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Small Animal Digestive > Unit 2- Liver, Gall Bladder, Pancreas, > Flashcards

Unit 2- Liver, Gall Bladder, Pancreas, Flashcards

1
Q

What are the two venous inputs to the liver and which one carries more blood/nutrients

A

Caudal vena cava and portal vein and portal vein carries more nutrients to the liver

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2
Q

What is contained within the portal tract and where is it located

A

the portal vein, hepatic artery, and bile duct- these are located at the 6 corners of the hepatocytes

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3
Q

Where within a liver cell are the more oxidative pathways taking place

A

Closer to the outside of the hepatic cell (zone 1) which is closer to the hepatic artery (duh needs to be close to the oxygen)

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4
Q

What is an example of something that causes pre-hepatic disease

A

severe anemia from hemolysis

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5
Q

What are some post-hepatic disease causes

A

bile duct obstruction, pancreatitis

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6
Q

A puppy presents for head pressing, confusion, fly biting, vomiting, and now seizures. You run some bloodwork and one of the values is an elevated ammonia. What might this puppy have?

A

He is probably experiencing hepatic encephalopathy and it may be from a liver shunt

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7
Q

Why are dogs with a liver shunt also often PU/PD

A

They are not properly producing urea, therefore they are not properly absorbing water because urea is one of the substances that forms the gradient with sodium to encourage water reabsorption in the collecting duct of the kidney

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8
Q

T/F a dog with a liver shunt will likely have a high BUN

A

False, likely will have a low BUN because they are not producing urea

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9
Q

What clotting factors are impacted by liver damage (yes this question just keeps coming back so hopefully we remember them)

A

Vitamin K dependent factors- II, VII, IX, X

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10
Q

What two causes result in ascites when there is liver dysfunction

A

Decreased albumin production–> decreased colloid oncotic pressure
increased portal pressure–> increased hydrostatic pressure

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11
Q

How does liver dysfunction effect drug metabolism/sensitivity

A

there is a decreased ability to metabolize certain drugs and there is less protein (hypoalbuminenia) to bind drugs

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12
Q

what are the five pseudoliver function tests

A

albumin, glucose, bilirubin, urea nitrogen, cholesterol

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13
Q

what are the two specific liver tests

A

ammonia and bile acids

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14
Q

what does anemia of chronic disease/early blood loss look like

A

normocytic, normochromic

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15
Q

what does blood loss anemia look like on bloodwork

A

macrocytic, hypochromic

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16
Q

What does iron deficiency anemia/ anemia of portosystemic shunts look like

A

microcytic, hypochromic

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17
Q

What does it mean if albumin is increased? How about decreased

A

Increased- dehydration (GI fluid loss)
Decreased- decreased production (liver dysfunction or shunt) or loss from leaky gut/ GI bleed

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18
Q

What does it mean if globulin is increased? How about decreased

A

Increased- chronic inflammation or neoplasia
Decreased- gut loss
use to differentiate from PLN and liver dysfunction

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19
Q

If there is liver dysfunction how does that impact cholesterol

A

it will be decreased

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20
Q

What does it mean if BUN is increased? How about decreased

A

increased- dehydration, GI blood loss/absorption
Deceased- liver dysfunction (earlier indicator)

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21
Q

Will bilirubin be increased or decreased with liver disfunction

A

increased

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22
Q

How might glucose be affected by liver dysfunction

A

decreased

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23
Q

What biochemistry liver enzymes are increased with cholestatic diseases

A

ALP and GGT

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24
Q

Which liver enzyme is leaked when the hepatocyte cytoplasm is damaged (aka is a liver damage enzyme)

A

ALT

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25
Q

Which is more concerning an elevated ALT/ALP in a cat or a dog

A

in a cat! the half lives are much shorter

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26
Q

T/F with a SEVERELY damaged liver the ALT will be high

A

False, when there is enough cell damage there won’t be anymore leakage of ALT so it may not be as elevated anymore

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27
Q

What type of crystals can you see with liver dysfunction

A

bilirubin or/and urate

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28
Q

Can you use bile acids if an animal has hyperbilirubinemia/is icteric

A

nope! they won’t be accurate

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29
Q

A gall bladder with a mucocele will look like what type of fruit on an X-ray

A

kiwi, sorry I don’t make this up apparently vet med just loves our food comparisons

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30
Q

Is FNA a good choice for diagnosing liver issues

A

no its usually not very accurate

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31
Q

what are some concerns with taking a liver biopsy that you should consider

A

hemorrhage (coagulopathic)- because of lack of clotting factors
hypoglycemia
slower drug metabolism

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32
Q

Do you need to restrict protein in a liver diet

A

no, unless they have hepatic encephalopathy

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33
Q

When considering a liver diet what nutrients do you want to decrease to keep them from accumulating more

A

copper and Iron

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34
Q

What nutrient can help bind copper and is a cofactor in the urea cycle that you can give in the diet

A

zinc

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35
Q

What is SAMe

A

an antioxidant

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36
Q

What antioxidant is given usually in the hospital IV for acute issues like a liver toxicity

A

N-acetylcysteine (NAC)

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37
Q

What is silymarin (Milk thistle extract) used for

A

it is an antioxidant and is anti-inflammatory

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38
Q

what fat soluble vitamin is also an antioxidant and anti-inflammatory (can help limit fibrosis)

A

vitamin E

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39
Q

What is the mechanism of action of ursodeoxycholic acid

A

choleretic (increase volume of bile) and acts as hepatocyte cytoprotection and is immunomodulating

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40
Q

Which drug is used as a copper chelator to mobilize copper from the liver to the urine

A

D-penicillamine

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41
Q

Can you also use zinc as a copper chelator

A

no, it only binds copper in the GI system to decrease absorption, is NOT a chelator

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42
Q

How are corticosteroids helpful in managing liver disease, but how can it make monitoring difficult

A

they are anti-inflammatory and anti-fibrotic, choleretic, and improve appetite
however they can cause ALP to increase which can make monitoring the liver enzymes more challenging

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43
Q

What does colchicine do

A

it can help minimize fibrosis in the liver

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44
Q

Why might you give a RAAS inhibitor to a patient with liver disease

A

to decrease portal hypertention which can also help decrease fibrosis formation

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45
Q

What is the main goal of treatment when trying to control hepatoencephalopathy and what drugs/treatments can help with this

A

Clear GI of absorbable potential neurotoxic substances
can give lactulose, enemas, also antibiotics (less bacteria to create ammonia)

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46
Q

Gastrointestinal ulceration can be a common complication with liver disease, what treatments might you give to manage this

A

proton pump inhibitor- omprazole
H2 blockers
Mucosal protectants- sucralfate, bismuth, barium

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47
Q

T/F in acute liver failure it is better to give vitamin K IV than orally

A

False, never give Vit. K IV and only every give orally because it can cause an allergic reaction

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48
Q

What are 3 potential treatments for ascites

A

diuretics like furosemide or Spironolactone, restrict dietary sodium (mildly), abdominocentesis

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49
Q

You should avoid metabolic ________ because it can worsen hepatoencephalopathy

A

alkalosis

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50
Q

What causes methemoglobinemia in cats and is classified as a dose dependent toxicity

A

acetaminophen

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51
Q

What anti-convulsant can cause a chronic, dose dependent liver toxicity

A

phenobarbital
(technically if you said oral diazepam in cats this may also kinda be right since it can be used as an anti-convulsant, but it is usually 5 days after starting the drug so probs not as chronic? IDK)

52
Q

Some Labrador Retrievers can have liver toxicities from what drug

A

Carprofen

53
Q

What drug are black and tan dogs sensitive to

A

potentiated sulfas

54
Q

Cats with hyperthyroidism starting treatment should have their liver values checked why (amongst other things that should be checked but we won’t think about all that endocrinology right now)

A

Because methimazole the treatment for hyperthyroidism can cause idiopathic liver toxicity within the first month of starting it

55
Q

What’s a weird liver thingy that older Scottish terriers get

A

vacuolar glycogen hepatopathy- looks like they have Cushing’s and they don’t but it also makes them more prone to hepatocellular carcinomas
this was super confusing so I googled it. Apparently the liver cells swell up because of cytosolic glycogen

56
Q

If a dog has toxic hepatopathy from blue green algae, afalotoxicosis, or xylitol what is the prognosis

A

probs not that great… still may get liver failure :/

57
Q

A young dog presents with vomiting, fever, lethargy, abdominal pain. Its eyes are also a weird hazy blue. What does this dog possibly have

A

Infectious canine hepatitis/ Canine adenovirus 1

58
Q

A dog presents with acute kidney and liver damage and you are suspicious of leptospirosis but the dog was vaccinated! How is this possible? What test can you run to prove this?

A

The vaccine doesn’t cover all serovars and it also probably only provides coverage for about 6 months
You can run a titer and look for elevation of one of the serovars or a titer to a serovar not in the vaccine he got

59
Q

What antibiotic must you give to get rid of leptospirosis IN THE CELLS (sorry for yelling its an important distinction)

A

Doxycycline (however sometimes penicillin is used first in the acute phase because doxy can be such a pain to give unless they can take it orally)

60
Q

How can an animal get aflatoxicosis

A

from moldy grains in the diet (like corn- it has the juice! and apparently the mold too…)

61
Q

Which pretty mushroom will hurt the liver (causes fulminant hepatic necrosis)

A

amanita mushroom (and honestly maybe others, don’t eat mushrooms you don’t know what they are friends)

62
Q

These pretty trees can be found in South Carolina (and other places but he just mentioned this as an example) and any part of it can cause acute liver failure (hepatocellular damage), but the seeds are the most toxic. What tree is this?

A

Sago Palm

63
Q

Two dogs present to your ER. One just ate some sugar free gum from mom’s purse no more than an hour ago. The other dog ate the dad’s sugar free gummy bears yesterday. How will their signs differ

A

If it wasn’t clear we are concerned here about Xylitol btw…
The dog who just got into the gum may be experiencing a large release of insulin which can cause hypoglycemia
The dog who ate the gummy bears yesterday may start having hepatic necrosis

64
Q

A young cat presents with fever, weight loss, and is icteric. On bloodwork there is a leukocytosis with a neutrophilia with a left shift and anemia. Her AST and bilirubin are also elevated. What might be going on? What is the pathogenesis?

A

feline acute suppurative cholangitis, neutrophils are within the bile duct lumen

65
Q

What is the primary treatment for feline acute suppurative cholangitis

A

antibiotics- broad spectrum like ampicillin, clavamox

66
Q

In order to see jaundice, weight loss, ascites, vomiting, PU/PD, and other clinical signs associated with chronic hepatopathy, what must have happened?

A

over 75% of the liver has been lost

67
Q

waxing and waning vague signs are common with acute or chronic hepatopathies

A

chronic

68
Q

What is the primary (most common) cause of chronic hepatopathy

A

idiopathic

69
Q

A doberman, labrador, Skye terrier, Bedlington terrier, Dalmatian, or cocker spaniel that has a chronic hepatopathy with an elevated ALT could have it because of what

A

Copper storage hepatitis

70
Q

Chronic hepatopathy is more common in cats or dogs

A

dogs

71
Q

what will give you a definite diagnosis for chronic active hepatitis

A

biopsy

72
Q

What should you do first to help treat copper storage hepatitis give zinc or D-penicillamine

A

D-penicillamine! this is the chelator, give zinc after chelation

73
Q

What is the main treatment of hepatic lipidosis

A

feeeeeddddd (me Seymour)

74
Q

A older small breed dog with diabetes mellitus presents with crusting on its paw pads, nose, and perianal region. On ultrasound his liver looks like Swiss cheese. What might he have and what is the mainstay of treatment?

A

Hepatocutaneous syndrome (superficial necrolytic dermatitis), give him more protein (amino acids)

75
Q

A can with chronic non-suppurative/mixed and lymphocytic portal hepatitis will have what clinical symptoms (because otherwise it looks like neutrophilic cholangitis)

A

Gradual weight loss, chronic disease, and hyperglobulinemia

76
Q

What are the two choleretics we talked about

A

Ursodiol and Deoxycholic acid

77
Q

What two veins may an extrahepatic portosystemic shunt attach to when coming from the portal system and bypassing the liver

A

the caudal vena cava or the azygous vein

78
Q

What are the three main categories for clinical signs of an extra-hepatic portosystemic shunt

A

Neurological (head pressing, circling, seizures, lethargy)
Gastrointestinal (vomiting, weight loss, anorexia)
Urinary tract signs (ammonium bitrate stones causing strangularia, pollakiuria, and hematuria)

79
Q

what are some special clinical signs that kitty cats with extra-hepatic portosystemic shunts have

A

drooling and copper eyes

80
Q

what type of anemia do you see with an extra-hepatic portosystemic shunt

A

microcytic, normochromic nonregenerative anemia

81
Q

What will the serum bile acids look like in an animal with an extra-hepatic portosystemic shunt

A

the post-prandial will be higher than the pre-prandial (normally the post-prandial shouldn’t be significantly higher

82
Q

What are the goals with medical management for an extra-hepatic portosystemic shunt

A

decrease absorption of toxins produced by intestinal bacteria
decrease interaction between bacteria and nitrogenous substrates in GI tract (so can’t make ammonium)

83
Q

What is the key part of a hepatic support diet in terms of medically managing an extra-hepatic portosystemic shunt patient

A

restricting protein amount and type- milk and vegetable proteins better than animal to reduce workload on liver

84
Q

What disease is similar to an extra-hepatic portosystemic shunts but is typically diagnosed at an older age

A

Microvascular dysplasia- portal vein hypoplasia

85
Q

Unlike an extra-hepatic portosystemic shunt, an intrahepatic shunt typically is seen in what type of dog

A

large breed (GSD, Goldens, labs, Irish wolfhounds)

86
Q

What is the pathogenesis of a gall bladder mucocele

A

thick bile–>immobile–> stretch GB wall–>necrosis–>peritonitis

87
Q

What are three predisopsing factors for developing a gall bladder mucocele

A

dyslipidemia, gall bladder dysmotility, endocrine disease/exogenous steroids

88
Q

What would you see on clinpath with a gall bladder mucocele

A

cholestatic pattern, elevated bilirubin and ALT,
left shift if there is bile peritonitis

89
Q

What are the three parts of medical treatment for a gall bladder mucocele

A

a choleretic (like ursodiol), an antioxidant (like SAMe or Silymarin), an antimicrobial (quinolone)

90
Q

What is the composition typically of a cholecystolith (3 things)

A

Cholesterol, bilirubin (or derivatives), calcium

91
Q

Why do cholecystoliths form

A

an imbalance between bile salts and cholesterol often secondary to hypercholesterolemia, hypertriglyceridemia, endocrine disease (diabetes, cushings, hypothyroidism), etc.

92
Q

What would you see on the clinicopathologic findings of a cat with cholecystitis

A

elevated ALT and total bilirubin (dogs have a cholestatic pattern)

93
Q

The treatment for cholecystitis is usually what

A

antimicrobials (quinolones)

94
Q

You ultrasound a gall bladder and you see thickened walls, and choleliths and gas within, what are you thinking might be going on with the gall bladder (other than the stones)

A

cholecystitis

95
Q

What are the three main causes for Extrahepatic bile duct obstruction

A

choledocholiths, pancreatitis, cancer (of bile duct, pancreas, duodenum)

96
Q

Most of the pancreas does what type of function

A

exocrine

97
Q

How does the pancreas prevent autodigestion

A

It secretes zymogen as an inactive precursor, it isn’t activated until it is in the duodenum and is activated by trypsin
The pancreas also releases pancreatic secretory trypsin inhibitor to keep trypsin from being activated within the pancreatic tissue

98
Q

What are the three major exocrine products of the pancreas (broad categories)

A

Proteases, amylases, and lipases

99
Q

We give entyce to stimulate hunger, what pancreatic hormone does it mimic

A

Ghrelin

100
Q

A German Shepherd has gross fatty stools (aka steatorrhea), a BCS of 2/9, and his owner complains he is always ravenous (omg voracious appetite with weight loss not many things do this). What might he have?

A

exocrine pancreatic insufficiency

101
Q

What are the two major causes of EPI

A

A lack of pancreatic ancinar cells (congenital, acquired, degenerative) or obstruction of the pancreatic duct

102
Q

What vitamin is produced in the pancreas that needs to be supplemented in dogs with EPI

A

Vitamin B12

103
Q

How is exocrine pancreatic insufficiency diagnosed and is this test more sensitive or specific (sorry I know I hate epi too but he seemed to harp on this)

A

Trypsin-like immunoreacitivity- will be low in EPI dogs
this test has high sensitivity so it can rule out the disease well (you can trust the negative)

104
Q

How can you treat EPI

A

feed the animal dried pancreatic extract or raw pancreas (hey at least its better than feeding the pigs the diseased intestines of their friends)

105
Q

Do you need to restrict fat in the diet of a dog with EPI

A

nope, just avoid super high fat diets and high fiber (high fiber because it will decrease digestibility and we want these guys getting alllll the nutrients- say it with me animals require….)

106
Q

Your EPI German shepherd friend isn’t responding to the treatment, what steps should you take to try and help

A
  1. evaluate the form of enzyme replacement
  2. Look for concurrent conditions
  3. proton pump inhibitor (acid may destroy supplemental lipase)
107
Q

Dogs are more likely to have what type of pancreatitis compared to cats

A

dogs usually have the acute form more and cats often have the chronic form

108
Q

Is a high fat diet a risk factor for pancreatitis

A

noooo

109
Q

pancreatitis from bacteria and multi-organ inflammation is more common in what animal

A

cats (cause they always must be special)

110
Q

What is a good test for pancreatitis (especially acute)

A

Pancreatic lipase immunoreactivity (PLI)

111
Q

T/F pancreatitis patients are usually just a little painful and don’t typically need pain meds

A

false, it is very painful and in severe cases may even be on a fentanyl CRI

112
Q

Why is fresh frozen plasma helpful for pancreatitis patients

A

it provides albumin, coagulation factors, is anti-inflammatory, and has protease inhibitors

113
Q

When is a low fat diet typically used for DOGS with pancreatitis

A

in cases with chronic pancreatitis

114
Q

What negative prognostic indicator is often common with cats with chronic pancreatitis

A

having another inflammatory disease like IBD (2/3 of cats have concurrent disease)

115
Q

What is the most common hepatic neoplasia in a dog

A

Trick question! The most common neoplasia in a dog’s liver is typically metastatic spread but the most common primary liver tumor is hepatocellular carcinoma

116
Q

What are the 3 ways to categorize hepatic tumors

A

Massive (solitary mass in one lobe), Nodular (multifocal in more than one lobe), Diffuse (multifocal to coalescing in all lobes)

117
Q

Hepatocellular carcinoma in dogs is most commonly what morphology and has what prognosis

A

it is commonly massive and has a good prognosis if it can be surgically removed (only invading one lobe and not invading a blood vessel in a major way)

118
Q

What is the most common liver neoplasia in a cat and what morphology is it usually

A

Bile duct adenoma, can have variable morphology (mix of all three)

119
Q

Can you ever surgically resect a diffuse morphological neoplasia

A

no, by definition is unresectable

120
Q

Which morphologic subtypes typically have a higher metastatic rate

A

nodular and diffuse

121
Q

Is it common to be able to palpate a cranial abdominal mass on physical exam of an animal with hepatic neoplasia

A

yes! Up to 75% of cases you can palpate a mass

122
Q

T/F you can use the patterns of a blood chemistry (ex. ALT, AST, ALP, GGT) to help you determine the histotype or type of neoplasia

A

false

123
Q

If you were a surgeon and got to choose, what side would you want a liver tumor to grow on for easiest resection

A

the left side- less vessels here

124
Q

Which has the higher metastatic rate the bile duct carcinoma in the cat or the hepatocellular carcinoma in the dog

A

bile duct carcinoma much higher metastatic rate and poorer prognosis

125
Q

What is the metastatic rate and prognosis of the exocrine pancreatic carcinoma

A

very high metastatic rate and very poor prognosis

126
Q

A cat presents with acute alopecia that started on its abdomen and is bilateral, the skin is shiny looking. What is going on

A

the cat may have an exocrine pancreatic carcinoma

Small Animal Digestive (2 decks)

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