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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
Q

What are the indications for liver failure on a chemistry profile?

A

Low albumin

Low cholesterol

Low glucose

Low BUN

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26
Q

How can we measure liver function?

A

Bile acids

  • Overflow from enterohepatic circulation
  • Can be measured in blood
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27
Q

Describe a liver function test

A

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
Q

What is hepatic encephalopathy?

A

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
Q

What are the clinical signs seen with hepatic encephalopathy?

A

Bizarre behaviour

Head pressing

Seizures

Intermittent blindness

Ptyalism

Urate stone formation

30
Q

How are urate stones formed?

A

Increased ammonium concentration in blood

Decreased ability to convert uric acid to allantoin in liver

More urate excreted in urine

31
Q

What are the most important diseases causing HE in cats?

A

Acute liver failure

Hepatic lipidosis

Neoplasia

Portosystemic shunts

32
Q

What are the most important diseases causing HE in dogs?

A

Portosystemic shunts

Liver failure (acute): toxins or infections

Liver failure (chronic): cirrhosis

33
Q

What three things can be used to evaluate liver function?

A

Enzymes

Metabolites

Function tests

34
Q

Which four enzymes indicate hepatocellular damage?

A

Alanine aminotransferase (ALT)

Aspartate aminotransferase (AST)

Sorbitol dehydrogenase (SDH)

Glutamate dehydrogenase (GLDH)

35
Q

What is the most commonly used hepatocellular enzyme to measure for damage?

A

ALT

  • Will increase within 12 hours of injury
  • Peaking at 1-2 days
  • Decreases over the next 2-3 weeks
36
Q

Which hepatocellular enzymes are assessed for liver damage in large animals and why?

A

SDH or GLDH as hepatic ALT activity is very low

37
Q

Why is AST not really used to assess for liver damage?

A

Not liver specific

38
Q

Where can both AST and ALT be derived from?

A

Muscle

39
Q

How can liver damage vs muscle damage be checked with raised AST and ALT?

A

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
Q

Which two enzymes indicate cholestasis (obstruction of bile flow with regurgitation of biliary substances in the blood)?

A

Alkaline phosphatase (ALP)

Gammaglutamyltransferase (GGT)

41
Q

Where is alkaline phosphatase derived from?

A

Bile duct epithelium

42
Q

Why is ALP increasd in young growing animals?

A

Found in bone

43
Q

Which species is the seroid induced isoform of ALP found?

A

Dogs

44
Q

Why is an increase in steroid induced isoform of ALP significant in cats?

A

Not usually found - indicates hyperthyroidism

45
Q

Where is gammagluatmyltransferase derived from?

A

Bile duct epithelium

46
Q

What is a more sensitive indicator of cholestasis in large animals?

A

GGT

47
Q

Why is GGT increased in nursing animals?

A

Found in colostrum

48
Q

When could GGT be found in the urine?

A

If renal tubular damage is present as it is renal tubular cells

49
Q

What seven things can be used as a measure of hepatic function?

A

Bilirubin

Albumin

Urea

Glucose

Cholesterol

Ammonia

Bile acids

50
Q

Describe the basic metabolism of bilirubin

A

Breakdown product of haemaglobin

Conjugated in the liver

Excreted with bile into the gut

Converted to urobilinogen

Excreted in faeces

51
Q

What colour will bilirubin cause serum/plasma to become?

A

Yellow

52
Q

What is the difference between finding bilirubin in dog urine compared to the cat?

A

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
Q

What is the main thing that is used to evaluate the renal system?

A

Urea

  • Its main route of excretion is via the kidneys
54
Q

What will be seen with hepatic disease in urea and ammonia levels?

A

Decreased urea

Increased ammonia

May also see ammonium biurate crystals in the urine

55
Q

Why is glucose not a sensitive indicator of hepatic dysfunction?

A

Decreases only occur with end-stage liver disease

56
Q

When would you see increases and decreases in cholesterol with liver disease?

A

Increases with cholestasis due to decreased excretion

Decreases with hepatic failure due to decreased synthesis

57
Q

How do cholesterol levels vary with T4 levels?

A

Inversely - increase with decrease in T4 and vice versa

58
Q

What two measurements should be made of bile acid concentration?

A

Fasted

Post prandial

59
Q

What does measuring bile acid concentration test?

A

Hepatic uptake

60
Q

Why should you only measure a single sample of bile acid concentrations in horses?

A

No gall bladder

61
Q

What hepatic lesion is suggested with acanthocytosis?

A

Haemangiosarcoma

Lipid metabolism defect

62
Q

What would anaemia suggest related to liver disease?

A

Hepatitis with a decrease in functional mass

63
Q

What would codocytosis suggest is occuring related to the liver?

A

Decrease in functional mass - altered lipid composition of erythrocyte membrane

64
Q

What would microcytosis suggest relating to the liver?

A

Decrease in functional mass

Portosystemic shunt

Decreased delivery of iron to precursors

65
Q

Are enzymes and function tests specific enough to determine cause of a liver lesion?

A

No

66
Q

What is required to determine the underlying cause of a liver lesion?

A

FNA (Fine needle aspiration)

Biopsy

Alimentary - Icterus and Hepatic Encephalopathy (3 decks)

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