Testing Flashcards
How can the pathology be described?
Primary or secondary
Active or quiescent
Hepatocellular, biliary or hepatobiliary
How is the status of the liver assessed?
ALT escapes from cytosol with hepatocellular injury
ALP, GGT released from reaction of biliary epithelium due to intrahepatic or extrahepatic cholestasis or drugs
How can serum albumin be interpreted?
If 80% loss of hepatic mass, albumin will no longer be synthesised.
Rule out PLE, PLN, haemorrhage
How can urea be interpreted?
Byproduct of protein degradation- if normal water intake and food, low values indicate PSS or severe chronic hepatobiliary disease
How is the bilirubin result interpreted?
Hyperbilirubinaemia occurs with increased production (haemolysis) or decreased excretion (cholestasis)
How is cholesterol interpreted?
High with cholestasis due to regurgitation
Low with severe hepatocellular disease or shunting (used up when BA circulation disturbed)
How is blood glucose related to hepatobiliary disease?
Frequently hypoglycaemia is seen in dogs with congenital PSS.
Unable to maintain euglycaemia with 80% loss of hepatic mass.
Hypoglycaemia is a common paraneoplastic syndrome of hepatocellular carcinoma.
Electrolyte abnormalities in hepatobiliary disease
Hypokalaemia from renal and GI losses, 2ndary hyperaldosteronism
Metabolic alkalosis - high serum CO2 due to overzealous diuretic therapy- worsens HE
What two functions do serum bile acids assess?
Hepatocellular function
Integrity of enterohepatic portal circulation
In the anicteric patient
What do abnormally high bile acids reflect?
Gall bladder ➡️ intestine ➡️portal vein➡️ liver.
A shunt or other disease requiring further testing
What does an increased plasma ammonia reflect and when is it required?
Bile acids are preferred but ammonia needed when cholestasis is present- high values suggest shunting or reduced mass to process ammonia
What urinalysis parameters are significant in hepatobiliary disease?
Bilirubinuria, USG <1.005 in PSS, hepatocellular disease.
Glucosuria + azotemia suggests hepatic leptospirosis
When are clinically relevant coagulation test abnormalities seen in hepatobiliary disease?
Acute hepatic failure-
Hepatic lipidosis in cats
Lymphoma in dogs and cats
Complete EBDO
Active DIC
What coagulation results are seen commonly in severe parenchymal liver disease? 🩸
❌Slightly prolonged APTT
❌Abnormal fibrin degradation products
❌Variable fibrinogen concentration
❌Elevated D-dimers (does not always mean DIC)
What abnormalities are seen in the complete blood count?
Microcytosis with normal MCHC is common in dogs with PSS due to chelation of iron in the liver
