SA Liver Flashcards
What enzymes of the liver are considered hepatocellular?
AST, ALT, LDS, GLDS, SDH
Which hepatocellular enzymes are liver specific?
ALT (mainly), SDH, GLDH
Which hepatocellular enzymes are NOT liver specific and where are they found?
ALT, AST, LDG - also found in muscle
Which enzymes of the liver are considered cholestatic?
ALP and GGT
Name the different isoforms of ALP.
Liver, bone (osteosarcs), Corticosteroid (stress induced), intestinal (lost in the intestine)
What substances can be measured in order to test liver function?
Bilirubin, bile acids, cholesterol, albumen, clotting factors
What is a cause of prehepatic jaundice?
Haemolysis - IMHA, lepto, NI etc, Haemorrhage, enzymeatic
What is a cause of hepatic jaundice?
Hepatic dysfunction - hepatitis, neoplasia. Intrahepatic cholestasis
What is a cause of post-hepatic jaundice?
Extra-hepatic obstruction - gall bladder
Why may jaundice persist after resolution of clinical disease?
Persistent delta-bilirubin which is strongly bound to albumen
What is a reactive hepatopathy?
Elevations in liver enzymes caused by extrahepatic disease
What would be the best marker hepatic cellular damage
Enzymes - ALT, AST, SDG, GLDH
What would be the best markers of cholestasis?
Bilirubin, cholestatic enzymes, ALP?
What would be the best markers of hepatic cellular function?
NH3/ urea, cholesterol, bile acids, albumen, coagulation proteins, metabolites, immunoglobulins
What would be the best markers of portal circulation?
Glucose, bile acids, BUN/ NH3, immunoglobulins
What can glucose tell you about liver function?
Hypo - decreased liver stores
Hyper - reduced portal circulation
Describe a bile acid stimulation test.
Test BA, give a fatty meal, measure post-prandial bile acids (should be removed from the blood in normal dogs and hence low! >25mmol/L is abnormal)
What haematological abnormalities are seen with liver disease?
Microcytosis, ovalocytes, acanthocytes
What urine abnormalities are seen with liver disease?
Isosthenuria, bilirubin, ammonium biurate crystals
What characteristic jaundice colour of the mucus membranes would be suggestive of HEPATIC disease (rather than haemolytic jaundice)?
Yellow-pink
Describe the pathophysiology of hepatic encephalopathy
Reduce urea formation (PSS/ hepatic dysfunction), increased blood ammonia (CNS dysfunction)
What clinical signs are associated with hepatic encephalopathy?
Anorexia, VD, PUPD, dull, blind, head pressing, ataxia
What can worsen clinical signs in dogs with hepatic encepahlopathy?
Proteinaceous meal, GI bleeding, dehydration. acid-base imbalance
What infectious and non-infectious agents cause hepatitis?
Infectious - lepto, CAV, FIP, CHV, toxo
Non-infectious - toxic, iatrogenic
What disease processes can cause reactive hepatopathy?
IBD, PLE, septicaemia, pancreatitis, dental disease, HAC, addisons
What radiographic characteristic is useful for liver assessment?
Gastric axis - able to assess changes in liver size
What dietary management should be used for PSS?
Low protein - minimise NH3 production
What dietary management should be used for chronic hepatitis?
Low Cu, high Zn, high quality protein, anti-oxidants - protein will encourage regeneration
What dietary management should be used for hepatic encephalopathy?
Protein restriction/ modification - minimise NH3 production
What dietary management should be used for chronic active inflammation?
Mineral balance - fat soluble vitamins, taurine
What empirical therapies may be used for hepatic encephalopathies?
Ampicillin/ metronidazole
When might steroids be indicated in liver disease?
Chronic active inflammation, hepatic fibrosis
What breeds are associated with copper associated hepatopathies?
Labs, bedlington terriers, WHWT, dalmatian, dobermann
Name two copper chelators.
D-penicillamine, trientine
What is the MOA of UDCA (BEARS)?
Alters bile composition (hydrophilic), stimulates bile flow, modulates inflammation/ immune response
What is the MOA of SAMe (Denamarin)?
Antioxidant - glutanates - think cats and paracetamol
What is the MOA of milk thistle?
Free-radical scavenger, inhibits inflammation, inhibits lipid peroxidase, inhibits collagen deposition, increased glutathionine
What is the toxic dose of paracetamol for a cat?
> 65mg/kg (1 tablet)
Why can cats not process paracetamol?
Cannot glucoronidate - hence methaemoglobinaemia occurs - haemolytic anaemia, facial oedema and hepatocellular damage
What treatment should be used for cats with paracetamol toxicity?
Emesis if soon enough? NAC, SAMe, Vitamin C, supportive - fluids
What clinical signs are associated with feline liver disease
Anorexia, wt loss, jaundice, PUPD, hepatoencepahlopathy, hypersalivation, uveitis
