Liver Disease

Question 1

Indications for hepatic sampling

Answer 1

1. Unexplained, persistent increases in liver enzyme activities and/or abnormal hepatic function tests**
2. Determine cause of architectural abnormalities as defined by PE or imaging studies; examples include enlargement, irregular contours, nodules, or changes in echogenicity**
3. Stage neoplastic diseases (e.g. mast cell tumors in dogs, lymphoma)
4. Assess response to therapy for previously diagnosed disorder
5. Follow progression of previously diagnosed disease if not treated

Question 2

What types of fluids might you expect in small animals with primary liver disease?

Answer 2

• Pure transudates
• Modified transudates
• High protein exudates (in cats with FIP, in leakage of hepatic abscess, perforation of gastric ulcer, leakage of bile into the peritoneal cavity)

Question 3

What two mechanisms could contribute to the formation of PURE transudates (defined by protein <1.5 g/dL and low cell count) in the abdomen of patients with hepatic disease?

Answer 3

• Low oncotic pressure secondary to hypoalbuminemia

- Portal hypertension

Question 4

What are potential antibiotics that you could use for empirical treatment of liver disease?

Answer 4

• Ampicillin/penicillin G
• Cefazolin
• Enrofloxacin
• Amikacin/gentamicin
• Tetracycline/doxycycline
• Metronidazole
• All of these have good bile penetration and are effective against many common bacterial causes of hepatobiliary infection

Question 5

How would you treat liver disease related to feline hepatic lipidosis?

Answer 5

• Feeding

Question 6

Antidote for acetaminophen toxicity

Answer 6

• N-acetylcysteine

Question 7

Antidote for copper hepatopathy

Answer 7

• chelating agents such as d-penicillamine

Question 8

Inflammatory causes of acute hepatobiliary disease in dogs (infectious)

Answer 8

• Bacterial (many, including leptospirosis, and other GIT derived organisms)
• Viral (young dogs and cats)
• Rickettsial (RMSF and ehrlichiosis in dogs)
• Protozoal (Toxoplasmosis, etc.)
• Fungal (Histoplasmosis, blastomycosis)

Question 9

Inflammatory causes of acute hepatobiliary disease in dogs (non-infectious)

Answer 9

• Pancreatitis

- Peritonitis

Question 10

Toxic causes of acute hepatobiliary disease

Answer 10

• Drugs (acetaminophen, anticonvulsants, anesthetic/analgesic agents, other including antibiotics like doxycycline)
• Biologic toxins (aflatoxins, mushrooms)
• Many others (e.g. xylitol); idiosyncratic reactions to any drugs are possible

Question 11

Hypoxic/ischemic causes of acute hepatobiliary disease

Answer 11

• Liver lobe torsion
• Thrombosis
• Congestion
• Hypoxemia