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E&E > SA Chronic Hepatobiliary Disease (DeMonaco) > Flashcards

SA Chronic Hepatobiliary Disease (DeMonaco) Flashcards

1
Q

Canine hepatobiliary disease

Chronic Idiopathic Hepatitis definition

A

Insult to liver that initiates immune-mediated inflammation (pathogen, drug, vaccine, toxin, change in intestinal microbiome)

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2
Q

Canine hepatobiliary disease

Chronic idiopathic hepatitis bloodwork

A
  • elevated ALT
  • elevated ALP
  • +/- decreased albumin
  • hyperbilirubinemia

ALT = hepatocyte leakage/injury enzyme

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3
Q

Canine hepatobiliary disease

How is chronic idiopathic hepatitis diagnosed?

A

Biopsy

changes seen on AUS are non-specific and suppportive evidence only

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4
Q

Canine hepatobiliary disease

Copper Hepatopathy definition

A

dysfunction in copper metabolism -> copper accumualtes abnormally in liver -> reactive oxygen species

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5
Q

Canine hepatobiliary disease

What breeds are common in chronic idiopathic hepatitis?

A

Labradors, doberman pinschers, cocker spaniels

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6
Q

Canine hepatobiliary disease

What breeds are common in copper hepatopathy

A

Terriers, labradors, westies, dobermans, dalmatians

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7
Q

Canine hepatobiliary disease

Where are 1º versus 2º copper hepatopathy lesions?

A

1º: Centrilobular portions
2º: Periportal

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8
Q

Canine hepatobiliary disease

Cirrhosis definition

A

Chronic hepatic inflamamtion -> end-stage condition
- marked bridging fibrosis, nodular regeneration, distortion of hepatic architecture (“grapes” appearance)
- portal hypertension

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9
Q

Canine hepatobiliary disease

Dogs versus cats hepatic neoplasia

A

Dogs: usually metastatic (from spleen, pancreas, GI)
Cats: usually primary hepatobilliary neoplasia

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10
Q

Canine hepatobiliary disease

Most common hepatic neoplasia in dogs

A

1. Hepatocellular carcinoma
- malignant liver tumor
- good prognosis (if caught before metastasis)

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11
Q

Canine hepatobiliary disease

Steroid Hepatopathy: definition and sequela

A
  • elevated hepatic enzymes, especially cALP
  • hepatomegaly
  • acumulation of glycogen in hepatocytes -> vacuolar hepatopathy

Recall: dogs have cALP enzyme!

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12
Q

Canine hepatobiliary disease

Nodular Hyperplasia

definition and characteristics

A

Old age-related change in dogs
- benign, asymptomatic
- mild-marked increased ALP
- no tx required

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13
Q

Canine hepatobiliary disease

How to prep for a liver biopsy

A

Assess BMBT, CBC (platelets), PT/PTT (clotting times)

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14
Q

Canine hepatobiliary disease

Tru-Cut biopsy
- advantages
- disadvantages

A

Advantages
- least invasive

Disadvantages
- cannot visualize liver lobes
- can’t immediately contorl post-biopsy hemorrhage

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15
Q

Canine hepatobiliary disease

Laparoscopic biopsy
- advantages
- disadvantages

A

Advantages
- minimally invasive
- can visualize the liver
- can directly stop hemorrhage
- larger samples than tru-cut

Disadvantages
- can’t acccess entire liver
- smaller, less-targeted samples than surgical

most common method

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16
Q

Canine hepatobiliary disease

Surgical biopsy
- advantages
- disadvantages

A

Advantages
- bigger, more targeted samples
-

Disadvantages
- most invasive
- anesthesia required

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17
Q

Canine hepatobiliary disease

When is obtaining a liver biopsy indicated?

A

Chronic liver enzyme elevation, even if asymptomatic; tumor presence

18
Q

Canine hepatobiliary disease

Main drug for controlling chronic idiopathic hepatitis in dogs

A

Prednisone - control inflammation, anti-fibrotic properties

rely on ALT for improvement since prednisone will affect ALP

19
Q

Canine hepatobiliary disease

Why is dietary protein imperative in treatment for chronic idiopathic hepatitis?

A

need protein for hepatocyte regeneration

20
Q

Canine hepatobiliary disease

Main drug used in copper hepatopathy

A

D-penicillsmine (DPA) - binds up to copper -> eliminated in urine

21
Q

Canine hepatobiliary disease

What two clinical signs decrease prognosis greatly in dogs with chronic idiopathic hepatitis?

A

Ascites and bridging portal fibrosis (6mo)

22
Q

Canine hepatobiliary disease

Bacterial Cholangiohepatitis

A
  • inflammation of the biliary tree and liver
  • neutrophilic inflammation (indicate bacteria like E. coli, enterococcus, and anaerobic bateria)
  • v+, anorexia, lethargy, jaundice, abdominal pain
  • tx = abx
23
Q

Canine hepatobiliary disease

Cholecystitis

A
  • caused by Gram negative bacteria affecting the gallbladder
  • acute: sudden onset of abd pain, fever, v+, lethargy, icterus, +/- shock
  • dx = bile culture via cholecystocentesis
24
Q

Canine hepatobiliary disease

Gallbladder Mucoceles (GBM)
- pathogenesis
- signlament

A
  • most significant biliary disease in dogs
  • older dogs (~10 y/o); shetland sheepdogs, mini schnauzers, cocker spaniels
  • Risk factors: endocrine diseases, hyperlipidemias
  • Pathogenesis: excessive secretion of mucous by the gallbladder -> cystic mucinous hyperplasia -> so much mucous builds up -> GB necrosis and rupture +/- infections
25
Q

Canine hepatobiliary disease

How do GBM patients typically present?

A

cholestatic-to-mixed hepatopathy +/- icterus

26
Q

Canine hepatobiliary disease

How is GBM diagnosed on AUS?

A

stellate or striated GB contents – kiwi pattern

27
Q

Feline hepatobiliary disease

Elevation of which hepatic enzyme is always significant?

A

ALP

also all other hepatic enzymes

28
Q

Feline hepatobiliary disease

Feline Neutrophilic Cholangitis
- definition
- etiology
- AUS findings

A
  • Inflammation of the biliary tree
  • ascending bacterial (E. coli ) infection from GIT up to the biliary tree, +/- hematogenous spread
  • AUS can be normal in 60% of cats with cholangitis

abd pain, v+, d+, icterus

29
Q

Feline hepatobiliary disease

How is Feline Neutrophilic Cholangitis diagnosed and treated?

A
  • dx = cholecystocentesis for bile analysis and culture, +/- liver biopsies for evidence of neutrophilic inflammation (and to differentiate from lymphoplasmacytic cholangitis)
  • tx = abx (acute & chronic), anti-inflamm. for chronic
30
Q

Feline hepatobiliary disease

Feline Lymphocytic Cholangitis
- etiology
- common concurrent conditions
- tx

A
  • Etiology: immune-mediated or inflammatory
  • A slowly progressive disease (chronic) concurrent IBD and pancreatitis is common
  • tx = prednisolone
31
Q

Feline hepatobiliary disease

Clinical signs of feline neutrophilic and lymphocytic cholangitises and how to differentiate

A

Anorexia, vomiting, lethargy, weight loss, icterus

  • Neutrophilic: fever
  • Lymphocytic: always chronic condition– chronic, intermittent signs
32
Q

Feline hepatobiliary disease

Hepatic Lipidosis

A

Most common hepatobiliary disease in cats
- incited by a negative energy balance (anorexia for a duration of time– 2 days to 2 weeks)
- Sequela: build up of triglycerides in hepatocytes (combo of issues) -> hepatocyte swelling and damage

33
Q

Feline hepatobiliary disease

Primary versus secondary hepatic lipidosis

A
34
Q

Feline hepatobiliary disease

Predisposing factor for hepatic lipidosis

A

Higher BCS (more fat in peripheral tissues that are mobilized as energy source)

fat in peripheral tissues = NEFAs

35
Q

Feline hepatobiliary disease

Common clinpath findings for hepatic lipidosis in cats

A
  • elevated serum ALP
  • normal GGT (can be elevated)
  • hyperbilirubinemia
36
Q

Feline hepatobiliary disease

Dx

A

Hepatic lipidosis dx via FNA + cytology

AUS: hyperechoic liver

37
Q

Feline hepatobiliary disease

Biliary cystadenoma

A
  • accounts for > 50% of hepatobiliary tumors in cats
  • benign, cystic lesions on liver
  • good prognosis with liver lobectomy
38
Q

Feline hepatobiliary disease

Biliary cystadenocarcinoma

A
  • Most common malignant tumor in cats
  • other hepatic neoplasia in cats: lymphoma

second most common in dogs

39
Q

Why are elevated hepatic enzymes in cats more significantthan in dogs?

A

hepatic enzymes in cats have different 1/2 lives

40
Q

Two most common hepatic diseases in cats

A
  • Hepatic lipidosis
  • Cholangitis (acute or chronic; neutrophilic [E. coli and enterococci] and lymphocytic)

E&E (30 decks)

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