Liver Dz Part 1 & 2

Question 1

Which Acinar zone is MOST susceptible to toxic/ hypoxic damage?

Answer 1

Zone 3

Question 2

Do horses have a gallbladder?

Answer 2

NO, which is why there is no need to perform PRE or POST prandial sampling for bile acid analysis

Nor do they have a sphincter….. so the bile is unconcetrated and continuously flows

Question 3

What are the C.S.’s of Liver failure?

Answer 3

• Unspecific signs*
  1. Wt loss
  2. Colic
  3. Abdominal distention
  4. Diarrhea
  5. Tenesmus —> Retal prolapse
  6. Spontaneous bleeding, petechiation
  7. (Foals) Fecal color changes
  8. (Ponies) Inspiratory stertor

Question 4

What organ has the highest capacity of PHAGOCYTES in the entire body?

Answer 4

The Liver

Question 5

T/F: The Portal vein brings both Nutrients and oxygenated blood

Answer 5

False, the blood is NOT oxygenated but it does bring nutrients

Question 6

What artery brings Oxygentated blood to the Liver?

Answer 6

Hepatic Artery

Question 7

What % of the entire body weight does the liver make up?

Answer 7

1% —> Its one of the largest organs

Question 8

Which zone of the Acinar is most metabolic?

Answer 8

Zone 1

Question 9

What are the 4 MAIN functions of the liver? What two other systems does it function w/?

Answer 9

1. Metabolic
2. Storage
3. Excretory/ Detoxification
4. Secretory

• Innate Immune fx
• Digestive fx

Question 10

The liver maintains a LOW or HIGH serum level of aromatic amino acids?

Answer 10

Low

They are Tryptophan, tyrosin, phenylalanine

Question 11

What % of plasma proteins does the liver sythesize?

What are the 2 important ones?

Answer 11

90%

Albumin & coagulation factors/fibrinolysis

Question 12

Ammonia detoxification occurs in what organ?

Answer 12

Liver

Question 13

T/F: Unconjugated bilirubin is excreted into the bile

Answer 13

False, CONJUGATED bilirubin

Question 14

Bile acids are completely cleared from the body in how many circulations?

Answer 14

1

Question 15

How well is Bilirubin cleared from the body?

Answer 15

Ineffective clearance and recirculation

Question 16

If your patient has an INCREASED conjugated bilirubin, will you test the bile acids?

Answer 16

No, bile acids always INCREASE 1st….. so if conjugated bilirubin is increased…… bile acids are def. INCREASED

Don’t waste your client’s money!

Question 17

How often does the liver repair itself?

& fibrosis “bridging” b/w lobules impairs what fx?

Answer 17

Constantly

Impairs regeneration, also…. lack of portal blood supply will REDUCE regeneration

Question 18

What % of damage must occur to the liver before you will see abnormal fx or failure?

Answer 18

70-80%

Question 19

T/F: Liver Dz is common in Horses

Answer 19

TRUE

Question 20

C.S.’s of liver Dz

Answer 20

UNSPECIFIC

1. Wt loss
2. Anorexia
3. Depressed mentation
4. Colic

Question 21

Most common cause of wt loss in horses? & what are 3 reasons for this?

Answer 21

Lack of nutrients

• nutrition
• dental issues
• Parasites

Question 22

What is Colic?

Is this a Dx or a syndrome?

Answer 22

Visceral abdominal pain

Syndrome

Question 23

At what stage of liver failure would you see abdominal distention/ Ascities?

Answer 23

SEVERE

Question 24

What is the pathophysiology of ascites?

Answer 24

Portal hypertension & lymph leakage

Question 25

Pitting edema can be seen d/t?

Answer 25

SEVERE HYPOalbuminemia

Question 26

What C.S can result in a rectal prolapse?

Answer 26

Tenesmus (unknown pathophys.)

Question 27

Liver failure causes fecal color changes in the Equine adult or foal? Will the poop look darker or lighter? What causes the color change?

Answer 27

FOAL Lighter color A lack of bilirubin (Cholestasis) —> Lack of stercobilirubin

Question 28

Inspiratory stertor/dyspnea d/t Liver failure is seen in? Older horses Adults Ponies Foals

Answer 28

Ponies —> results in Pharyneal or Laryngeal collapse

Question 29

Spontaneous bleeding / Petechiation is seen w/ what stage of liver dz?

Answer 29

Advanced

Question 30

Icterus/ Jaundice is?

Answer 30

Yellow discoloration of: 1. Mucous membranes 2. Sclera

Question 31

What causes a more pronounced icterus? Increased production of bilirubin OR decreased excretion of bilirubin

Answer 31

Decreased excretion of bilirubin

Question 32

What is a Neuropsychiatric syndrome caused by hepatic dysfunction or portosystemic shunt?

Answer 32

Hepatic Encephalopathy

Question 33

INCREASED levels of AMMONIA can cause swelling of what cells?

Answer 33

Astrocytes (suspected)

Question 34

Process of Photosensitization d/t plant origin. | Which Hypersensitivity rx is this?

Answer 34

Chlorophyll —> phylloerythrin (Liver fails to excrete) Type 3

Question 35

Photosensitization d/t primary photodynamic agent entering skin by ingestion is classified as Type ___? I II III

Answer 35

Type 1

Question 36

Hepatogenous secondary to Photosensitization is which type? I II III

Answer 36

Type 3

Question 37

Which type of Photosensitization is not seen in horses? What is it d/t?

Answer 37

Type 2 - accumulation of endogenous photodynamic agents

Question 38

If Liver Dz is suspected, what ancillary tests would you want to perform? (4 tests)

Answer 38

1. Blood analysis 2. Transabdominal US 3. Abdominocentesis 4. Liver bx - Histopath. / bacteriology

Question 39

T/F: You need to fast your Equine patient before running a Bile Acid test

Answer 39

FALSE - b/c horses have NO GALLBLADDER