Necroinflammatory Disease (Rudinsky February 10th - Continued Online If Needed)

Question 1

• Heterogeneous group
• Chronic inflammation and necrosis
• Progresses to cirrhosis (irreversible)
• Cause usually unknown
  - EXCEPT copper toxicity; chronic phenobarb

Answer 1

Canine Chronic Hepatitis

Question 2

(T/F) Chronic hepatitis is more common in cats than in dogs

Answer 2

False, it is more common in dogs and tends to be fibrotic
- Cats tend to get a more cholestatic disease, and their hepatitis doesn’t tend to be fibrotic

Question 3

Definition:
- Fibrosis
- Regenerative nodules
- Loss of architecture
- Irreversible

Answer 3

Hepatic Cirrhosis

Question 4

List Causes for Canine Chronic Hepatitis:

Answer 4

• Infectious
• Familial
  
  • Copper
• Drugs and toxins
• Autoimmune
• Idiopathic

Question 5

List the Therapy Goals for Chronic Hepatitis:

Answer 5

• Decrease inflammation
  
  • Corticosteroids
  • Azathioprine (immunosuppressive medication)
• Reduce hepatic copper
  
  • Penicillamine; zinc
  • diet
  • depends on who is being treated
• Prevent oxidant injury (Vit E; SAMe)
• Promote choleresis (Ursodiol)

Question 6

What stain is used for copper granules?

Answer 6

Rhodanine Stain

Question 7

• Essential trace element
• Required for normal metabolism
• Toxic in high amounts (oxidative stress)
• Metabolism
  
  • Dietary intake
  • Intestinal absorption
  • Hepatic storage
  • Biliary secretion

Answer 7

Copper Metabolism

Question 8

List the most common breeds with increased Hepatic Cu:

Answer 8

• Bedlington terrier
• Doberman
• WHWT
• Skye terrier
• Dalmatian
• Labrador retriever

Question 9

(T/F) Serum copper tests are helpful

Answer 9

False, Serum copper tests are not helpful

Question 10

How do we treat Copper Accumulation?

Answer 10

• Low copper diet
• Penicillamine
  
  • Copper chelator
  • Pulls copper from body/ a lot of side effects
• Zinc
  
  • Decreased Cu absorption
  • Safer but less effective
• Vitamin E
  
  • Anti-oxidant

Question 11

List the complications of liver disease:

Answer 11

• Coagulopathy
• Anemia
• Ncephalopathy
• Intestinal and gastric ulcers
• Ndotoxemia and infection
• Effusion
  Remember CANINE

Question 12

Ascites and Edema
List the management strategies:

Answer 12

• Sodium restriction
  - Dietary, fluid therapy
• Diuretics
  
  • Furosemide
  • Spironolactone
• Colloids
  
  • Hetastarch
• Abdominocentesis

Question 13

What is the most common organ damaged by toxins?

Answer 13

Liver

Question 14

What drains the intestinal tract and flows directly to the liver?

Answer 14

Portal vein

Question 15

(T/F) Liver exposed to all ingested substances that are absorbed into the portal blood

Answer 15

True

Question 16

What organ is central to the metabolism of virtually every foreign substance?

Answer 16

Liver

Question 17

Definition:
Liver dysfunction occurring in the absence of known pre-existing liver disease

Answer 17

Acute liver disease

Question 18

Definition:
Liver dysfunction occurring in the absence of known pre-existing liver disease plus hepatic encephalopathy and coagulopathy

Answer 18

Acute liver failure

Question 19

What are the potential causes of Acute Liver Injury?

Answer 19

• Drugs or toxins
• Infectious agents
• Systemic or metabolic disorders
• Traumatic thermal, hypoxic injury

Question 20

• Dose-related
• Short latent period
• One or more species
• Affects all individuals
• Reproducible experimentally
• Parent drug or reliably generated toxic metabolite

Answer 20

Predictable Hepatotoxin

Question 21

Predictable Hepatotoxin
Historical = carbon tetrachloride phosphorus chloroform

Answer 21

Acetaminophen

Question 22

• Therapeutic doses
• Variable latency
• Infrequent
• Hard to detect on pre-market screening
• Must discontinue the drug

Answer 22

Idiosyncratic Hepatotoxin

Question 23

When to suspect drug-induced liver disease?

Answer 23

• Asymptomatic liver enzyme elevations
• Acute hepatic injury
• Chronic hepatic disease
• EVERY patient with liver disease