
What is the most common liver disease of dogs?
Primary chronic hepatitis in dogs
Usually mixed inflammatory cell infiltrates and hepatocellular necrosis
What are the primary hepatitis?
Copper associated
Genetic
Drug induced (anti-epi, some NSAIDS)
Infectious (lepto or ICH)
Immune mediated
AST and ALT - mod inc
ALP and GGT- mod inc
Serum bilirubin - normal to inc
Bile acids - Normal to inc
Primary hepatitis
-results depend on stage of disease
Enzyme activity can be normal to increased
Bile acids are increase
Microcytic anemia
What do you suspect?
Portosystemic shunt (early)
AST and ALT - inc
ALP and bili - norm to inc
Albumin, BUN, glucose, cholesterol and coats - dec
Bile acids- mark inc
Microcytic anemia
Portosystemic shunt (late)
