Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

ACVECC Exam 2024 > Liver/Biliary > Flashcards

Liver/Biliary Flashcards

1
Q

T/F: Young GSD with EPI are prone to mesenteric volvulus

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Most common causes of hemoabdomen in cats

A

Non-neoplastic causes (54%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Difference between BG and peritoneal fluid glucose suggestive of septic abdomen

A

> 20 mg/dL - in dogs 100% sens/specific, in cats 86% sensitive/100% specific

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Difference between blood lactate and peritoneal fluid lactate suggestive of septic abdomen

A

> 2 mmol/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Fluid to serum potassium ratio for diagnosis of uroabdomen in dogs vs. cats

A

Dogs: 1.4:1
Cats: 1.9:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Fluid to serum creatinine ratio for diagnosis of uroabdomen in dogs and cats

A

2:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Fund to blood bilirubin ratio for diagnosis of bile peritonitis

A

> 2:1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Two subcategories of acute pancreatitis

A

Interstitial edematous pancreatitis
Necrotizing pancreatitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Risk factors for development of pancreatitis in dogs

A

Hypertriglyceridemia
Endocrine disease
Drug reactions (Azthioprine)
Surgery
Hypercalcemia
Biliary duct obstruction
Biliary reflux
Pancreatic trauma
Dietary factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What anatomical feature may predispose cats to development of pancreatitis?

A

80% of cats only have one pancreatic duct that joins the bile duct prior to entering the duodenum (vs. in dogs they remain separate) –> may predispose to biliary reflux

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Which pancreatic enzyme activates the other pancreatic enzymes?

A

Trypsin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

If more than ___% of trypsin is activated, trypsin inhibitor can no longer inactivate trypsin

A

10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

T/F: Trypsin and chymotrypsin can initiate neutrophil migration into the pancreas

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Neutrophil migration into the pancreas results in:

A

ROS production
Nitric oxide production

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What enzyme can result in increased vascular permeability, specifically in the lungs, kidneys, and liver

A

Elastase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What enzyme associated with acute pancreatitis results in degradation of surfactant

A

Phospholipase A2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Trypsin can also activate ______ which may result in hypotension, vasodilation, AKI

A

Kallikrein-kinin system

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Hypocalcemia associated with acute pancreatitis is uncommon but is more common in dogs/cats

A

Cats

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

In dogs and cats with acute pancreatitis, cytology of the pancreas consists of _____ and large numbers of _____

A

Degenerate acinar cells and neutrophils

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Four proposed independent risk factors for short-term death in dogs with acute pancreatitis

A

SIRS
Coagulation disorders
Increased creatinine
Ionized hypocalcemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

How does PANOQUELL®-CA1 (FUZAPLADIB SODIUM FOR INJECTION) supposedly work

A

Fuzapladib sodium is a leukocyte function-associated antigen-1 (LFA-1) activation inhibitor which is reasonably expected to block the specific pathway of inflammation associated with acute canine pancreatitis.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Two main histologic subtypes of cholecystitis in dogs and cats

A

Neutrophilic cholecystitis
Lymphoplasmacytic, follicular cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Most common bacterial species implicated in infectious cholecystitis in dogs and cats

A

Enteric pathogens: E. coli (gas-producing), Enterococcus, Clostridium spp. (also gas-producing)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Sources of bactobilia

A

Reflux of duodenal contents into the biliary tree, hematogenous spread

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Breed of dog that seems to be predisposed to bacterial cholecystitis

A

Dachshunds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Three classifications of necrotizing cholecystitis

A

Type I: Areas of necrosis without gallbladder rupture
Type II: Acute inflammation with rupture
Type III: Chronic inflammation with adhesions and/or fistulae to adjacent organs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Most frequently seen feline parasites which can cause cholecystitis/cholangitis

A

Platynosomum concinnum
Amphinerus pseudofelineus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Dilation of the common bile duct in the case of EHBDO occurs within ____ hours; dilation of the intrahepatic biliary tree occurs within ___-___ days

A

24 hours
5-7 days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Most common constituents of choleliths

A

Calcium carbonate and bilirubin pigments (bilirubin or calcium bilirubinate)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Gallbladder mucocele in dogs has been associated with

A

Glucocorticoid administration/excess
Dyslipidemias
Cushing’s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Histopathology of the gallbladder from dogs with mucoceles often reveals

A

Cystic mutinous hyperplasia in addition to other changes consistent with necrotizing cholecystitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

T/F: Bacterial infection is uncommonly seen in conjunction with GB mucocele

A

True- only seen in about 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Elective cholecystectomy has a much better prognosis (__% mortality) as compared to non-elective cholecystectomy (__% mortality)

A

2% vs. 20%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Proposed benefits of ursodiol

A

Increase bile flow (choleresis)
Immunomodulatory properties
May decrease mucin production
May improve GB motility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Two factors associated with negative prognosis for surgery on GB mucocele dogs

A

Hyperlactatemia and hypotension in the period period

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Gallbladder infarction is associated with GB rupture in ____% of cases

A

50%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Cholangitis in cats is typically _____ or _____ cholangitis; in dogs, neutrophilic cholangitis is most common

A

Neutrophilc or lymphocytic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
38
Q

T/F: Neutrophilic cholangitis in dogs is more commonly associated with bacterial involvement.

A

True

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
39
Q

Dog breeds predisposed to chronic hepatitis

A

American Cocker Spaniel
Bedlington Terrier
Dalmation
Doberman Pinscher
English Cocker Spaniel
English Springer Spaniel
Labrador Retriever
Skye Terrier
Standard Poodle
West Highland White Terrier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
40
Q

Proven or suspected copper hepatopathy breeds

A

Bedlington Terrier
Dalmation
Doberman Pinscher
Labrador Retriever
Skye Terrier
West Highland White Terrier

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
41
Q

Over ___ of dogs with chronic hepatitis have excess hepatic copper levels

A

Over 1/3

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
42
Q

Excess liver copper causes what

A

Oxidative stress
Cellular degeneration
Cell death associated with inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
43
Q

Infectious canine hepatitis virus

A

Canine adenovirus I
*Uncommon because of cross-reaction with CAV-2 vaccine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
44
Q

Infectious canine hepatitis disease course is dependent upon the patient’s level of antibody response; animals with ____ antibody response can die acutely

A

Decreased antibody response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
45
Q

Liver involvement can happen in __-__% of canine Leptospirosis cases

A

20-90%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
46
Q

Two serovars of Lepto that are more often associated with liver involvement

A

L. icterohemorrhagicae
L. pomona

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
47
Q

The liver can regenerate ___% of its functional capacity in only a few weeks.

A

75%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
48
Q

Hepatic encephalopathy (HE) secondary to liver failure in dogs and cats typically arises when more than ___% of liver function is lost

A

More than 70%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
49
Q

Toxins implicated in development of hepatic encephalopathy

A

Ammonia
Aromatic amino compounds
Bile acids
Decreased alpha-ketoglutaramate
Endogenous benzodiazepines
False neurotransmitters
GABA
Glutamine
Manganese
Phenol
Short chain fatty acids
Tryptophan

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
50
Q

In general, how are these toxins suspected to lead to HE?

A

May impede neuronal and astrocyte function, causing cell swelling, inhibition of membrane pumps or ion channels leading to increased intracellular calcium concentrations, depression of electrical activity, and interference with oxidative mechanisms.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Three types of hepatic encephalopathy

A

Type A: acute, associated with ALF
Type B: bypass, associated with shunts
Type C: chronic, found with cirrhosis and portal hypertension

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

Ammonia is normally converted to ___ and ___ in the normal liver

A

Urea
Glutamine

(via the Urea cycle)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
53
Q

Ammonia is ____ and associated with release of glutamate, the major excitatory hormone in the brain.

A

Excitotoxic

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What is one of the mechanisms for HE-associated seizures?

A

Over-activation of glutamate receptors, mainly N-methyl-D-aspartate receptors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

With chronicity, inhibitory factors such as ___ and ___ surpass the excitatory stimulus, causing CNS depression

A

GABA and endogenous benzodiazepines

56
Q

Proposed mechanisms suggested for hyperammonemia

A

Increased brain tryptophan and glutamine
Decreased ATP availability
Increased excitability
Increased glycolysis
Brain edema
Decreased microsomal N/K/ATPase in the brain

57
Q

Proposed mechanisms suggested for aromatic amino acids

A

Decreased DOPA neurotransmitter synthesis
Altered neuroreceptors
Increased production of false neurotransmitters

58
Q

Proposed mechanisms suggested for bile acids and HE

A

Membranocytolytic effects alter cell/membrane permeability
BBB more permeable to other HE toxins
Impaired cellular metabolism

59
Q

Proposed mechanisms suggested for decreased alpha-ketoglutaramate

A

Diversion from Krebs cycle for ammonia detoxification
Decreased ATP availability

60
Q

Proposed mechanisms suggested for endogenous benzos

A

Neural inhibition
Hyperpolarized neural membrane

61
Q

Proposed mechanisms suggested for false neurotransmitters

A

Decreased norepinephrine action
Synergistic with ammonia and SCFA

62
Q

Proposed mechanisms suggested for GABA

A

Neural inhibition
Hyperpolarized neural membrane

63
Q

Proposed mechanisms suggested for glutamine

A

Alters BBB amino acid transport

64
Q

Proposed mechanisms suggested for manganese

A

Seen in hepatic failure and HE and results in neurotoxicity

65
Q

Proposed mechanisms suggested for short-chained fatty acids (SCFA)

A

Decreased microsomal N/K/ATPase in brain
Uncoupled oxidative phosphorylation
Impaired oxygen use

66
Q

Proposed mechanisms of coagulopathy in liver disease

A

Decreased coagulation factor synthesis
Increased consumption of coagulation factors
Decreased coagulation factor turnover
Increased fibrinolysis and tissue thromboplastin release
Synthesis of abnormal clotting factors (dysfibrinogenemia)
Decrease PLT function and numbers
Vitamin K deficiency (esp. in patients with bile duct obstruction)
Increased production of anticoagulants

67
Q

Euglycemia can be maintained up until ___% or more of the liver is nonfunctional.

A

75% or more

68
Q

Mechanisms for sepsis in liver failure

A

If severe liver dysfunction present, impaired ability to clear bacterial pathogens passing through from portal system

Inhibition of metabolic activity of granulocytic cells, cell adhesion, and chemotaxis, has been described.

69
Q

Liver macrophage cells

A

Kuppfer cells

70
Q

Most common organisms seen with liver failure and sepsis

A

Gram negative enteric organisms
Staph
Fungal organisms

71
Q

What happens during portal hypertension

A

Massive sinusoidal collapse can block intrahepatic blood flow, causing portal pressure elevations

72
Q

T/F: Dogs and cats with liver failure secondary to congenital PSS should not be hyperbilirubinemic

A

True

73
Q

T/F: GGT is useful in the diagnosis of cholestatic disease and is more specific but less sensitive than ALP (esp. in cats)

A

True

74
Q

Bilirubin is a breakdown product of

A

Hemoglobin
Myoglobin
Cytochromes

75
Q

Albumin represents ___% of all of the liver proteins synthesized

A

25%

76
Q

Altered albumin production is not seen until more than ___ to ___% of the liver function is lost.

A

66-80%

77
Q

How long is albumin’s half life and why is that important for determining degree of liver dysfunction

A

Half life is long (8 days in dogs and cats) and so hypoalbuminemia is a hallmark of chronic liver dysfunction

78
Q

Cholesterol synthesis occurs in many different tissues; ___% occurs in the liver

A

50%

79
Q

The cat renal threshold for bilirubin is ____ times higher than dogs

A

9 times higher

80
Q

Three drugs proposed to theoretically decrease fibrous tissue formation in the liver

A

Prednisone
D-penicillamine
Colchicine

81
Q

Milk, soy, and vegetable proteins are lower in _____ and higher in _____ than animal proteins and are considered less likely to potentiate HE

A

Lower in aromatic amino acids
Higher in branched chain amino acids (valine, leucine, isoleucine)

82
Q

Poor prognostic indicators for liver ~

A

PT > 100 seconds
Very young or very old animals
Viral or idiosyncratic drug reaction
Markedly increased bilirubin level

83
Q

Portal venous pressure (PVP) =

A

PVP = portal blood flow (PBF) x intrahepatic venous resistance (IHVR)

84
Q

Portal hypertension is caused by

A

Increased resistance in the portal pre hepatic, hepatic, or post hepatic circulation followed by an increase in portal blood flow

85
Q

Portal hypertension- three classifications

A

Prehepatic: increased resistance in the extrahepatic portal vein associated with intraluminal obstruction or extraluminal compression

Intrahepatic: increased resistance in the hepatic microcirculation which can be pre sinusoidal, sinusoidal, or post sinusoidal

Posthepatic: obstruction of the larger hepatic veins, the posthepatic caudal vena cava, or right atrium

86
Q

Increased intrahepatic resistance is caused by damage and remodeling of the ____ and ___

A

Hepatocytes and non-parenchymal cells

87
Q

Two cell types which are phenotypically altered during liver injury

A

Sinusoidal epithelial cells (SECs)
Hepatic stellate cells (HSCs)

88
Q

Presinusoidal PH

A

Occurs because of increased resistance in the terminal intrahepatic portal vein tributaries

89
Q

Sinusoidal PH

A

Most often is the result of fibrotic hepatopathies

90
Q

Postsinusoidal PH

A

Associated with veno-occlusive disease which is caused by damage to the sinusoidal endothelium and hepatocytes in the centriobular region

91
Q

Budd-Chiari like syndrome

A

Obstruction of hepatic venous outflow in the caudal vena cava or larger extra hepatic vessels

92
Q

Prehepatic and pre sinusoidal PH typically results in a ____ protein effusion

A

LOW ≤2.5 g/dL

93
Q

Posthepatic, post sinusoidal, sinusoidal intrhepatic PH typically increases ____ formation resulting in loss of _____ fluid from the leaky sinusoidal endothelium

A

Increases hepatic lymph formation resulting in effusion with a higher protein ≥2.5 g/dL

94
Q

Ultrasonographic features associated with portal hypertension

A

+/- multiple small shunts (acquired) in the left perirenal area
Enlarged portal vein
Decreased portal blood flow velocity (<10 cm/s)
Portal vein to aorta ratio <0.65

95
Q

Acquired portosystemic collaterals (APSCs) occur as a result of

A

Neoangiogenesis through growth factor signaling as well as the dilation of embryonic remnant vessels
Form over a period of 5-14 weeks

96
Q

Why is hyponatremia seen in PH

A

Dilutional (hypervolemic) hyponatremia is seen due to nonosmotic release of ADH in response to decreased effective blood volume secondary to peripheral vasodilation

97
Q

What percentage of ascites volume should be removed (i.e. removal of more of this can lead to circulatory collapse)

A

20-50%

98
Q

Risk for development of neurological complications post surgical shunt attenuation goes up with

A

Patients who already have HE
Older dogs

99
Q

What is the typical mechanism of hypoalbuminemia seen in PSS patients

A

Chronic disease

100
Q

Use of ____ may decrease disk of post-attenuation seizures

A

Keppra

101
Q

The “safe” degree of PSS attenuation

A

Increase in portal pressure with temporary or complete PSS attentuation of no greater than 10 cm H2O

102
Q

Surgical attentuation of a PSS can lead to portal hypertension because of

A

Increase in portal vein blood flow - pre hepatic PH

103
Q

Post-operative seizures have been reported to occur as many as __ hours following surgery in dogs, and __ days in cats.

A

As far as 72 hours post op in dogs, as many as 5 days later in cats

104
Q

Post-operative neurologic signs have been reported in __-__% of cases of dogs undergoing PSS attenuation

A

5-18%

105
Q

Cats tend to have a higher incidence of post-operative neurologic dysfunction than dogs, and ___% of cats developed neuro complications and __% developed seizures

A

37%
23%

106
Q

Most prominent feature of acute HE

A

Cytotoxic brain edema

107
Q

How does cytotoxic edema develop

A

Ammonia inhibits glutamine release from astrocytes
Glutamine is osmotically active
Promotes cellular swelling

108
Q

Anticoagulant protein C

A

Synthesized by the liver
Has been used to evaluate response to shunt attenuation post operatively

109
Q

Lactulose changes the GI pH-

A

Decreases pH which converts NH3 to NH4 and traps it in the gut

110
Q

Idiopathic chronic hepatitis WSAVA definition

A

Hepatocellular apoptosis or necrosis
Mononuclear or mixed inflammatory cell infiltrate
Regeneration and fibrosis

111
Q

Normal function of stellate cells

A

Reside in the space of Disse
Normal function - storage site of vitamin A, synthesize extracellular matrix components, MMPs, cytokines and growth factors

112
Q

What are the proposed etiologies of idiopathic chronic hepatitis

A

Metabolic
Copper
Autoimmune
Toxic
Infectious

113
Q

With chronic injury, how do stellate cells change

A

They transform into collagen-secreting, activated stellate cells, which express smooth muscle-specific-actin and secrete high-density matrix and collagen

–> fibrosis

114
Q

Liver biopsy recommendations

A

At minimum 5 biopsies from at least 2 liver lobes

115
Q

Copper metabolism- copper is absorbed in the _____ with the copper transporter _____

A

Absorbed in small intestine; copper transporter is CTR1

116
Q

Mutation of Bedlington Terriers leading to copper storage

A

Autosomal recessive
Mutation in COMMD1

117
Q

Are male or female dogs more predisposed to copper storage in Labradors and Dobies

A

Females

118
Q

Urinalysis findings in dogs with copper storage disease

A

Evidence of proximal tubular dysfunction- dilute urine, proteinuria, glucosuria

119
Q

Copper accumulation is most frequently seen in what area of the liver on biopsy

A

Hepatic copper accumulation most often located in centrilobular areas (Zone 3)

120
Q

Dogs with Cushing’s disease are ____ times more likely to have mucoceles

A

29 times more likely

121
Q

Hypothyroid dogs are ___ times more likely to have a GB mucocele

A

3 x more likely

122
Q

How does thyroxine affect bile composition/bile movement

A

Thyroxine may affect bile acids composition, and does affect relaxation of sphincter of Oddi

123
Q

Shelties may have a gene mutation of ____ leading to abnormalities in phospholipid metabolism on the canalicular membrane

A

ABCB4 gene

124
Q

Where is the space of Disse located

A

Between the hepatocytes and sinusoids

125
Q

Kuppfer cells make up __-__% of the tissue macrophages in the body

A

80-90%

126
Q

Zones of the liver acinus

A

Zone 1: periportal/central; most vascular supply
Zone 2: midzonal/intermediate
Zone 3: centrilobular/peripheral *MOST sensitive to anoxic injury

127
Q

What transporter uptakes bilirubin in the liver

A

OATP (organic ion transporting polypeptide)

** can be suppressed by cytokines

128
Q

What can explain some of the protracted duration of icterus in some patients after cholestasis is resolved

A

Bilirubin can become irreversibly bound to albumin as biliprotein/delta-bilirubin, and the half life matches that of albumin (6-8 days)

129
Q

T/F: Ammonia is freely permeable across the BBB

A

True

130
Q

Microcytosis in liver disease is due to

A

Abnormalities in iron metabolism

131
Q

S-adenosylmethionine (SAMe)

A

Hepatoprotective, antioxidant, anti-inflammatory
Precursor of glutathione production which is important for hepatocyte detoxification

132
Q

Vitamin E

A

May help decrease lipid peroxidation within hepatocytes

133
Q

Silymarin (milk thistle)

A

Antioxidant
Inhibits lipid peroxidation of hepatocyte and microsomal membranes
Increases hepatic glutathione content, slows hepatic collagen formation

134
Q

Ursodeoxycholic acid

A

Anti inflammatory
Immunomodulatory
Decreases toxic effects of hydrophobic bile acids on hepatocytes
Promotes choleresis

135
Q
A

ACVECC Exam 2024 (26 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions