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

Liver diseases of the dog Flashcards

1
Q

In dogs what does chronic parenchymal disease typically progress to?

A

Fibrosis and cirrhosis

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2
Q

Is primary biliary disease rare or common in dogs?

A

Rare

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3
Q

What is a common sequele to chronic liver disease in dogs?

A

Portal hypertension

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4
Q

Is chronic or acute hepatitis more common in dogs?

A

Chronic

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5
Q

Why is chronic hepatitis often not diagnosed until late stage?

A

Because it rarely causes icterus
Ends up manifesting as hepatic insufficiency in the end
Frequently associated with portal hypertension

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6
Q

What 3 defining features characterise chronic hepatitis in dogs histologically?

A

Hepatocellular apoptosis or necrosis
Variable mononuclear or mixed inflammatory cell infiltrate
Regeneration and fibrosis

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7
Q

Name some dog breeds that are predisposed to chronic hepatitis?

A 
Spaniels
Terriers
Dalmatian
Doberman
Great Dane
Labrador
Saomyed
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8
Q

What age group of dogs is overrepresented in chronic hepatitis?

A

Young to middle aged

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9
Q

What is the most common cause of chronic hepatitis in dogs?

A

Usually idiopathic

- maybe unidentified infectious agent, toxin, immune mediated

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10
Q

Although uncommon in dogs with chronic hepatitis, what 3 specific processes may contribute to icterus?

A

Hepatocyte swelling
Fibrosis
Portal hypertension

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11
Q

In dogs with chronic hepatitis what is the main reason for the resulting portal hypertension?

A

Inflammation and fibrosis which obstructs and disrupts the sinusoids

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12
Q

As a result of portal hypertension, what 3 other things does this then predispose the dog to?

A

Ascites
Chronic - acquired intrahepatic portosystemic shunts (PSS)
Splanchnic congestion

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13
Q

If splanchnic congestion as a result of portal hypertension isn’t relieved by acquired PSS, what can then happen?

A

Gastric mucosal hypoperfusion and hypoxia

Results in GI bleeding

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14
Q

What are the 9 clinical signs to look for in a dog with chronic hepatitis?

A 
Vomiting and diarrhoea
Anorexia
Polyuria/polydipsia
Weight loss 
Ascites
Icterus sometimes
Hepatic encephalopathy in end-stage
Coagulopathy
GI bleeding
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15
Q

How do you definitively diagnose chronic hepatitis in dogs?

A

Liver biopsy

Although remember to do a coagulation test first!

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16
Q

In a dog with chronic hepatitis what is the most commonly elevated enzyme?

A

ALT
Although other enzymes may be elevated
But if cirrhotic may produce overall minimal enzymes

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17
Q

In late stage chronic hepatitis in dogs, when the functional mass is being destroyed what 4 functional indicators become abnormal? (Not enzymes)

A 
Low urea
Low albumin
Possibly -
Increased bilirubin
Increased SBA's
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18
Q

What are the 3 goals of treatment for a dog with chronic hepatitis?

A

Find and address underlying cause
Slow disease progression
Support liver function

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19
Q

In a dog with chronic hepatitis what should you do to its protein intake?

A

Give it a high quality highly digestible protein
Reduces hepatic work and ammonia production
Don’t restrict dietary protein

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20
Q

What drug has an antifibrotic effect?

A

Colchicine

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21
Q

What drug class should you give to a dog with confirmed chronic hepatitis for anti-inflammatory and anti-fibrotic properties?

A

Glucocorticoids

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22
Q

What are the 5 contraindications for administration of glucocorticoids in a dog with chronic hepatitis?

A 
Portal hypertension
Non-inflammatory fibrosis
Infection
Hepatic encephaolopathy 
GI ulceration
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23
Q

What breed gets true copper storage disease and why?

A

Bedlington terriers
Genetic defect in copper storage and transport
Accumulates in perivenous hepatocytes

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24
Q

What causes secondary copper storage disease?

A

Any chronic hepatitis with cholestasis

Usually mild and accumulates in peribiliary area

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25
Q

Apart from true copper storage and secondary copper storage disease, what is the 3rd type of copper storage disease?

A

Copper toxicosis

Fed a high copper diet

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26
Q

How do you definitively diagnose a copper storage disease?

A

Biopsy with copper staining and/or genetic testing of Bedlington Terriers

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27
Q

What can the clinical pathology and imaging of idiopathic chronic hepatitis also look like?

A

Copper storage disease

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28
Q

What are 4 key management points for copper storage disease?

A

Intensive support for acute hepatic crisis
Copper chelation
Feed low copper, high zinc diet
Liver support and medication similar to chronic hepatitis

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29
Q

What are 2 infectious cause that rarely, but may cause canine chronic hepatitis?

A

Atypical leptospirosis

Sporadically Borartonella

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30
Q

What are the 5 infectious causes of canine acute hepatitis?

A 
Canine adenovirus 1
Canine herpesvirus
Leptospira interrogans
Endotoxaemia
Yersinia
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31
Q

What are the 2 toxic causes of canine acute hepatitis?

A

Aflatoxins and blue-green algae
Drugs
-Paracetamol, phenobarbitone, carprofen, sulfonamides, lomustine

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32
Q

Other than infectious and toxic causes of canine acute hepatitis, what are 3 other causes?

A

Heat stroke
Copper storage disease
Mercury poisoning

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33
Q

What are the 9 clinical signs you should look for in a dog with acute hepatitis?

A 
Anorexia
Vomiting
Polydipsia
Hepatic encephalopathy 
Icterus
Coagulopathy
Pyrexia
Pain
DIC
34
Q

What are 4 characteristic clinical pathological findings for canine acute hepatitis?

A

Increase in liver enzymes
Hyperbilirubinaemia
Hypoglycaemia
Coagulopathy

35
Q

What 3 things are usually used to diagnose a dog with acute hepatitis?

A

History
Clinical signs
Clinical pathology findings

-Usually can’t biopsy because it is severe and acute disease

36
Q

What is the most common congenital portovascular anomaly in dogs?

A

Congenital portosystemic shunt

37
Q

What is the portal pressure like in a dog with a congenital portosystemic shunt?

A

It has low portal pressure unless there are additional anomalies

38
Q

What are the 7 main clinical signs of a dog with a congenital portosystemic shunt?

A

Poor growth and body condition
Neurological signs
PU/PD
Ammonium biurate crystalluria and LUT signs
Renomegaly
Other congenital defects like cryptorchidism
Anaesthetic intolerance

39
Q

Post prandially, a dog with a congenital portosystemic shunt will have a high what?

A

High serum bile acids

40
Q

What is the treatment of choice for a dog with congenital portosystemic shunt?

A

Surgical ligation of anomalous vessel - referral

41
Q

How does a dog with a portovascular disorder with portal hypertension usually present?

A

Has typical signs of a portosystemic shunt
But also ascites
Can only systematically treat but do NOT give glucocorticoids

42
Q

What 3 things do a dog with cholangitis and cholecystitis typically present with?

A 
Acute onset of-
Anorexia
Vomiting
Icterus
\+/- Pyrexia
43
Q

Diagnostically what should you do to a dog with suspected cholangitis/cholecystitis?

A

Clinical pathology and ultrasound that supports a post-hepatic icterus
Obtain liver and/or gall bladder histopathology sample and bile cultureq

44
Q

How will the gallbladder appear on ultrasound in a dog with a gall bladder mucocoele?

A

Stellate appearance

45
Q

What are the two treatment options for a dog with a gall bladder mucocoele?

A

Surgical - cholecystectomy +/- biliary diversion

Medical management - low fat diet, antioxidant and choleretic

46
Q

What is the most common cause of extrahepatic bile duct obstruction in the dog?

A

Acute-on-chronic pancreatitis

47
Q

What are the 6 causes of extrahepatic bile duct obstruction in the dog?

A 
Acute-on-chronic pancreatitis
Neoplasia
Inflammation and stricture
Cholelithiasis
Diaphragmatic hernia
Intestinal foreign body at level of bile papilla
48
Q

What will you see on ultrasound of a dog with extrahepatic bile duct obstruction?

A

Dilated tortuous bile ducts

Gall bladder distension

49
Q

What do you need to be aware of in a dog when diagnosing it with a suspected extrahepatic bile duct obstruction via ultrasound?

A

That gall bladder distension alone can occur if the dog has been fasting

50
Q

What does chronic, complete obstruction of the common bile duct in dogs result in? (3 things)

A

Acholic faeces
Vitamin-K responsive coagulopathy
Lack of urobilinogen in faeces

51
Q

What can incomplete obstruction of the common bile duct in dogs also present as?

A

Other types of biliary disorders -unspecific

52
Q

What are the 2 most common causes of bile peritonitis in the dog?

A

Trauma

Pathological rupture of a diseased gall bladder

53
Q

What are the 6 signs of bile peritonitis in the dog?

A 
Initially non-specific signs
Acute abdomen (pain)
Icterus
Pyrexia
Vomiting
Anorexia
Abdominal effusion
54
Q

What is the effusion from a bile peritonitis usually contain?

A

Bile pigment
Initially non-septic inflammation
Later cell necrosis and increased intestinal permeability causes septic peritonitis

55
Q

What is the treatment of bile peritonitis in the dog?

A

Surgical with aggressive supportive treatment

56
Q

What should you do about nodular hyperplasia in the dog?

A

Nothing. It is a benign condition of older dogs with no clinical signs

57
Q

What 2 diseases can nodular hyperplasia be misdiagnosed as?

A

Cirrhosis

Neoplasia

58
Q

What clinical pathology signs will you see in a dog with nodular hyperplasia?

A

Moderate to high elevation of ALP

But no evidence of liver dysfunction

59
Q

How do you definitively diagnose canine nodular hyperplasia?

A

Wedge biopsy

With a FNA you can’t differentiate from hepatocellular adenoma or carcinoma

60
Q

What hepatic neoplasia type is more common in dogs, Primary or metastatic?

A

Metastatic

61
Q

Are malignant or benign hepatic neoplasia more common in dogs?

A

Malignant

62
Q

Why can diagnosing canine hepatic neoplasia be difficult?

A

Because clinical signs are non-specific
On imaging it can be diffuse or nodular
Clinical pathology results can be normal or reflect hepatocellular damage and cholestasis

63
Q

What type of canine hepatic neoplasia carries the best prognosis usually?

A

A massive hepatocellular carcinoma

Has a low metastatic rate and usually surgical resection of affected lobe gives a low recurrence rate

64
Q

Why do many primary canine hepatic neoplasias carry a poor prognosis?

A

Poor response to chemotherapy
Can’t do radiation
Metastasise earlier and difficult to surgically resect all of the affected area

65
Q

What does the prognosis of a secondary canine hepatic tumour depend on?

A

What the primary tumour is

E.g. if lymphoma generally responds well to chemo

66
Q

What do canine hepatic abscesses usually result from?

A

Embolism from an infected site

Generally pretty rare

67
Q

What 2 things predispose a dog to contracting a hepatic abscess?

A

Endocrine disorder

Immunosuppression

68
Q

Are gram negative or positive organisms more common in a canine hepatic abscess?

A

Gram negative

69
Q

What 7 things will a dog with a hepatic abscess present with clinically?

A 
Anorexia
Lethargy
Vomiting
Fever
Dehydration
Abdominal pain
Predisposing factors
70
Q

What 5 things contribute to a diagnosis of a canine hepatic abscess?

A

Neutrophilic leukocytosis with left shift
High serum ALT and ALP
Imaging may reveal mass and emphysema
FNA mass to differentiate from other lesions
Ideally MC&S from deep in lesion

71
Q

What are the 5 steps for treating a dog with a hepatic abscess?

A

Surgical removal of affected tissue
Antibiotics based on the MC&S
Supportive care for sepsis
Address underlying problem

72
Q

What changes contribute to the pathophysiology of canine dermatological conditions associated with liver disease?

A 
Probably multifactorial 
Low circulating amino acid concentration
\+/- zinc deficiency
\+/- fatty acid deficencies
decreased plasma amino acid concentrations
73
Q

In dogs with dermatological conditions associated with liver disease, what and where are the typical skin lesions?

A 
Erythema
Crusting 
Hyperkeratosis 
Affects - 
Footpads
Nose
Periorbital
Perianal
Genital areas
Limb pressure points
Painful
74
Q

How do you diagnose a dog with a dermatological condition that is associated with liver disease?

A

A skin biopsy
There are nonspecific clinical pathological changes consistent with liver problems
On ultrasound the liver appears like ‘swiss cheese’

75
Q

What is the management and prognosis of a dog with a dermatological condition that is associated with liver disease?

A

Usually live under 6 months
Poor prognosis unless underlying cause is found and treated
Treat symptomatically and supportively
Amino acid and protein supplementation
Antibiotics for secondary skin infections
Do NOT give glucocorticoids - predispose to diabetes mellitus

76
Q

Are primary or secondary hepatic changes more common in dogs?

A

Secondary

77
Q

In a canine secondary hepatopathy, what are the liver enzymes and liver function typically like?

A

Liver enzymes mild to moderately elevated

No compromise to liver function

78
Q

Why do you need to do a complete work up of a dog you suspect with a secondary hepatopathy?

A

Exclude primary liver disease

Determine the underlying extra-hepatic disorder

79
Q

What 2 secondary hepatic disorders of dogs is most common if hepatic vaculolation exists?

A

Endocrine disease

Certain drugs

80
Q

What 2 secondary hepatic disorders are most commin if hepatic congestion and oedema exists?

A

Right sided congestive heart failure

Other causes of post-hepatic venous congestion

A - Medicine Liver (3 decks)

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