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2nd path test > Study guide liver (Dark) > Flashcards

Study guide liver (Dark) Flashcards

1
Q

Normal liver morph and anatomy

A
  • Sharp edges, dark mahogany color
  • Acinus: bile secreting unit
  • Lobule: blood filtering unit
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2
Q

Liver blood flow

A

From portal vein => hepatic veins through the liver => central vein

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3
Q

Bile flow

A

From bile canaliculi in central vein => bile duct in portal triad (periphery)

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4
Q

Functions of liver

A
  • secrete bile
  • filter blood
  • produce proteins, clotting factors
  • metabolizes drugs and toxins
  • gluconeogenesis
  • breaks down ammonia
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5
Q

CS liver dz

A
  • Icterus (hyperbilirubinemia)
  • Head pressing, neuro signs (ammonia build up)
  • Bleeding, prolonged clotting times (liver synthesizes clotting factors)
  • Edema (hypoproteinemia)
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6
Q

Hyperbilirubinemia

Inc production

Dec excretion

A
  • Inc production
    • hemolysis
    • congenital defect in bilirubin conjugation
  • Dec excretion
    • Hepatic dysfunction
    • Cholestasis
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7
Q

Hemolysis

Intravascular

Extravascular

A
  • Intravascular
    • RBC breakdown in blood vessels
    • See hemoglobinemia
    • Leptospira, babesia, acetaminophen, snake venoms, transfusion reaction, RBC fragmentation, hypoosmolarity, phosphofruktokinase deficiency
  • Extravascular
    • RBC breakdown outside vessels, in spleen
    • see icteric serum
    • cytauxzoon, Eperythrozoon, Mycoplasma hemofelis, IMHA, Neoplasia (hemangiosarcoma), RBC fragmentation
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8
Q

Extrahepatic Cholestasis

Causes

A
  • Choleliths
  • Cholecystitis
  • Biliary neoplasia
  • Clonorchis sp
  • Eurytrema sp
  • Metorchis sp
  • Platynosum sp
  • Mucocele
  • Pancreatic dz
    • affects duodenal papilla, causes back up of bile => cholestasis
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9
Q

Extrahepatic Cholestasis

CS

A
  • Depression
  • Dehydration
  • Vomiting
  • Diarrhea
  • Anorexia
  • Abdominal pain
  • Icterus
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10
Q

Bile duct obstruction

A

Often due to pancreatic disease, neoplasia

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11
Q

Cystic mucosal hyperplasia

A

incidental finding

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12
Q

Mucocele

A
  • Entire lumen of gallbladder filled with mucus
  • Animal is very sick
  • will see biliary duct hyperplasia
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13
Q

Biliary cyst

A

incidental finding

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14
Q

Chronic Passive congestion

A
  • Caused by resistance to outflow of blood in liver
  • will see necrosis in centrilobular region, accentuated reticular pattern (nutmeg liver)
  • often caused by obstruction in vena cava
    • pheochromocytoma
    • right sided heart failure
    • thrombus
    • heartworms
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15
Q

Congenital PSS

Intrahepatic

A
  • Usually found in large dogs
  • macro or microvascular
  • failure of ductus venosus to close
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16
Q

Congenital PSS

Extrahepatic

A
  • small breed dogs, not doing well
  • portal vein to azygous
  • portal vein to vena cava
  • gastric vein to vena cava (common in cats)
  • atresia of portal vein
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17
Q

CS/TX PSS

A
  • CS
    • depression
    • anorexia
    • vomiting
    • CNS
    • Low BUN
    • High ammonia
  • TX
    • med management
    • sx
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18
Q

Acquired PSS

A
  • chronic hepatic injury with diffuse fibrosis
    • results in portal hypertension
    • shunt vessels form to allow blood in portal vein to bypass liver
  • Ascites: increased hydrostatic pressure
19
Q

Steroid hepatopathy

A
  • midzonal hepatocellular glycogen accumulation
  • can be incidental if animal is on corticosteroids
    • pathological if animal has cushings
20
Q

Lipidosis

A
  • Physiologic: cattlein late pregnancy, lactation
  • Pathologic: inc synthesis, inc lipolysis and uptake of FFA, decrease FA oxidation, decreased apoprotein synthesis and decreased lipoprotein excretion (cattle and cats)
21
Q

Feline fatty liver syndrome

A
  • idiopathic hepatic lipidosis in cats
  • typically obese, anorectic cats
  • CS
    • hepatic failure
    • icterus
    • hepatic encephalopathy
22
Q

Cirrhosis

A
  • End stage liver dz
  • cause:
    • chronic inflammation
    • bacterial/viral infection
    • CCl4
    • alkaloid plants in horses
23
Q

Causes of liver abscesses

A
  • rumen acidosis
  • ascending umbilical infection
  • necrobacillus
  • Tuberculosis
24
Q

Leptospirosis histo

A

small spirochetes in liver

25
Q

Adenovirus

A
  • CAV - 1 = infectious hepatitis
  • CAV - 2= respiratory type that cross protects
    • vax can cause corneal edema
26
Q

Feline infectious peritonitis

A
  • feline enteric Coronavirus
  • perivascular pyogranulomatous inflammation of liver
    • gold standard dz: liver biopsy with IHC
27
Q

Toxins

A
  • enter periportal, to liver, out central vein
  • intrinsic
    • produce consistenet hepatotoxicity
    • causes
      • pyrrolizidine alkaloids
      • aflatoxins
  • idiosyncratic
    • produce sporadic hepatotoxicity
    • Causes
      • NSAIDS
      • anesthetics
      • anti-convulsants
28
Q

Toxin processing in the liver

A
  • biotransformation
    • processing of toxins by liver
    • bioactivation
      • when biotransformation activates instead of deactivating toxins
      • ex: sago palm, amanita toxins
29
Q

Copper storage dz

A
  • Bedlington terriers
  • Gross: liver has nodules
  • histo: will see copper on special stain
  • will cause hemoglobinuria because sudden release of copper from hepatocytes causes lysis RBCs
30
Q

Types of liver cancer

A
  • Hepatoma (benign tumor hepatocyte origin)
  • Biliary adenocarcinoma
  • Hepatocellular carcinoma
  • Metastasis of other tumor types
  • Hemangiosarcoma
31
Q

Define lobular unit

A
  • Lobular unit: Portal triads form eges, centered around central vein
    • Portal region: highest concentration of O2 rich blood and nutrients
    • Midzonal region: intermediate O2 and nutrients
    • Centrilobular/periacinar: lowest O2 conc
32
Q

define acinar unit

A
  • Acinar unit: acinus + portal triads form edges
    • zone 1 = portal region
    • zone 2 = midzonal region
    • zone 3 = centrilobular/periacinar region
33
Q

list possible clinical manifestations of liver failure w/ pathophysiolgy of CS

A
  • Jaundice: buildup of bilirubin
  • Encephalopathy: elevated ammonia
  • Edema/ascites: dec oncotic pressure from hypoalbuminemia
  • Cutaneous lesions: photosensitization from failure to break down chlorophyll
  • Clotting abnormalities: dec synthesis of clotting factors
  • Abdominal pain
34
Q

Define Intrinsic toxin

A
  • consistently toxic
  • can be experimentally reproduced
35
Q

define idiosyncratic toxins

A
  • toxicity is unpredictable
  • cannot be reproduced experimentally
36
Q

pattern of damage

hematogenous spread of bacteria

A

random, multifocal

37
Q

pattern of damage

Chloroform/CCl4

A
  • centrilobular: hypoxia
38
Q

pattern of damage

Alfatoxins, steroids

A
  • midzonal
39
Q

pattern of damage

toxins that don’t need to be metabolized (pyrrolizidine, alkaloid in horses)

A
  • Periportal
40
Q

pattern of damage

Blue green algae, Theiler’s dz, viruses

A
  • Massive
    • necrosis of entire lobule/acinus
41
Q

possible causes for microhepatica

A
  • starvation
  • portosystemic shunts
  • hepatocellular necrosis
  • chronic hepatocellular injury with secondary fibrosis
42
Q

possible causes of hepatomegaly

A
  • congestion
  • amyloidosis
  • lipidosis
  • neoplasia
  • acute diffuse hepatitis
43
Q

Common neoplasms of the liver

A
  • Hepatic nodular hyperplasia
    • well organized
    • common in older dogs
  • Hepatomas
    • benign neoplastic hepatocytes
  • Hepatocellular carcinomas
    • rare
    • usually just 1 enlarged liver lobe
  • Biliary carcinomas
    • rare
    • met to LN and lungs
    • umbilicated (central necrosis)
  • Metastatic
    • hemangiosarcomas
    • lymphosarcomas

2nd path test (10 decks)

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