SA Chronic Hepatobiliary Disease (DeMonaco) Flashcards
Canine hepatobiliary disease
Chronic Idiopathic Hepatitis definition
Insult to liver that initiates immune-mediated inflammation (pathogen, drug, vaccine, toxin, change in intestinal microbiome)
Canine hepatobiliary disease
Chronic idiopathic hepatitis bloodwork
- elevated ALT
- elevated ALP
- +/- decreased albumin
- hyperbilirubinemia
ALT = hepatocyte leakage/injury enzyme
Canine hepatobiliary disease
How is chronic idiopathic hepatitis diagnosed?
Biopsy
changes seen on AUS are non-specific and suppportive evidence only
Canine hepatobiliary disease
Copper Hepatopathy definition
dysfunction in copper metabolism -> copper accumualtes abnormally in liver -> reactive oxygen species
Canine hepatobiliary disease
What breeds are common in chronic idiopathic hepatitis?
Labradors, doberman pinschers, cocker spaniels
Canine hepatobiliary disease
What breeds are common in copper hepatopathy
Terriers, labradors, westies, dobermans, dalmatians
Canine hepatobiliary disease
Where are 1º versus 2º copper hepatopathy lesions?
1º: Centrilobular portions
2º: Periportal
Canine hepatobiliary disease
Cirrhosis definition
Chronic hepatic inflamamtion -> end-stage condition
- marked bridging fibrosis, nodular regeneration, distortion of hepatic architecture (“grapes” appearance)
- portal hypertension
Canine hepatobiliary disease
Dogs versus cats hepatic neoplasia
Dogs: usually metastatic (from spleen, pancreas, GI)
Cats: usually primary hepatobilliary neoplasia
Canine hepatobiliary disease
Most common hepatic neoplasia in dogs
1. Hepatocellular carcinoma
- malignant liver tumor
- good prognosis (if caught before metastasis)
Canine hepatobiliary disease
Steroid Hepatopathy: definition and sequela
- elevated hepatic enzymes, especially cALP
- hepatomegaly
- acumulation of glycogen in hepatocytes -> vacuolar hepatopathy
Recall: dogs have cALP enzyme!
Canine hepatobiliary disease
Nodular Hyperplasia
definition and characteristics
Old age-related change in dogs
- benign, asymptomatic
- mild-marked increased ALP
- no tx required
Canine hepatobiliary disease
How to prep for a liver biopsy
Assess BMBT, CBC (platelets), PT/PTT (clotting times)
Canine hepatobiliary disease
Tru-Cut biopsy
- advantages
- disadvantages
Advantages
- least invasive
Disadvantages
- cannot visualize liver lobes
- can’t immediately contorl post-biopsy hemorrhage
Canine hepatobiliary disease
Laparoscopic biopsy
- advantages
- disadvantages
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
Canine hepatobiliary disease
Surgical biopsy
- advantages
- disadvantages
Advantages
- bigger, more targeted samples
-
Disadvantages
- most invasive
- anesthesia required
Canine hepatobiliary disease
When is obtaining a liver biopsy indicated?
Chronic liver enzyme elevation, even if asymptomatic; tumor presence
Canine hepatobiliary disease
Main drug for controlling chronic idiopathic hepatitis in dogs
Prednisone - control inflammation, anti-fibrotic properties
rely on ALT for improvement since prednisone will affect ALP
Canine hepatobiliary disease
Why is dietary protein imperative in treatment for chronic idiopathic hepatitis?
need protein for hepatocyte regeneration
Canine hepatobiliary disease
Main drug used in copper hepatopathy
D-penicillsmine (DPA) - binds up to copper -> eliminated in urine
Canine hepatobiliary disease
What two clinical signs decrease prognosis greatly in dogs with chronic idiopathic hepatitis?
Ascites and bridging portal fibrosis (6mo)
Canine hepatobiliary disease
Bacterial Cholangiohepatitis
- 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
Canine hepatobiliary disease
Cholecystitis
- caused by Gram negative bacteria affecting the gallbladder
- acute: sudden onset of abd pain, fever, v+, lethargy, icterus, +/- shock
- dx = bile culture via cholecystocentesis
Canine hepatobiliary disease
Gallbladder Mucoceles (GBM)
- pathogenesis
- signlament
- 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
Canine hepatobiliary disease
How do GBM patients typically present?
cholestatic-to-mixed hepatopathy +/- icterus
Canine hepatobiliary disease
How is GBM diagnosed on AUS?
stellate or striated GB contents – kiwi pattern
Feline hepatobiliary disease
Elevation of which hepatic enzyme is always significant?
ALP
also all other hepatic enzymes
Feline hepatobiliary disease
Feline Neutrophilic Cholangitis
- definition
- etiology
- AUS findings
- 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
Feline hepatobiliary disease
How is Feline Neutrophilic Cholangitis diagnosed and treated?
- 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
Feline hepatobiliary disease
Feline Lymphocytic Cholangitis
- etiology
- common concurrent conditions
- tx
- Etiology: immune-mediated or inflammatory
- A slowly progressive disease (chronic) concurrent IBD and pancreatitis is common
- tx = prednisolone
Feline hepatobiliary disease
Clinical signs of feline neutrophilic and lymphocytic cholangitises and how to differentiate
Anorexia, vomiting, lethargy, weight loss, icterus
- Neutrophilic: fever
- Lymphocytic: always chronic condition– chronic, intermittent signs
Feline hepatobiliary disease
Hepatic Lipidosis
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
Feline hepatobiliary disease
Primary versus secondary hepatic lipidosis
Feline hepatobiliary disease
Predisposing factor for hepatic lipidosis
Higher BCS (more fat in peripheral tissues that are mobilized as energy source)
fat in peripheral tissues = NEFAs
Feline hepatobiliary disease
Common clinpath findings for hepatic lipidosis in cats
- elevated serum ALP
- normal GGT (can be elevated)
- hyperbilirubinemia
Feline hepatobiliary disease
Dx
Hepatic lipidosis dx via FNA + cytology
AUS: hyperechoic liver
Feline hepatobiliary disease
Biliary cystadenoma
- accounts for > 50% of hepatobiliary tumors in cats
- benign, cystic lesions on liver
- good prognosis with liver lobectomy
Feline hepatobiliary disease
Biliary cystadenocarcinoma
- Most common malignant tumor in cats
- other hepatic neoplasia in cats: lymphoma
second most common in dogs
Why are elevated hepatic enzymes in cats more significantthan in dogs?
hepatic enzymes in cats have different 1/2 lives
Two most common hepatic diseases in cats
- Hepatic lipidosis
- Cholangitis (acute or chronic; neutrophilic [E. coli and enterococci] and lymphocytic)
