Liver-Gutten Flashcards
What is the connection of the biliary tree and the liver?
Hepatocytes cannaliculi
Indicators of liver function according to Guttin
ABC G BA Albumin BUN Cholesterol Glucose Bile Acids
Function of liver that can lead to DAMAGE:
– Drugs/toxins/hormones: activation/deactivation, clearance
– Bile: synthesis and recycling
– Immune system- Kupffer cells (macrophages)
How does bile acid build up damage the liver?
It becomes hepatotoxic.
Liver function we can see on bloodwork (Guttin)
Metabolism (carb/fat/protein)
Synthesis of coagulation factors, bile, alb, glu, urea, chol
Storage: vitamins, minerals, iron
Why is it important to catch patients in the subclinical phase of disease?
Because by the time patients show signs, their liver function has been decreased by 75-80%!!! This is due to the vicious cycle of inflammation/necrosis she talked about so it’s important to catch the problem before the sequelae of inflammation.
Sequelae for liver inflammation (3 things)
1) insult causing immune response and damaged bile ducts
2) chronic cholestasis/inflammation and toxic bile acids because they build up and remember they’re toxic to the liver
3) all of this leads to fibrosis–>cirrhosis–>liver failure
What is pu/pd an indicator of as we consider liver issues?
decreased BUN. remember urea is needed for medullary gradient and without it you have medullary washout
Enzyme patterns—why are they sooooo important?
They give clues especially when considering Infectious causes of liver dz. Guttin also said that when you see an increase, it’s important to consider how much of an increase there is. Remember her AST/ALT example….
Blood work—things to look for to suggest hepatocellular/leakage:
AST
ALT
Blood work—things to look for to suggest CHOLESTATIC//INDUCIBLE
ALP
GGT
Blood work—things to look for to suggest liver function according to GUTTIN
- Tbili • BUN • Glu • Alb
* Chol (She mentioned coagulation factors on another slide in addition to the rest)
U/A—things to look out for
Bilirubin in cats
Remember a bit in dogs is normal
Ammonium biurates
You can start as gall bladder dz and progress into liver dz T/F
T
You can start as liver dz and progress into gall bladder dz T/F
T
Which one is worse? INTRA or EXTRAhepatic shunts?
extra
Which one intra/extra is found in large breeds?
intra
What will hemogram look like with congenital PSS?
microcytic/hypochromic
Acquired PSS is generally secondary to what?
1) portal v hypertension (the hypertension leads to little vessels that bypass the liver or it could be some embryologic remnant that gets opened up by the pressure)
2) fibrosis to cirrhosis
3) inflammation
Portal v hypertension is usually a consequence of:
1) liver cirrhosis
2) thrombus
3) right sided heart failure
U/A is important for kidney AND…??
liver dz
Clinical signs for acquired PSS will be different as acquired PSS T/F
F
The number 1 clinical sign for liver disease is 1) GI related 2) pu/pd 3) neuro pick one
neuro—hepatic encephalopathy (ataxia/seizures maybe)
localized to the forebrain
TWO Unique clinical signs seen especially in cats
ptyalism and copper irises (NAVLE question!!)
What’s the deal with ptyalism?
Guttin said that usually 1-2 hrs post prandial you’ll notice ptyalism as the liver is trying to break down protein and the bacteria turn it into ammonia and all that ammonia isn’t cleared away properly and goes to the brain…
Which test is highly sensitive for SHUNTS?
Bile Acid Test!
Normal Bile Acid Test means…
patient most likely doesn’t have a shunt!
The MOST SPECIFIC AND SENSITIVE LIVER FUNCTION TEST???
Bile Acid Test!
C-BAG or ABC G is more general. (GUTTIN)
For bile acid test, what’s considered abnormal, pre or post?
either one that’s elevated
Is an increase in BA (bile acids) specific to shunts?
NO! any liver dz can cause increase in BA
***How do we interpret Total bilirubin that’s greater than 1.5 mg/dl as it pertains to BA and liver function?
Guttin said that at this point, BA is not a valid way to determine liver function as lots of bilirubin is usually due to blocked common duct. So some obstruction that can’t be differentiated from defect in liver function with BA test. If the patient is icteric, do NOT do a BA test.
NON invasive way to see what’s going on with the liver as far as shunts and portal vein hypoplasia…
Ammonia blood test but remember it’s finicky. You have to run it within a certain time period otherwise you’re going to get a false negative! (Clin path/Guttin)
High ammonia level means?
Liver dysfunction
Normal ammonia level?
Liver dysfunction could still be present
Is ammonia the only neurotoxic thing we can measure that contributes to the neuro signs?
YEs. remember there are other neuro toxic thing due to liver being unable to take care of them the way it should
Liver inflammatory diagnosis is done via…?
BIOPSY but try to rule out other issues as biopsy is incredibly invasive.
Liver condition commonly seen in Labs and Bedlington Terriers
Copper hepatopathy
Cats can have either hepa or chole pattern T/F
T
What’s important to do BEFORE biopsy??
Coagulation test!
Perform FNA when what two conditions are on the top of your differential list?
Hepatic lipidosis
Round Cell Neoplasia
Toxins in the liver…acute signs or chronic?
ACUTE and Sick as ever. Will still have a snowball effect so try to stop the inflammation ASAP.
What’s the best diagnostic test for toxin associated liver issue?
History!
