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SAM2 > Liver Disease > Flashcards

Liver Disease Flashcards

1
Q

What are the functions of the liver?

A
  • Metabolizes fat/carbs/proteins/drugs/vitamins
  • Stores vitamins/minerals/glycogen
  • Makes proteins/clotting factors/ bile acids
  • Detox
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2
Q

What are the broad CS of liver dz?

A

Vague symptoms!!

V/D+, weight loss, ulcers, melena, hematemesis, fever, coagulopathies, jaundice, ascites, PU/PD, seizures

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3
Q

What is the gold-standard marker for hepatocellular dz?

A

ALT

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4
Q

How do you interpret ALT values?

  • when do you decide to check back in 2 weeks?
  • when do you go ahead with further workup?
  • when does it become an emergency?
A
  • 2x increase = check back in 2 weeks
  • 2-5x increase = continue with diagnostic workup
  • 5x increase = emergency/immediate diagnostic workup
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5
Q

What is AST? When is it elevated?

A

Less specific enzyme

Can be seen in liver, skeletal muscle, cardiac tissue, and kidney issues

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6
Q

What is the best enzymatic marker to look for in cholestasis?

A

ALKP

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7
Q

What are the 4 main values that we look at to assess liver function?

A
  1. TBilli
  2. Ammonia
  3. Bile Acids
  4. Coagulopathies
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8
Q

What are the K dependent clotting factors of the liver?

A

2, 7, 9, 1O

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9
Q

What do we have to rule out in stable patients with mild-mod liver value elevations?

A

Rule out infectious diseases first

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10
Q

In mod-severe liver value increases we need to use DI. WHat is the best modality to use?

A

CT/MRI is the most sensitive

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11
Q

T/F: FNAs and biopsies are done routinely in order to help diagnose liver disease

A

False.

FNAs are very inaccurate
Biopsies have high sampling error

if do either one you must check coags 1st

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12
Q

What does supportive liver treatment consist of?

A

Antioxidants

SAMe
Silybin
Vitamin E
Ursodeoxycholic Acid

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13
Q

What is SAMe?

A

An antioxidant

Increases liver glutathione levels

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14
Q

What are some of the effects of ursodeoxycholic acid?

A

Anti-inflammatory
Anti-fibrotic
Draws water in

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15
Q

What is the main cause for the development of hepatic encephalopathy?

A

Liver not being able to detox!!

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16
Q

MOA of hepatic encephalopathy

A

Ammonia that is usually detoxified in the liver is not
Astrocytes in brain swell with increasing ammonia levels
The swelling of the astrocytes leads to cerebral edema/inflammation
Neuro signs!!!

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17
Q

Name some CS of HE:

A

Head pressing
Seizure
Coma
Ataxia

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18
Q

What are the treatment options for HE?

A

Lactulose
Protein diet
Antibiotics
Keppra - if seizing

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19
Q

T/F: Lactulose binds the ammonia and gets rid of some of the bacteria

A

True

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20
Q

What are some liver-specific things that cause ascites?

A
  1. Hypoalbuminemia
  2. Fibrosis
  3. Cirrhosis
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21
Q

What s orthopnea?

A

When the animal is dyspnic when laying down and we see them pacing

Seen with ascites
They are uncomfortable!

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22
Q

How do we diagnose and treat ascites?

A

Dx: abdominocentesis, US, bloodwork

Tx: low salt diet, spironolactone [furosemide if very severe]

23
Q

Why do we see low K in liver dz??

A

In liver dz we have decreased bile salts
Bile acids are needed for absorption of lipids
Vit K is lipid soluble and absorption is decreased!

24
Q

T/F: to check coags, PT will be prolonged first because it is intrinsic and only has factor 7

A

False

PT will be prolonged first because it is EXTRINSIC and only has factor 7

25
Q

What must we make sure to administer in animal with severe liver dz?

A

Antibiotics!

They have increased gut permeability and this can lead to sepsis

26
Q

How do we treat fibrosis?

A

Treat underlying liver dz
Antioxidants
Prednisolone

27
Q

What is hepatocutaneous syndrome?

A

Rare, fatal, 2ry to DM

Leads to severe vascular hepatopathy and ulcerative lesions [footpads]

28
Q

What do we see @ US that tells us we are dealing with hepatocutaneous syndrome?

A

Honeycomb/Swiss cheese liver

29
Q

How can we treat hepatocutaneous syndrome?

A
  • treat underlying condition
  • treat any 2ry conditions
  • zinc supplements
  • protein/eggs [helps prolong survival a bit]
30
Q

T/F: hepatocutaneous syndrome has a good prognosis once treatment is initiated

A

False

Poor prognosis regardless of treatment [protein helps prolong life a little bit though]

31
Q

Name some drugs that can cause liver toxicity:

A 
Phenobarbital 
CCNU
Sulphonamides
NSAIDs
Methimazole
Diazepam [cats]
32
Q

T/F: xylitol and cycasin can cause liver toxicities

A

True

33
Q

General treatment of liver toxicity?

A

Induce V+
Gastric lavage
Activated charcoal
Supportive care

34
Q

What are the CS for acute liver injury?

A
  • Acute onset CS that are vague = anorexia, lethargy, V/D+
  • hyperbilirubinemia
  • prolonged PT
35
Q

What are the 2 most common causes of canine acute liver injury?

A

Neoplasia

Lepto

36
Q

Name some ways we can treat acute liver injury?

A 
Fluids
Antioxidants
Vit k
Abx
Diet - easily digestible, normal protein levels
37
Q

With chronic hepatitis, what are some CS?

A 
Inappetence
Lethargy
Weight loss
V/D+
Jaundice
Cranial abdominal pain 
Fever
38
Q

In diagnosing chronic hepatitis, what can we see?

A

Increased liver enzymes
Prolonged PT
Increased acanthocytes/codocytes = cholesterol imbalance
Bilirubinemia
Increased TBili/ammonia if there is fibrosis

39
Q

How do we treat chronic hepatitis?

A 
Antioxidants
Pred
Diuretics
Easily digestible carbs - no protein restriction 
Zinc
40
Q

With Cu-associated hepatitis, which breed is know for this?

A

Bedlington terriers

41
Q

T/F: Stored/bound Cu is toxic and causes oxidative damage and Cu-associated hepatitis

A

False!

Stored/bound is good and normal.
It is the free copper that is toxic

42
Q

Where in the liver will we see this Cu?

A

Centrilobularly

43
Q

How do we treat Cu-associated hepatitis?

A

DECREASE the cu! [chelators and intake restriction]

Standard hepatitis tx like antioxidants, diet, etc.

44
Q

T/F: There aren’t all that many 1ry hepatobiliary tumors but many tumors met to the liver

A

True!

45
Q

Name some paraneoplastic syndromes that we see in hepatobiliary tumors?

A

HYPOglycemia

Shiny ventral alopecia in cats

46
Q

T/F: bile duct tumors can be easily surgically removed

A

False, they have high metastatic rates and so sx is not usually possible

47
Q

Cholecystitis is an infection of the bile duct. What is the most common infectious agent that causes this?

A

E. Coli

48
Q

How do we treat cholecystitis?

How do we treat is there is biliary obstruction associated with it?

A

Treat with abx/liver support

If there is obstruction, we may need sx

49
Q

What are the major differences btwn:

Neutrophilic cholangitis
Lymphocytic cholangitis
Chronic cholangitis

A
  • Neutrophilic = acute dz
  • Lymphocytic = chronic dz
  • Chronic = eosinophilic [associated with flukes]
50
Q

T/F: the most common infectious agent in neutrophilic cholangitis is Staph.

A

False, it’s E. Coli

51
Q

What is in the DDx list with lymphocytic cholangitis and why?

A

Dry FIP
Lymphoma

yellow, lethargic, skinny cat

52
Q

What does ursodeoxycholic acid do?

A

Anti-inflammatory and helps increase bile flow

53
Q

We treat acute and lymphocytic cholangitis like any typical liver disease. How are we going to treat chronic cholangitis?

A

Praziquantel [since it’s associated with flukes] and hepatic support

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