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?

- 2x increase = check back in 2 weeks - 2-5x increase = continue with diagnostic workup - 5x increase = emergency/immediate diagnostic workup

Liver Disease Flashcards by Nikita S

What are the functions of the liver?

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

How well did you know this?

Not at all

Perfectly

What are the broad CS of liver dz?

Vague symptoms!!

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

How well did you know this?

Not at all

Perfectly

What is the gold-standard marker for hepatocellular dz?

ALT

How well did you know this?

Not at all

Perfectly

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?

2x increase = check back in 2 weeks
2-5x increase = continue with diagnostic workup
5x increase = emergency/immediate diagnostic workup

How well did you know this?

Not at all

Perfectly

What is AST? When is it elevated?

Less specific enzyme

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

How well did you know this?

Not at all

Perfectly

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

ALKP

How well did you know this?

Not at all

Perfectly

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

TBilli
Ammonia
Bile Acids
Coagulopathies

How well did you know this?

Not at all

Perfectly

What are the K dependent clotting factors of the liver?

2, 7, 9, 1O

How well did you know this?

Not at all

Perfectly

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

Rule out infectious diseases first

How well did you know this?

Not at all

Perfectly

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

CT/MRI is the most sensitive

How well did you know this?

Not at all

Perfectly

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

False.

FNAs are very inaccurate
Biopsies have high sampling error

if do either one you must check coags 1st

How well did you know this?

Not at all

Perfectly

What does supportive liver treatment consist of?

Antioxidants

SAMe
Silybin
Vitamin E
Ursodeoxycholic Acid

How well did you know this?

Not at all

Perfectly

What is SAMe?

An antioxidant

Increases liver glutathione levels

How well did you know this?

Not at all

Perfectly

What are some of the effects of ursodeoxycholic acid?

Anti-inflammatory
Anti-fibrotic
Draws water in

How well did you know this?

Not at all

Perfectly

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

Liver not being able to detox!!

How well did you know this?

Not at all

Perfectly

MOA of hepatic encephalopathy

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!!!

How well did you know this?

Not at all

Perfectly

Name some CS of HE:

Head pressing
Seizure
Coma
Ataxia

How well did you know this?

Not at all

Perfectly

What are the treatment options for HE?

Lactulose
Protein diet
Antibiotics
Keppra - if seizing

How well did you know this?

Not at all

Perfectly

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

True

How well did you know this?

Not at all

Perfectly

What are some liver-specific things that cause ascites?

Hypoalbuminemia
Fibrosis
Cirrhosis

How well did you know this?

Not at all

Perfectly

What s orthopnea?

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

Seen with ascites
They are uncomfortable!

How well did you know this?

Not at all

Perfectly

How do we diagnose and treat ascites?

Dx: abdominocentesis, US, bloodwork

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

Why do we see low K in liver dz??

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!

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

False

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

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

Antibiotics! | They have increased gut permeability and this can lead to sepsis

How do we treat fibrosis?

Treat underlying liver dz Antioxidants Prednisolone

What is hepatocutaneous syndrome?

Rare, fatal, 2ry to DM | Leads to severe vascular hepatopathy and ulcerative lesions [footpads]

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

Honeycomb/Swiss cheese liver

How can we treat hepatocutaneous syndrome?

- treat underlying condition - treat any 2ry conditions - zinc supplements - protein/eggs [helps prolong survival a bit]

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

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

Name some drugs that can cause liver toxicity:

``` Phenobarbital CCNU Sulphonamides NSAIDs Methimazole Diazepam [cats] ```

T/F: xylitol and cycasin can cause liver toxicities

True

General treatment of liver toxicity?

Induce V+ Gastric lavage Activated charcoal Supportive care

What are the CS for acute liver injury?

- Acute onset CS that are vague = anorexia, lethargy, V/D+ - hyperbilirubinemia - prolonged PT

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

Neoplasia | Lepto

Name some ways we can treat acute liver injury?

``` Fluids Antioxidants Vit k Abx Diet - easily digestible, normal protein levels ```

With chronic hepatitis, what are some CS?

``` Inappetence Lethargy Weight loss V/D+ Jaundice Cranial abdominal pain Fever ```

In diagnosing chronic hepatitis, what can we see?

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

How do we treat chronic hepatitis?

``` Antioxidants Pred Diuretics Easily digestible carbs - no protein restriction Zinc ```

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

Bedlington terriers

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

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

Where in the liver will we see this Cu?

Centrilobularly

How do we treat Cu-associated hepatitis?

DECREASE the cu! [chelators and intake restriction] | Standard hepatitis tx like antioxidants, diet, etc.

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

True!

Name some paraneoplastic syndromes that we see in hepatobiliary tumors?

HYPOglycemia | Shiny ventral alopecia in cats

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

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

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

E. Coli

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

Treat with abx/liver support If there is obstruction, we may need sx

What are the major differences btwn: Neutrophilic cholangitis Lymphocytic cholangitis Chronic cholangitis

- Neutrophilic = acute dz - Lymphocytic = chronic dz - Chronic = eosinophilic [associated with flukes]

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

False, it’s E. Coli

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

Dry FIP Lymphoma *yellow, lethargic, skinny cat*

What does ursodeoxycholic acid do?

Anti-inflammatory and helps increase bile flow

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

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