Liver disease – Diagnosis Flashcards
(36 cards)
List the steps used in diagnosing liver disease
History & clinical signs
Physical examination
Laboratory evaluation
Diagnostic imaging
Liver biopsy
What signs may present on physical examination which would indicate liver disease?
- Icterus: present in serum before visible to the eye. Can have severe disease without icterus
- Ascites
- Hepatomegaly / microhepatica: can feel the liver just behind the costal arch when its enlarged
- Pain e.g. abdominal pain
Which laboratory tests can be done in suspected liver disease cases?
Haematology
Serum biochemistry
Urinalysis
Coagulation - Before liver biopsy
Liver function tests
Peritoneal fluid cytology - Ascites investigation
Which liver enzymes are hepatocellular markers?
ALT
AST
What are hepatocellular markers?
An insult that effects the liver cell can lead to the release of enzymes into the bloodstream. The damage doesn’t have to be fatal damage to the cell.
Number of enzymes reflects how many cells are affected.
In cirrhosis there aren’t many normal liver cells left so ALT and AST may not be that markedly increased
Which liver enzymes are cholestatic markers?
ALP
GGT
What are cholestatic markers?
Present within the biliary system.
Any insult that leads to cholestasis or bile stasis, can lead to increases in these markers
Which substances can be used to assess the function of the liver?
- Serum proteins (albumin)
- Glucose, urea, cholesterol
- Bilirubin
- Bile acids
Why can glucose, urea and cholesterol levels be used to assess the function of the liver?
All produced by the liver so if it is not functioning the levels of these will change
The levels of which markers in serum biochemistry tests will change in early liver disease?
ALT, ALP
Bile acids
The levels of which markers in serum biochemistry tests will change in end-stage liver disease
Increased clotting factors
Decreased glucose
At what stage of liver disease do clinical signs begin?
In chronic hepatitis there is a ‘window of no clinical signs’
Once cirrhosis begins, clinical signs develop through to end stage liver disease
Which test should you run when youre looking for possible liver disease and the patient is not yet jaundice?
Bile acid test
How can urinalysis complement haematology and biochemistry
Urine bilirubin is a more sensitive marker than serum
Evidence of protein
What are the 4 major reasons of decreased albumin?
- Blood loss: pale mm
- Through the GIT: protein losing enteropathy
- Protein losing nephropathy: albumin loss through the glomeruli (if there isn’t protein in the urine then this can be ruled out)
- Albumin isn’t being lost through the liver
Describe how radiographs are used for diagnosing liver disease
Normal – axis of the stomach should be parallel to the ribs
If the liver is enlarged, it will push the axis caudally
Can tell you if there’s an abnormal shape of the liver
What is portovenography?
Inject contrast into a BV adjacent to the intestines which goes to the portal vein - contrast radiographs
Which liver abnormalities can be detected on ultrasound?
Liver size
Heterogeneous parenchymal disease
Biliary obstruction
Biliary calculi
Masses
Vasculature - Portosystemic shunts, Arteriovenous fistulas
List the indications for a liver biopsy
- Persistent increases in liver enzymes
- Altered liver size
- Monitoring progressive liver disease
- To evaluate response to treatment
What must always be done before a liver biopsy?
Check clotting profile
What are the 3 liver biopsy techniques?
- Percutaneous
- ‘Blind’
- Ultrasound guided “Tru-cut” technique - Laparoscopy
- Coeliotomy
List the contraindications for a percutaneous liver biopsy
Lack of operator experience
Small liver, unless ultrasound available
Focal disease
Extrahepatic cholestasis
Bleeding disorder
Severe anaemia
Describe the pathology of juvenile hepatic fibrosis
- Uncommon disease seen in young dogs (GSD, Rottweiler)
Progressive fibrosis
Minimal inflammatory reaction
Central vein fibrosis & occlusion most common
Secondary acquired shunts occur following?
Hepatic fibrosis
