Specific Liver Diseases Flashcards
1
Q
Acute hepatitis
- causes and therapy (4)
- more specific therapies (4)
A
- infectious/drug/toxin induced
- symptomatic therapy
- correct fluid and electrolyte imbalance (do NOT use hartmanns!)
- K supplementation
- monitor K and glucose levels
- hepatic encephalopathy: lactulose, IV ABs, keppra
- portal hypertension: PPI, H2 blockers, gastric protectants
- ascites: spirinolactone
- anti-oxidant therapy: NAC, SAM-e
2
Q
Chronic hepatitis
- Facts (3)
- Therapy (2)
A
- non specific CS
- waxing and waning, eventually leads to fibrosis and cirrhosis
- biopsy required
Therapy:
- same as acute + prednisilone at anti-inflammatory dose (only AFTER hepatic encephalopathy has resolved)
3
Q
Idiopathic chronic hepatitis
- causes (4)
- Dx (3)
A
- Genetic influences
- Metabolic defects: Copper associated disease
- Autoimmune disease
- Infectious causes: Cholangiohepatitis(bacteria)/ Leptospirosis / adenovirus
- Drugs and toxins
Dx:
- haemogram: mild anaemia (normocytic, normochromic), decrease in platelets, increats in PT/APTT
- biochem: increase in ALT, ALKP, bilirubin, hypoalbuminaemia, urea
- Biopsy: true cut are best
4
Q
monitoring efficacy of steroids (3)
A
- ALKP will increase as a side effect
- ALT should decrease if therapy is effective
- normally 4-6 week tapering dose
5
Q
Copper associated hepatopathy
- predisposition
- pathogenesis
- disease
- Tests
A
- beddlington, dalmation, WHWT
- Usually stored in hepatic lysosymes and then excreted via biliary tree
- Excess copper accumulates in cytosol –> oxidative damage
Disease can be primary disease or secondary disease due to choleostasis
Tests:
- Quantitative analysis*
- Histology and zonal distribution
6
Q
Copper analysis
A
- 1 gram of tissue required (Not formalin fixed)
- Primary copper disease likely if > 2000 ppm
- Rubeanicacid staining of biopsy to look at distribution and qualitative accumulation
7
Q
Progression of copper hepatopathy (4)
A
- Copper accumulation initially subclinical –> Therapy works
- Hepatocyte death – ALT increases –> Therapy works
- Progression and development of chronic hepatitis –>Therapy unlikely to be effective
- Massive Cu release – anaemia and renal failure
8
Q
beddligton terriers (5)
A
- Mutation in COMMD-1 gene
- Commercial test available
- Will detect 95% of affected / carriers
- Early screening and low copper diets can prevent disease progression
- N.B Copper restricted diets should only be fed to fully grown dogs as also low in protein
9
Q
Copper hepatopathy Treatment (4 + facts)
A
D-penicillamine
- Chelating agent
- Binds extravascular copper
- Effective over many months (4-6)
- 30% have vomiting – give with food
Once hepatic copper levels reduced switch to zinc:
- chelating agent
- stops Cu absorption across GI tract
- DON’T use with D penicillamine: since decreases the efficacy of it!
Copper restricted diet (L/d)
Anti-oxidant therapy
10
Q
Feline Inflammatory Liver Disease
A
- Neutrophilic cholangitis
- Lymphocytic cholangitis
- Mixed cell cholangitis
11
Q
Neutrophilic cholangitis
- definition
- test
- where
- predisposition? (2)
A
- Ascending infection from intestines via the biliary tree – anatomical problem in cats! (E.coli most common)
- Suppurative inflammation on histology
- Cannot differentiate on FNA
- occurs in bile ducts +/- parenchyma involved
- Underlying inflammatory bowel disease may predispose
- Triaditis: Concurrent IBD and pancreatitis & Common opening between CBD and pancreatic duct
12
Q
Neutrophilic Cholangitis CS (8)
A
- Usually middle aged to older cats
- Acute onset can be seen but typically more insidious
- Systemically unwell
- Jaundice, anorexia and pyrexia most common (due to choleostasis)
- Intrahepatic choleostasis
- Vomiting / lip smacking
13
Q
Neutrophilic cholangitis Dx (5)
A
- Bloods: anaemia, liver enzymes, bilirubin, neutrophilia*
- Feline PLI for pancreatic assessment
- Imaging
Mottled / hypoechoic parenchyma
Distended bile duct and thickened gall bladder wall
Possible cholelithiasis - FNA not useful
- biopsy: tru cut: allows surgical inspection of viscera and feeding tube to be placed at the same time
14
Q
Neutrophilic cholangitis
- treatment (3)
- prognosis (2)
A
- Antibiotics Amoxycillin-clavulonate +/- fluoroquinolones - Hepatic support therapy - Diet modification to control IBD? - Prognosis good if early intervention Mean survival 29 months 5/6 alive at 12 months
15
Q
Lymphocytic Cholangitis
A
- Lymphocytic inflammation around portal triads (not bile ducts)
- Variable fibrosis – can be very severe
- Immune mediated disease
