Liver Diseases Flashcards
Exam of the Liver
It is located deep in the diaphragmatic dome, asymmetrically
Phys exam is impossible
Ancillary:
- US and US guided biopsy
- Nuclear scintigraphy
- Biopsy
- Clincopatho exams- specific and non-specific indicators of liver disease
Some notes about US
It is limited because the liver is covered by the lungs
Must compare the echogenicity of the spleen and liver
At the 7th ICS on the left- the left liver lobe and spleen are overlapping, this is a good site for biopsy
Clinicopatho exams: specific indicators of liver disease
SDH (not stable in the blood)
GGT
Bile acids
Arginase
GLDH
Direct bilirubin
Ammonia
Bromosulphthalein half-life
Branched chain aa to aromatic aa ratio
Urine bilirubin
Clinicopatho exams: Non-specific indicators of liver disease
Total and indirect bilirubin
LDH-3
AST
(ALT) conc is v low in Eq
ALP
Decr in blood urea nitrogen
Globulins
decr Albumin
decr Glucose
PTT, APTT (as these are produced in the liver)
Triglyceride
Incr or decr WBC’s
Urine Bilirubin
The total doesn’t give you info about the fractions!
Direct=conjugated, indirect=unconjugated
Incr direct is more reliable, but both should be measured
Incr indirect: anorexia, haemolysis, intestical obstruction
- Prehepatic icterus: incr indirect (direct may incr slightly)
- Hepatic: Liver disease/damage!! Both increase, esp indirect, direct is less than 25% of the total
- Posthepatic: cholestasis: direct incr, more than 30% of total
Normal amount does NOT rule out liver disease
Significance of GLDH and Bile acids
Are elevated with hepatopathies!!!
Indicate gross liver function
**because total bile acids are a FUNCTIONAL parameter- they indicate gross liver function- the other enzymes may only indicatr liver damage
Clinical signs of hepatic insufficiency
Because of large capacity: Greater than 80% of mass must be affected before clinical signs!! similar to kidneys in this case
Good regenerative properties
Disease may be present without insufficiency
Diseases are not necessarily manifesting
- Depression
- Anorexia
- Colic
- HEPATIC ENCEPHALOPATHY
- Weight loss
- Icterus
Less common signs of hepatic insufficiency
photosensitization: primary liver, secondary skin! Dermal acc of phylloerythrin (this should be removed by a healthy liver)
Dx
Bleeding
Ascites
Dependent edema
Rare signs of hepatic insufficiency
Steatorrhea
Tenesmus
Generalized seborrhoea
Pruritis
Endotoxic shock: decr clearance of toxins from portal circ
Polydypsia
Pigmenturia- from Br or Hgb
Hepatoencephalopathy
If neuro symptoms- always run normal bloods to rule it out! kidney failure can also display neuro signs when urea adn creatinine are not excreted
Depression
Yawning
Ataxia, paresis
Circling
Forward walking
Dementia/confusion
Treatment of liver disease
Diet!! low protein- give more branched chain aa’s because the aromatic aa’s are already high. Also decr oil and fat
IV fluids and electrolytes: cover acid-base requirements
IV glucose
IV brached chain aa’s
Vitamins, mineral oil
Oral neomycin (not usually given systemically) to decrease NH3 prod in gut so that less is being abs!
Sedatives
Protection from sunlight- photosens!!
Theiler’s disease
Serum associated hepatitis
Horse usually had serum product a few weeks before signs
Common cause of acute, diffuse hepatic necrosis in adults
Clinical signs of Theiler’s disease
Adults
Peracute/acute onset of signs of hepatic failure
Usually develop hepatoencephalopathy very quickly
Anorexia
Fever
Icterus
Colic
Dependent edema
Haem diathesis
Photoderm
Sudden death
Lab results of Theiler’s disease
Incr direct and indirect bilirubin
Incr GGT, AST and SDH
Incr bile acids
Glucose: incr, decr or stays the same
Decr BUN
Prolonged clotting
Albumin normal
Diagnosis of Theiler’s disease
History (serum/plasma few wks prev)
Abrupt onset of the clinical signs
Liver biopsy: necrosis, hepoptosis and haem!
