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A - Medicine Liver > Liver Clinical signs and diagnosis (lec 1-2) > Flashcards

Liver Clinical signs and diagnosis (lec 1-2) Flashcards

1
Q

List hepatic causes of abdominal transudate effusion - ascites

A

Portal venous hypertension

Cirrhosis, failure of albumin production

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2
Q

List non-hepatic causes of ascites (Specific conditions)

A 
Right CHF
intestinal
caval syndrome
neoplasia
albumin loss
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3
Q

List 2 hepatic causes of icterus (jaundice)

A

Hepatocellular damage

biliary obstruction

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4
Q

List 2 non-hepatic causes of icterus

A

Haemolysis

Severe inflammation

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5
Q

List a hepatic cause of encephalopathy

A

Hepatic failure - build up of ammonia and other endogenous toxins

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6
Q

List 3 non-hepatic causes of encephalopathy

A

Forebrain or brainstem disease
Metabolic or toxic disease
Hypoxia

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7
Q

List a hepatic cause of coagulopathy

A

Clotting factors not being produced by liver

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8
Q

List 4 non-hepatic causes of coagulopathies

A

Rodenticide
Haemophilia
Platelet disorder or deficiency
DIC

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9
Q

What 3 organs are the most likely to cause abdominal enlargement by organomegaly?

A

Liver
Spleen
Kidneys

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10
Q

What are the 5 causes of extra-hepatic hepatomegaly?

A 
Passive congestion
RCHF
Caudal vena caval obstruction
Metastatic neoplasia
Extra-medullary haematopoiesis
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11
Q

What 2 causes of extra-hepatic hepatomegaly do you also usually get splenomegaly?

A

Passive congestion

Extra-medullary haematopoiesis

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12
Q

What are the 8 causes of hepatomegaly by hepatobiliary aetiology?

A 
Hepatic lipidosis
Steroid hepatopathy
Acute hepatotoxicity
Inflammation
Neoplasia
Nodular hyperplasia
Biliary obstruction
Amyloidosis
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13
Q

In a normal dog and cat is the liver palpable?

A

Yes

Can just feel it caudal to the costal arch

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14
Q

What 8 things can hepatomegaly be identified and investigated by?

A 
Palpation
Radiography
Ultrasound
CBC
Biochemistry
Urinalysis
FNA and cytology 
Exploratory laparotomy and biopsy
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15
Q

Is abdominal effusion more common with liver disease in dogs or cats?

A

Dogs

Except for FIP with liver involvement

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16
Q

What is the mechanism of formation of a transudate effusion?

A

Pressure differential

Either low oncotic pressure or increased hydrostatic pressure

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17
Q

What is the mechanism of formation of a non-septic exudate effusion?

A

Inflammation that is not due to pyogenic infection

Usually sterile or viral

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18
Q

What is the mechanism of formation of a septic exudate effusion?

A

Inflammation due to pyogenic infection

Usually bacterial

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19
Q

What is the mechanism of formation of a haemorrhagic effusion?

A

Bleeding from lesion or coagulopathy

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20
Q

What effusion type has the lowest protein and NCC concentration?

A

Transudate

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21
Q

What effusion type has predominantly non-degenerate neutrophils?

A

Non-septic exudate

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22
Q

What effusion type has predominantly degenerative neutrophils?

A

Septic exudate

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23
Q

What effusion type has a HCT which is high compared to vascular HCT?

A

Haemorrhagic

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24
Q

What is the mechanism of formation of a chylous effusion?

A

Rupture of lymphatics from intestine to thoracic duct
Trauma
RCHC
Idiopathic

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25
Q

What is the mechanism of formation of a uroabdomen effusion?

A

Urinary tract rupture

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26
Q

What is the mechanism of formation of a neoplastic effusion?

A

A neoplasm… duh

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27
Q

What effusion is milky/creamy pink in colour, has high triglycerid content and lymphocytes predominate?

A

Chylous effusion

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28
Q

What effusion is a yellowish fluid which will become inflammed over time, has a high BUN and creatinine that is 3-5 times that of blood

A

Uroabdomen effusion

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29
Q

What type of effusion is a neoplasm most likely to produce?

A

Modified transudate, nonseptic exudate or haemorrhagic fluid which will also have some neoplastic cell exfoliation

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30
Q

Effusions caused by liver disease are most commonly formed by what 5 mechanisms?

A

Increased portal venous hydrostatic pressure
Decreased intravascular oncotic pressure
Altered vascular permeability
Insufficient resorption
RAAS activation
-note effusion can be caused by one or more mechanisms

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31
Q

What two mechanisms can cause increased portal venous hydrostatic pressure?

A

Increased resistance to portal flow at the portal triad

Hepatic venous/post hepatic caval congestion

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32
Q

What mechanism most commonly is the cause of an effusion from liver disease?

A

Increased portal venous hydrostatic pressure

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33
Q

What is the normal serum concentration of bilirubin

A

Under 10 micromol/L

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34
Q

What is the concentration that serum becomes icteric?

A

25 micromol/L

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35
Q

What is the concentration of serum that tissues become jaundiced?

A

50 micromol/L

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36
Q

What are the 3 major mechanisms that hyperbilirubinaemia can occur?

A

Prehaptic
Hepatic
Post-hepatic

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37
Q

What causes hyperbilirubinaemia pre-hepatically?

A

Intravascular or extravascular haemolysis or haematoma

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38
Q

What causes hyperbilirubinaemia hepatically?

A

Hepatocellular inability to process and excrete bilirubin

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39
Q

What causes hyperbilirubinaemia post-hepatically?

A

Extra-hepatic biliary obstruction

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40
Q

What part of serum bilirubin can make its way into the renal tubules from blood?

A

Only the non-protein bound conjugated fraction

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41
Q

Why can bilirubinuria be a normal finding in dogs?

A

They have a low renal resorptive threshold and their renal tubules can somewhat process bilirubin

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42
Q

Is bilirubinuria in cats and dogs always pathological?

A

Always in cats

Not always in dogs

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43
Q

What are 4 differential diagnosis for pre-hepatic hyperbilirubinaemia?

A

Haemolytic anaemia
Intravascular - free Hb in plasma
Extravascular - destruction by splenic macrophages
Massive haematoma resorption

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44
Q

What are 5 differential diagnosis for hepatic hyperbilirubinaemia?

A 
Hepatic lipidosis - cats
FIP - cats
hepatic neoplasia 
Hepatotoxicity 
Hepatitis
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45
Q

What are 6 differential diagnoses for post-hepatic hyperbilirubinaemia?

A 
Pancreatitis
Cholangitis
Mass obstructive lesion
Cholelithiasis
Biliary rupture
Sepsis
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46
Q

What can you identify with a PCV/TP and blood smear in an icteric animal?

A

If it is a regenerative anaemia - rule in/out prehepatic cause and assess hydration

47
Q

What can you identify with CBC, serum biochemistry and urinalysis in an icteric animal?

A 
Assess hepatocellular and cholestatic enzymes
Liver function
Inflammation
Abnormal circulating cells
Indirect indicators of liver function
Degree of bilirubinuria
Involvement of other organs
48
Q

What do you use diagnostic imaging (ultrasound) for in an icteric animal?

A

Asess biliary tree
Pancreas
Other organs
Liver parenchyma

49
Q

What is hepatic encephalopathy caused by?

A

Effects of endogenous toxins that have not been removed from the circulation by the liver - Most come from the intestines

50
Q

What 2 main mechanisms causes hepatic encephalopathy to develop?

A

Significant reduction in liver functional mass

Portal blood bypassing the liver

51
Q

What 4 things contribute to the pathogenesis of hepatic encephalopathy?

A

Increased blood ammonia levels
Increased levels of aromatic amino acids
Increased short chain fatty acids, mercaptans, skatole and indoles
Altered CNS neurotransmitter activity

52
Q

What 5 clinical signs may be seen with hepatic encephalopathy?

A 
Motor dysfunction
Changed mentation/behaviour
Seizures
Cortical blindness
Hypersalivation - cats esp.
53
Q

Failure of conversion of ammonia to urea and uric acid causes precipitation in what in urine?

A

Ammonium biruate crystals

54
Q

Nausea, inappetance and vomiting from living disease is a result of a combination of what 5 mechanisms?

A 
Disturbed metabolism
Increased endogenous toxins in circulation
Hyperbilirubinaemia
Liver distension and pain
GI bleeding
55
Q

Why are coagulopathies common from liver disease?

A

Most coagulation proteins and inhibitors are synthesised in the liver

56
Q

What clotting factors are vitamin K dependent?

A

2, 7, 9, 10

57
Q

What does complete biliary obstruction or rupture prevent?

A

Prevents bile acid facilitation of fat absorption

58
Q

By what 2 mechanisms can portal hypertension predispose to rupture?

A

Induce vascular congestion

More fragile

59
Q

By what 2 mechanisms can portal hypertension predispose to GI ulceration?

A

Poor GI mucosal perfusion from portal hypertension

Splanchnic pooling of blood

60
Q

What 5 mechanisms contribute to the cause of polyuria/polydipsia in liver disease?

A

Reduced hepatic metabolism of aldosterone and cortisol
Altered threshold for ADH release
Hypokalaemia -impairs ADH action at receptors
Low urea reduces medullary conc. gradient
Primary polydipsia - inc. thirst from hepatic encephalopathy

61
Q

What breed is predisposed to copper storage disease?

A

Bedlington Terriers

62
Q

What breeds are prone to copper accumulation?

A

WHWT
Skye terrier
Dalmation
Siamese cats

63
Q

What breeds are prone to idiopathic chronic hepatitis?

A

Doberman

Cocker spaniel

64
Q

What breeds are prone to portosystemic vascular anomalies?

A 
Yorkshire
Maltese
Pugs
Schnauzer
Cattle Dog
OESD
Wolfhound
Retrievers
DSH
Persians
Himalayan cats
65
Q

What breeds are prone to amyloidosis?

A

Shar Pei
Abyssinian
Siamese
Oriental cat

66
Q

What 3 liver disorders are more likely in young animals?

A

Toxic
Inflammatory
Congenital

67
Q

What 2 liver disorders are more likely in older animals?

A

Chronic hepatopathies

Neoplasia

68
Q

What are 6 non-specific clinical signs/history that are associated with liver disease?

A 
Anorexia
PU/PD
Vomiting
Diarrhoea
Weight loss
Lethargy
69
Q

What are 5 specific clinical signs/history that are associated with liver disease?

A 
Stunted growth
Hepatotoxic drug
Anaesthetic intolerance
Abdominal effusion
Icterus
70
Q

When doing a clinical exam on an animal with suspected liver disease, what 6 things should you specifically look for?

A 
Body condition score
Abdominal distension and pain
Mentation
Icterus and pallor
Liver palpation and splenomegaly present
Dermatological lesions
71
Q

What is poikilocytosis?

A

The presence of abnormal RBC’s

72
Q

What are 4 potential red blood cell hematological abnormalities from liver disease?

A

Regenerative anaemia with spherocytes
Poikilocytosis
Microcytes in portosystemic shunt
Oxidative damage

73
Q

White are 2 potential white blood cell haematological abnormalities from liver disease?

A

Evidence of inflammation

Atypical cells

74
Q

What do liver enzymes provide evidence for?

A

Hepatocellular and biliary damage.

Do NOT provide any info on liver function

75
Q

What does the magnitude of elevated ALT and AST reflect?

A

Extent of hepatocellular injury, but not the reversibility

76
Q

Where does ALT come from?

A

Leaks from cytosol of hepatocytes when they are injured or necrosed

77
Q

Other than hepatocellular damage what else can cause a rise in ALT?

A

Muscle injury

Some drugs like corticosteroids and phenobarbitone

78
Q

Where does AST come from?

A

Cytosol and mitochondria of hepatocytes

However it is also found in most tissues

79
Q

Where does ALP come from?

A

Membrane-bound enzyme that is released from cholestasis or enzyme induction

80
Q

What 5 things can cause a rise of ALP?

A 
Intra or extra-hepatic cholestasis
Bone lysis or remodelling
Endogenous and exogenous corticosteroids
Hepatic lipidosis - cats
Feline hyperthyroidism
81
Q

Where is GGT from?

A 
Hepatocyte microvilli
Biliary epithelium
Renal tubules
Mammary epithelium
Can also be induced in dogs by corticosteroids
82
Q

In cats, what is the most sensitive enzyme test for cholestasis?

A

GGT

83
Q

What 7 components are indicators of failure of hepatic synthesis and homeostasis?

A 
Urea
Albumin and globulin
Glucose
Cholesterol
Coagulation factors
Ammonia
Potassium
84
Q

What causes a low BUN concentration?

A

Failure of liver to convert ammonia to urea

85
Q

What causes hypoalbuminaemia in liver disease?

A

Failure of albumin synthesis

86
Q

What is the serum half life of albumin?

A

10 days

87
Q

Chronic hepatopathies may have increased what 2 kinds of globulins?

A

Beta and gamma

88
Q

When will glucose homeostasis suffer as a result of liver dysfunction?

A

When over 70% hepatic functional mass is loss

89
Q

When may hypocholesterolaemia be seen as a result of liver disease?

A

Hepatopathies

especially PSS and cirrhosis

90
Q

When may hypercholesterolaemia be seen as a result of liver disease?

A

Severe cholestasis

91
Q

What can be problematic about testing ammonia?

A

Needs to be immediately tested or need to separate and freeze serum

92
Q

What is the most common electrolyte disorder with hepatopathy and may also worsen hepatic encephalopathy?

A

Hypokalaemia

93
Q

How is bilirubin produced? And where is it conjugated?

A

Degradation of haem protein

Conjugated in liver

94
Q

Is measuring conjugated or unconjugated bilirubin the most direct reading?

A

Conjugated

95
Q

Where is conjugated bilirubin produced/from?

A

Formed in hepatocyte, gets water soluble and excreted in bile

96
Q

Where is unconjugated bilirubin produced/from?

A

Bilirubin is transported into the blood bound to albumin

97
Q

What is bilirubinuria caused by?

A

Passage of conjugated bilirubin through glomerulus

98
Q

What is the USG usually like in liver disease?

A

Hyposthenuric -inadequate concentration

99
Q

What is testing for urobilinogen useful for?

A

Bugger all. It is rapidly oxidised so even normal animals can appear abnormal

100
Q

What is serum bile acids a good test for?

A

Clinically significant hepatobiliary disease

Congenital or acquired portosystemic shunting

101
Q

Where are bile acids from?

A

Synthesised in the liver from cholesterol

Then conjugated and secreted in bile -aids in lipid digestion

102
Q

How are bile acids usually resorbed?

A

Resorbed from ileum
Undergo enterohepatic recirculation
Extracted from portal blood by hepatocytes

103
Q

During cholestasis there is an increased level of bile acids, what else may this contribute to? (what does it damage)

A

Contribute to hepatocellular membrane damage by detergent action

104
Q

Why isn’t serum bile acids measurement a good test if cholestasis is present?

A

It increases the levels via reflux into blood stream - Artifically elevates

105
Q

What 2 things is radiography unhelpful for?

A

No information on parenchymal change

If lots of peritoneal effusion present

106
Q

What may you see on a radiograph if there is necrotic liver disease present?

A

Hepatic gas

107
Q

What 3 things is ultrasound particularly useful for?

A

Guidance of FNA or tru-cut biopsy
Assessment of parenchymal change
Assessment of portal and hepatic venous system

108
Q

What must you do before conducting a FNA?

A

Rule out a coagulopathy

109
Q

What 4 things may be identified from a FNA?

A

Hepatic lipidosis
Neutrophilic inflammation
Lymphoma
Non-specific hepatopathy

110
Q

What is the only thing that you can do with an FNA of the liver?

A

Cytology

111
Q

What should you also request when sending a liver biopsy away?

A

Copper staining
Immunohistochemistry
PCR

112
Q

Why is an exploratory laparotomy preferred to a percutaneous biopsy in the cat?

A

High morbidity and mortality associated with biopsy

Usually want to also assess pancreas and SI at the same time

113
Q

Why can a liver biopsy be more informative compared to an FNA?

A

It is a histopathological sample and therefore hepatic architecture can also be assessed

A - Medicine Liver (3 decks)

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