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Y4 SA - Internal medicine > Liver disease 1 > Flashcards

Liver disease 1 Flashcards

1
Q

Describe the structure of the liver

A
  • Made up of lobes with a lobular structure
  • Corners of the lobules = portal triads = hepatic artery, portal vein, and bile duct
  • Hepatic vein lies in the centre of the lobule
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2
Q

Most of the blood comes to the liver via which vessel?

A

Portal vein
Also some from hepatic artery

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3
Q

Where does blood in the portal vein come from?

A

GIT - detoxification

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4
Q

List the hepatic functions

A

Intermediate metabolism
Storage
Protein synthesis
Production of bile
Detoxification

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5
Q

What are the consequences of hepatic dysfunction

A

Consequences on:
- Bile production
- Metabolic
- Circulation
- Detoxification
- Coagulation

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6
Q

Icterus is another name for..?

A

Jaundice

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7
Q

Bilirubin is a breakdown product of …?

A

RBCs

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8
Q

How is the liver involved in bilirubin?

A

Livers role is to remove bilirubin

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9
Q

How can hepatic and post-hepatic icterus be differentiated from pre-hepatic?

A

MM colour
Pink and yellow jaundice = Hepatic and post-hepatic
Pale yellow on CRT

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10
Q

What is the cause of pre-hepatic jaundice?

A

Haemolysis
Rapid break down of RBCs means there’s more bilirubin present than can be broken down by the liver

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11
Q

What is the cause of hepatic jaundice?

A

Hepatocyte dysfunction
Intrahepatic cholestasis – obstruction of bile flow

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12
Q

What is the cause of post-hepatic jaundice?

A

Extra-hepatic cholestasis
If something is obstructing the bile ducts

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13
Q

What are the signs of metabolic dysfunction due to liver disease

A
  • Loss of condition
  • Weight loss
  • Hypoglycaemia
  • Hypoalbuminaemia: only in chronic disease, can contribute to ascites
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14
Q

List the 3 circulatory disturbances seen in ascites

A

Hypoalbuminaemia
Portal hypertension
Sodium and water retention

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15
Q

Name the other circulatory disturbances that can occur due to liver disease

A

Polyuria/polydipsia - cannot concentrate urine maximally
Portosystemic shunts

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16
Q

Describe how portosystemic shunts result occur as a consequence of liver disease

A

Congenital (single) or Acquired (multiple)
Cirrhosis
Portal hypertension – increased pressure in the portal system

17
Q

What are the consequences of portosystemic shunts in the liver?

A

Lead to a build up of toxins in the liver which would normally be eliminated, particularly ammonia

18
Q

A build up of ammonia leads to which condition?

A

Hepatic encephalopathy

19
Q

What are the two causes of hepatic encephalopathy

A

Decreased functional liver mass
and/or
Portosystemic shunt

20
Q

Describe the aetiology of hepatic encephalopathy

A

Increased blood NH3 (plus other toxins)
Leads to altered CNS function

21
Q

List the clinical signs of hepatic encephalopathy

A

Anorexia, V & D, PU/PD
Dullness, aggression, staggering, blindness, head-pressing, seizures
Copper coloured irises in cats

22
Q

When are the clinical signs of hepatic encephalopathy worsened?

A
  • High protein meal
  • Gastrointestinal bleed
  • Dehydration, acid-base imbalance
23
Q

Why does bleeding occur as a result of liver disease?

A
  • Defective production and storage of clotting factors
  • Vitamin K malabsorption
  • Portal hypertension -> GI bleeding
24
Q

List the main clinical signs of liver disease

A
  • Icterus
  • Faecal changes: grey, melaena
  • Hepatic encephalopathy
  • Drug intolerance
  • Ascites
  • Stunted growth (if young)
  • V + D
  • PU/PD
  • Anorexia, weight loss, weakness
25
Q

How are hepatopathies classified?

A

Primary
- Inflammatory diseases: Infectious, Non-infectious
- Non-inflammatory diseases: Non-infectious
Secondary

26
Q

Describe the features of secondary hepatic disease

A

Non-specific & reversible liver changes
- Anoxia
- Toxaemia
- Nutritional imbalance
- Metabolic changes
- Infection

27
Q

Name the most common liver abnormality

A

Reactive hepatopathies

28
Q

How are reactive hepatopathies treated?

A

By treating the underlying disease

29
Q

Name some examples of reactive hepatopathies

A

IBD
Bacterial infections
Periodontal disease
Acute pancreatitis
Diabetes mellitus
Hyperadrenocorticism
Hypoadrenocorticism
Hyperthyroidism
Haemolytic anaemia
Septicaemia
Shock
Right sided HF

30
Q

List some infectious inflammatory causes of hepatopathies

A
  1. Bacterial
    - Leptospirosis
    - Bacterial cholangiohepatitis
  2. Viral
    - Infectious canine hepatitis
    - Canine Herpes virus
    - FIP
  3. Protozoal - Toxoplasma
31
Q

List some non-infectious inflammatory causes of hepatopathies

A
  • Toxic hepatic disease
  • Drug-induced hepatic disease
  • All forms of chronic hepatitis
32
Q

List some non-inflammatory causes of hepatopathies

A

Congenital portosystemic shunt
Juvenile hepatic fibrosis
Feline hepatic lipidosis
Neoplasia
Telangiectasis and Peliosis
Surgical - Trauma, Liver lobe torsion

33
Q

Feline hepatic idiosyncrasies is caused by?

A

Relative deficiency of glucuronyl transferase
- Difficulty in conjugating toxins

34
Q

Feline hepatic idiosyncrasies is the reason cats are susceptible to which substances?

A

Aspirin
Paracetamol
Phenols, pine tars, morphine, benzenes, alcohols, barbiturates

35
Q

Describe paracetamol toxicity in cats

A
  • Relative deficiency of glucuronidation
  • Relative deficiency of glutathione conjugation
  • Methaemoglobinaemia
  • Haemolytic anaemia
  • Facial oedema
  • Hepatocellular damage
36
Q

How is paracetamol toxicity in cats treated?

A

N-acetylcysteine
S-adenosyl methionine?
Vitamin C
Supportive care

37
Q

Describe the clinical signs of liver disease in cats

A
  • Anorexia and weight loss most common
  • Icterus relatively common
  • Polyuria / polydipsia - less severe
  • Hepatoencephalopathy, increased hypersalivation
  • Microhepatica & cirrhosis rarely seen
  • Pyrexia common in suppurative cholangitis
  • Chorioretinitis or uveitis (FIP, toxoplasmosis)

Y4 SA - Internal medicine (7 decks)

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