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A - Medicine Liver > Liver diseases of the cat > Flashcards

Liver diseases of the cat Flashcards

1
Q

Does liver disease usually progress to cirrhosis in cats?

A

No, rarely

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2
Q

Why is diagnosing cats with hepatobiliary disease hard to do?

A

Clinical signs and tests results are non-specific

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3
Q

Is portal hypertension common in cats?

A

No it is rare. Which also means that liver disease doesn’t tend to cause ascites

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4
Q

What does an elevation of ALP usually reflect in a cat?

A

Cholestasis

They have no steroid isoenzyme of ALP

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5
Q

What is feline primary hepatic lipidosis characterised by?

A

Acute hepatopathy
Massive accumulation of fat in hepatocytes
Leading to loss of hepatocyte function

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6
Q

What is the pathogenesis of feline primary hepatic lipidosis?

A

Excessive peripheral fat mobilisation to the liver

With concurrent primary appetite disturbance

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7
Q

What happens to hepatic glutathione levels during feline primary hepatic lipidosis? And what is the importance of glutathione

A

They decrease

Glutathione is an important antioxidant

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8
Q

What are the predisposing factors for a cat developing secondary hepatic lipidosis?

A

Any anorexic cat with concurrent disease

Most commonly associated with - pancreatitis, diabetes mellitus, IBD, neoplasia, other hepatic disorders

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9
Q

What are the clinical features of feline hepatic lipidosis?

A 
Middle aged cat
History of a stressful event/concurrent disease and anorexia
Acute loss of hepatocyte function (reversible)
Hepatocyte swelling
Intrahepatic cholestasis 
Resulting in -
Icterus
Intermittent vomiting
Dehydration
\+/- diarrhoea/ constipation
Hepatomegaly
Hepatic encepholopathy - depression, ptyalism
Coagulopathies
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10
Q

What clinical pathology results will you get from a cat with hepatic lipidosis?

A 
Hyperbilirubinaemia
Elevated ALT, AST, ALP 
\+/- high GGT if other hepatic issue
Low urea
Electrolyte disturbances - hypokalaemia
Fasting cholesterol and glucose may be high 
Coagulopathies
Anaemia
Heinz bodies 
Serum bile acids not helpful
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11
Q

What will diagnostic imaging show with a cat that has hepatic lipidosis?

A

Hepatomegaly
Weight loss but still has falciform fat pad
Hyperechoic parenchyma which is non-specific

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12
Q

How do you definitively diagnose feline hepatic lipidosis? And what can be problematic about this?

A

Biopsy and histopathology
However usually they will be too sick to do this
Instead do FNA after a coagulation test and look at cytology

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13
Q

How do you treat a cat with hepatic lipidosis?

A 
Early and intensive feeding with high protein diet - Nasoesophageal tube first until stable, then a oesophagostomy or gastrotomy tube
IV fluid support including electrolytes and glucose
Manage hepatic encephalopathy 
Coabalamin (B12) and Vit K
Antiemetics
Prokinetics
S-adenosylmethionine
Identify and treat underlying disease
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14
Q

What is the most common feline hepatopathy and what is it also known as?

A

Biliary disease

Also known as triaditis

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15
Q

What may be a reason that biliary disease is so common in cats?

A

The anatomy and proximity of the biliary and pancreatic duct joining and then entering the duodenum

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16
Q

What clinical signs will you see in cats with a biliary disease?

A

Lethargy
Anorexia
Icterus
-Clinical, clinicopathological and diagnostic imaging will not distinguish between forms

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17
Q

How does neutrophilic (suppurative) cholangitis in cats usually occur from?

A

Ascending bacterial infection from small intestine

Common with concurrent pancreatitis and intestinal disease

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18
Q

What are the characteristics of neutrophilic (suppurative) cholangitis?

A

Neutrophilic infiltrate in bile duct lumen and walls
Oedema and neutrophils in periportal areas
Biliary duct hyperplasia
+/- cholecystitis
If chronic - mixed periportal inflammatory infiltrate

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19
Q

What is the clinical presentation of a cat with neutrophilic (suppurative) cholangitis?

A 
Acute
Middle aged cats more common 
Sepsis
Lethargy
Pyrexia
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20
Q

Why is chronic neutrophilic cholangitis and lymphocytic cholangitis in cats hard to diagnose?

A

They present clinically identical

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21
Q

What diagnostic results will you get from a cat with neutrophilic cholangitis?

A

High ALT, total bilirubin, neutrophilia with left shift - Not sensitive or specific but
Ultrasound not sensitive or specific, may appear normal or not
Cytology reveal neutrophilic infiltrates - liver parenchyma may have minimal change and pathology confined to biliary tract
Cytology and MC&S of bile - but can get leakage if sampling percutaneously

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22
Q

How do you treat a cat with neutrophilic cholangitis?

A

Antibiotics based on MC&S results for 4-6 Weeks
While waiting for results can start straight away with amoxycillin
IV fluids
Nutritional support +/- tube feeding
Ursodeoxycholic acid
Antiemetics
Analgesia

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23
Q

What are the characteristics of feline lymphocytic (non-suppurative) cholangitis?

A

Slowly progressive
Infiltration of hepatic portal areas with small lymphocytes
May have biliary hyperplasia and peribiliary fibrosis
or atrophy of biliary ducts
Unknown aetiology

24
Q

What are the two main DDX’s of biliary hyperplasia and peribiliary fibrosis or atrophy of biliary ducts?

A

Lymphocytic cholangitis

Hepatic lymphoma

25
Q

What are the clinical features of feline lymphocytic cholangitis?

A 
Any age
Long history of waxing and waning low grade illness - weight loss, anorexia, lethargy 
Icterus common 
Less commonly pyrexic 
Occasionally ascites
26
Q

How do you diagnose a cat with lymphocytic cholangitis?

A

Ultrasound and pathology support diagnosis but aren’t sensitive or specific
Increased gamma globulins
Increased coagulation times - test for before biopsy, give vit K
Definitive diagnosis by histopathology - sample multiple lobes

27
Q

What two findings of lymphocytic cholangitis can lead to a DDx of FIP?

A

Ascites

Increased gamma globulins

28
Q

How do you treat feline lymphocytic cholangitis?

A

There is uncertain aetiology which means there is a variety of options
Antibiotic therapy until infectious agent ruled out
Ursodeoxycholic acid
Antioxidants
Nutritional support
Acute flare ups - Glucocorticids, maybe hospitilisation and fluids
Will usually persist chronically despite treatment

29
Q

Is chronic feline lymphocytic cholangitis fatal?

A

Not usually

Doesn’t progress to cirrhosis

30
Q

What are the characteristics of feline sclerosing cholangitis?

A

End stage fibrotic liver
More likely from complete biliary obstruction or liver fluke, compared to lymphocytic cholangitis
Typical signs of chronic biliary disease plus those from portal hypertension - ascites, GI ulceration, acquired shunts, hepatic encephalopathy

31
Q

How do you diagnose sclerosing cholangitis?

A

Hepatic biopsy

32
Q

How do you treat sclerosing cholangitis?

A

Supportive therapy only

33
Q

Are liver flukes in cats in Australia common?

A

They are exotic to Australia

34
Q

When do you commonly get cholecystitis in combination with?

A

Neutrophilic cholangitis

35
Q

What are the characteristics of feline biliary cysts?

A

Multiple congenital cysts
Usually part of systemic polycycstic disease
Can be incidental finding
May cause biliary obstruction if large
Can be secondary (acquired) to trauma, inflammation, neoplasia

36
Q

What is the aetiology of feline extrahepatic bile duct obstruction?

A

Most common cause is inflammation of the pancreas, duodenum, biliary tree - all or one
Second most common is neoplasia
May be due to intraluminal or extraluminal lesions
Less common causes - stricture, sphincter dysfunction, cholelithiasis, cysts, flukes

37
Q

What are the clinical features of feline extrahepatic bile duct obstruction?

A 
Icterus
Anorexia
Depression
Vomiting
Hepatomegaly 
Malabsorption of fats and fat-soluble vitamins - coagulopathy
38
Q

What are the diagnostic findings and diagnosis of feline extrahepatic bile duct obstruction?

A

Coagulopathy
Increased liver enzymes, bilirubin, cholesterol - non-specific
Ultrasound shows biliary distension and free fluid (bile leakage)
Do Not do biliary FNA - increased pressure may cause leakage
Exploratory laparotomy

39
Q

How do you treat a cat with extrahepatic bile duct obstruction?

A

Partial obstruction - medical management by using choleretic and antioxidant
Complete obstruction - Surgery - Has high morbidity and mortality, prognosis is poor

40
Q

What is the characteristics and clinical signs of feline hepatic amyloidosis?

A

Liver becomes large, rigid and easily damaged
Amyloid A is associated with inflammation so look for source of chronic inflammation
Present with haemoabdomen from hepatic rupture after low grade trauma
Anaemia
Hypotension

41
Q

What is the prognosis for feline hepatic amyloidosis?

A

Long term poor prognosis - Intra-abdominal bleeding

42
Q

What diagnostic results will you see in a cat with hepatic amyloidosis?

A

Mild to marked increases in ALT and globulin
Rarely increased ALP and GGT
Ultrasound shows no biliary distension
FNA is not helpful detecting amyloid
Need to do liver histopathology for diagnosis

43
Q

How do you treat a cat with hepatic amyloidosis?

A 
Supportive only 
Eliminate or reduce the underlying inflammatory disorder which is causing the amyloid disposition 
Antioxidants
Vitamin K 
Blood transfusion may be needed
44
Q

What are 3 DDx’s for feline hepatic amyloidosis?

A

FIP
Hepatic lipidosis
Lymphoma

45
Q

Are benign or malignant hepatic tumours more common in cats?

A

Benign tumours more common

46
Q

Are primary liver tumours in cats common or uncommon?

A

Uncommon in cats

47
Q

What is the most common feline hepatic maglignant tumour? (Primary)

A

Biliary carcinoma

Is also more common than metastatic

48
Q

What is the most common secondary hepatic tumour in cats?

A

Haemopoietic

49
Q

What age group of cats are most likely to get primary malignant hepatic neoplasia?

A

Older cats

Signs are common to other hepatobiliary diseases

50
Q

What biochemistry results will you commonly see in hepatic neoplasia in cats?

A

High liver enzymes
Mild anaemia and neutrophilia - non-specific
Occasionally hyperbilirubinaemia
Otherwise liver function is normal unless diffusely affected

51
Q

How do you diagnose a hepatic neoplasia in a cat?

A

FNA cytology or biopsy - need to not only diagnose neoplasia, but what kind
Other cumulative tests - biochemistry, ultrasound may show changes in texture, irregularities, metastases and other organ involvement

52
Q

What are most cases of portosystemic shunts in cats caused by?

A

Usually congenital

Cats don’t usually get hepatic fibrosis or cirrhosis

53
Q

What are the clinical signs of a cat with a congenital portosystemic shunt?

A 
Signs are a result of shunting portal blood flow - 
Hepatic encephalopathy
Hepatic atrophy and insufficiency
\+/- infection and pyrexia
Hypersalivation
Poor growth and weight loss
Intermittent vomiting/diarrhoea
Urate urolithiasis and/or PUPD
Copper coloured irises
Do NOT get ascites
54
Q

How do you diagnose a cat with a congenital PSS?

A 
Low urea
Microcytosis
Mildly increased liver enzymes
Less common - hypoalbuminaemia or hypoglycaemia
Post prandial serum ammonia levels
Serum bile acids
Ultrasound/CT to identify shunting vessel
Liver biopsy at surgery
55
Q

Why are cats sensitive to toxins?

A

Because they have limited hepatic glucuronide transferase activity

56
Q

How can you treat paracetamol toxicity in cats?

A

With N-acetylcysteine

57
Q

What are some causes of hepatic infections in cats?

A

Neutrophilic cholangitis
FIP
Disseminated toxoplasmosis involving the liver
Other systemic infections

A - Medicine Liver (3 decks)

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