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Alimentary - Icterus and Hepatic Encephalopathy > Small Animal > Flashcards

Small Animal Flashcards

1
Q

Define icterus

A

Hyperbilirubinaemia

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2
Q

What is 70% of bilirubin produced in?

A

Senescent erythrocytes

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3
Q

Describe the progress of bilirubin from being formed to excretion in the urine

A

Newly formed insoluble in water so binds to albumin

Bilirubin dissociates from albumin before entering liver cell

Conjugated in liver cell with gluvuronic acid making it water-soluble for excretion in the urine

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4
Q

What would bacteria in the lower urinary tract cause?

A

Enterohepatic circulation

  • Converts bilirubin into urobilinogen
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5
Q

What occurs with pre-hepatic icterus?

A

Haemolysis

  • Too much blood breakdown
  • Production cannot keep up

Conjugation and uptake

  • Bilirubin into the liver overwhelmed
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6
Q

What occurs with hepatic icterus?

A

Uptake, conjugation and excretion of bilirubin in hepatocytes overwhelmed

Something gone wrong within the liver

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7
Q

What occurs with post-hepatic icterus?

A

Cholestasis - blocked excretion

Conjugation, excretion and uptake back into liver overwhelmed

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8
Q

What gastrointestinal clues can be provided that suggest icterus?

A

Vomiting

Diarrhoea

Acholic faeces - white faeces (post-hepatic)

Melaena

Abdominal effusion - ascites

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9
Q

What neurologic signs suggest icterus?

A

Personality change

Ptyalism (cats)

Head pressing

Disorientation

Seizures

Stupor

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10
Q

What is the term for icterus that affects the nerological system?

A

Hepatic encephalopathy

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11
Q

How does hepatic encephalopathy occur?

A

Liver not functioning properly

Nitrogen breakdown does not occur correctly

Ammonium builds up causing toxic effects

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12
Q

What renal/urinary signs suggest icterus?

A

PU/PD

Pollakiuria - small frequency of urination

Stranguria - increased urgency for urination

Dysuria - difficulty urinating

Bilirubinuria

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13
Q

What haematologic signs suggest icterus?

A

Pale mucous membranes

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14
Q

What are the differential diagnoses for prehepatic icterus?

A

Immune haemolytic anaemia

Babesia infection

Toxins: onions, lead and copper

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15
Q

What are the differential diagnoses for cats with hepatic icterus and which are most common?

A

Suppurative cholangiohepatitis

Lymphocytic plasmacytic hepatitis

Hepatic lipidosis

Feline infectious peritonitis

Toxins

Neoplasia

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16
Q

Describe hepatic lipidosis

A

Metabolic disease with build up of fat droplets in hepatocytes

Lead to lack of function and progressive liver disease

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17
Q

What are the differential diagnoses for dogs with hepatic icterus and which are most common?

A

Acute liver disease (toxins)

Leptospirosis

Chronic hepatitis

Neoplasia

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18
Q

What are the differential diagnoses for posthepatic icterus?

A

Pancreatitis

Neoplasia

Cholelithiasis

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19
Q

How would you differentiate between prehepatic and hepatic icterus?

A

PCV - low if prehepatic and normal if hepatic

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20
Q

How would you differentiate between hepatic and posthepatic icterus?

A

Ultrasound

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21
Q

What are some examples of workups used for hepatic diseases?

A

Haematology, chemistry profile and UA

Liver function tests

Coagulation tests

Abdominal ultrasound

Aspirate effusion and cytology

Liver fine needle aspirate

Fine needle aspirate and culture of bile

Liver biopsy

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22
Q

Why are liver enzyme elevations often seen in small animals?

A

Reversible damage to hepatocytes due to regenerative capacity of liver

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23
Q

Which is the most liver specific enzyme?

A

ALT

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24
Q

Where is AST also present apart from the liver?

A

Muscle

Intestines

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25
What are the indications for liver failure on a chemistry profile?
Low albumin Low cholesterol Low glucose Low BUN
26
How can we measure liver function?
**Bile acids** * Overflow from enterohepatic circulation * Can be measured in blood
27
Describe a liver function test
Take first measurement of bile acids fasted Give food then take second measurement Limited by re-uptake of bile acids from blood into hepatocytes Elevated in liver failure or portosystemic shunt
28
What is hepatic encephalopathy?
Protein digestion Ammonia and aromatic amino acids go directly into the blood without passing through the liver first Exposes CNS to gut-derived toxins
29
What are the clinical signs seen with hepatic encephalopathy?
Bizarre behaviour Head pressing Seizures Intermittent blindness Ptyalism Urate stone formation
30
How are urate stones formed?
Increased ammonium concentration in blood Decreased ability to convert uric acid to allantoin in liver More urate excreted in urine
31
What are the most important diseases causing HE in cats?
Acute liver failure Hepatic lipidosis Neoplasia Portosystemic shunts
32
What are the most important diseases causing HE in dogs?
Portosystemic shunts Liver failure (acute): toxins or infections Liver failure (chronic): cirrhosis
33
What three things can be used to evaluate liver function?
Enzymes Metabolites Function tests
34
Which four enzymes indicate hepatocellular damage?
Alanine aminotransferase (ALT) Aspartate aminotransferase (AST) Sorbitol dehydrogenase (SDH) Glutamate dehydrogenase (GLDH)
35
What is the most commonly used hepatocellular enzyme to measure for damage?
**ALT** * Will increase within 12 hours of injury * Peaking at 1-2 days * Decreases over the next 2-3 weeks
36
Which hepatocellular enzymes are assessed for liver damage in large animals and why?
SDH or GLDH as hepatic ALT activity is very low
37
Why is AST not really used to assess for liver damage?
Not liver specific
38
Where can both AST and ALT be derived from?
Muscle
39
How can liver damage vs muscle damage be checked with raised AST and ALT?
**Check creatine kinase** * Muscle specific * Most sensitive indicator of muscle injury * Increase within 1-2 hours of injury * Peak at 6-12 hours * Decrease over next couple of days
40
Which two enzymes indicate cholestasis (obstruction of bile flow with regurgitation of biliary substances in the blood)?
Alkaline phosphatase (ALP) Gammaglutamyltransferase (GGT)
41
Where is alkaline phosphatase derived from?
Bile duct epithelium
42
Why is ALP increasd in young growing animals?
Found in bone
43
Which species is the seroid induced isoform of ALP found?
Dogs
44
Why is an increase in steroid induced isoform of ALP significant in cats?
Not usually found - indicates hyperthyroidism
45
Where is gammagluatmyltransferase derived from?
Bile duct epithelium
46
What is a more sensitive indicator of cholestasis in large animals?
GGT
47
Why is GGT increased in nursing animals?
Found in colostrum
48
When could GGT be found in the urine?
If renal tubular damage is present as it is renal tubular cells
49
What seven things can be used as a measure of hepatic function?
Bilirubin Albumin Urea Glucose Cholesterol Ammonia Bile acids
50
Describe the basic metabolism of bilirubin
Breakdown product of haemaglobin Conjugated in the liver Excreted with bile into the gut Converted to urobilinogen Excreted in faeces
51
What colour will bilirubin cause serum/plasma to become?
Yellow
52
What is the difference between finding bilirubin in dog urine compared to the cat?
Low levels normally found in dog urine as the renal tubular epithelium can conjugate it Not normal in cat and is a significant finding
53
What is the main thing that is used to evaluate the renal system?
**Urea** * Its main route of excretion is via the kidneys
54
What will be seen with hepatic disease in urea and ammonia levels?
Decreased urea Increased ammonia May also see ammonium biurate crystals in the urine
55
Why is glucose not a sensitive indicator of hepatic dysfunction?
Decreases only occur with end-stage liver disease
56
When would you see increases and decreases in cholesterol with liver disease?
Increases with cholestasis due to decreased excretion Decreases with hepatic failure due to decreased synthesis
57
How do cholesterol levels vary with T4 levels?
Inversely - increase with decrease in T4 and vice versa
58
What two measurements should be made of bile acid concentration?
Fasted Post prandial
59
What does measuring bile acid concentration test?
Hepatic uptake
60
Why should you only measure a single sample of bile acid concentrations in horses?
No gall bladder
61
What hepatic lesion is suggested with acanthocytosis?
Haemangiosarcoma Lipid metabolism defect
62
What would anaemia suggest related to liver disease?
Hepatitis with a decrease in functional mass
63
What would codocytosis suggest is occuring related to the liver?
Decrease in functional mass - altered lipid composition of erythrocyte membrane
64
What would microcytosis suggest relating to the liver?
Decrease in functional mass Portosystemic shunt Decreased delivery of iron to precursors
65
Are enzymes and function tests specific enough to determine cause of a liver lesion?
No
66
What is required to determine the underlying cause of a liver lesion?
FNA (Fine needle aspiration) Biopsy

Alimentary - Icterus and Hepatic Encephalopathy (3 decks)

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