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
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
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)
4
Q
What is an example of something that causes pre-hepatic disease
A
severe anemia from hemolysis
5
Q
What are some post-hepatic disease causes
A
bile duct obstruction, pancreatitis
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
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
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
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
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
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
12
Q
what are the five pseudoliver function tests
A
albumin, glucose, bilirubin, urea nitrogen, cholesterol
13
Q
what are the two specific liver tests
A
ammonia and bile acids
14
Q
what does anemia of chronic disease/early blood loss look like
A
normocytic, normochromic
15
Q
what does blood loss anemia look like on bloodwork
A
macrocytic, hypochromic
16
Q
What does iron deficiency anemia/ anemia of portosystemic shunts look like
A
microcytic, hypochromic
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
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
19
Q
If there is liver dysfunction how does that impact cholesterol
A
it will be decreased
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)
21
Q
Will bilirubin be increased or decreased with liver disfunction
A
increased
22
Q
How might glucose be affected by liver dysfunction
A
decreased
23
Q
What biochemistry liver enzymes are increased with cholestatic diseases
A
ALP and GGT
24
Q
Which liver enzyme is leaked when the hepatocyte cytoplasm is damaged (aka is a liver damage enzyme)
A
ALT
25
Which is more concerning an elevated ALT/ALP in a cat or a dog
in a cat! the half lives are much shorter
26
T/F with a SEVERELY damaged liver the ALT will be high
False, when there is enough cell damage there won't be anymore leakage of ALT so it may not be as elevated anymore
27
What type of crystals can you see with liver dysfunction
bilirubin or/and urate
28
Can you use bile acids if an animal has hyperbilirubinemia/is icteric
nope! they won't be accurate
29
A gall bladder with a mucocele will look like what type of fruit on an X-ray
kiwi, sorry I don't make this up apparently vet med just loves our food comparisons
30
Is FNA a good choice for diagnosing liver issues
no its usually not very accurate
31
what are some concerns with taking a liver biopsy that you should consider
hemorrhage (coagulopathic)- because of lack of clotting factors
hypoglycemia
slower drug metabolism
32
Do you need to restrict protein in a liver diet
no, unless they have hepatic encephalopathy
33
When considering a liver diet what nutrients do you want to decrease to keep them from accumulating more
copper and Iron
34
What nutrient can help bind copper and is a cofactor in the urea cycle that you can give in the diet
zinc
35
What is SAMe
an antioxidant
36
What antioxidant is given usually in the hospital IV for acute issues like a liver toxicity
N-acetylcysteine (NAC)
37
What is silymarin (Milk thistle extract) used for
it is an antioxidant and is anti-inflammatory
38
what fat soluble vitamin is also an antioxidant and anti-inflammatory (can help limit fibrosis)
vitamin E
39
What is the mechanism of action of ursodeoxycholic acid
choleretic (increase volume of bile) and acts as hepatocyte cytoprotection and is immunomodulating
40
Which drug is used as a copper chelator to mobilize copper from the liver to the urine
D-penicillamine
41
Can you also use zinc as a copper chelator
no, it only binds copper in the GI system to decrease absorption, is NOT a chelator
42
How are corticosteroids helpful in managing liver disease, but how can it make monitoring difficult
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
43
What does colchicine do
it can help minimize fibrosis in the liver
44
Why might you give a RAAS inhibitor to a patient with liver disease
to decrease portal hypertention which can also help decrease fibrosis formation
45
What is the main goal of treatment when trying to control hepatoencephalopathy and what drugs/treatments can help with this
Clear GI of absorbable potential neurotoxic substances
can give lactulose, enemas, also antibiotics (less bacteria to create ammonia)
46
Gastrointestinal ulceration can be a common complication with liver disease, what treatments might you give to manage this
proton pump inhibitor- omprazole
H2 blockers
Mucosal protectants- sucralfate, bismuth, barium
47
T/F in acute liver failure it is better to give vitamin K IV than orally
False, never give Vit. K IV and only every give orally because it can cause an allergic reaction
48
What are 3 potential treatments for ascites
diuretics like furosemide or Spironolactone, restrict dietary sodium (mildly), abdominocentesis
49
You should avoid metabolic ________ because it can worsen hepatoencephalopathy
alkalosis
50
What causes methemoglobinemia in cats and is classified as a dose dependent toxicity
acetaminophen
51
What anti-convulsant can cause a chronic, dose dependent liver toxicity
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
Some Labrador Retrievers can have liver toxicities from what drug
Carprofen
53
What drug are black and tan dogs sensitive to
potentiated sulfas
54
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)
Because methimazole the treatment for hyperthyroidism can cause idiopathic liver toxicity within the first month of starting it
55
What's a weird liver thingy that older Scottish terriers get
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
If a dog has toxic hepatopathy from blue green algae, afalotoxicosis, or xylitol what is the prognosis
probs not that great... still may get liver failure :/
57
A young dog presents with vomiting, fever, lethargy, abdominal pain. Its eyes are also a weird hazy blue. What does this dog possibly have
Infectious canine hepatitis/ Canine adenovirus 1
58
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?
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
What antibiotic must you give to get rid of leptospirosis IN THE CELLS (sorry for yelling its an important distinction)
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
How can an animal get aflatoxicosis
from moldy grains in the diet (like corn- it has the juice! and apparently the mold too...)
61
Which pretty mushroom will hurt the liver (causes fulminant hepatic necrosis)
amanita mushroom (and honestly maybe others, don't eat mushrooms you don't know what they are friends)
62
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?
Sago Palm
63
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
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
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?
feline acute suppurative cholangitis, neutrophils are within the bile duct lumen
65
What is the primary treatment for feline acute suppurative cholangitis
antibiotics- broad spectrum like ampicillin, clavamox
66
In order to see jaundice, weight loss, ascites, vomiting, PU/PD, and other clinical signs associated with chronic hepatopathy, what must have happened?
over 75% of the liver has been lost
67
waxing and waning vague signs are common with acute or chronic hepatopathies
chronic
68
What is the primary (most common) cause of chronic hepatopathy
idiopathic
69
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
Copper storage hepatitis
70
Chronic hepatopathy is more common in cats or dogs
dogs
71
what will give you a definite diagnosis for chronic active hepatitis
biopsy
72
What should you do first to help treat copper storage hepatitis give zinc or D-penicillamine
D-penicillamine! this is the chelator, give zinc after chelation
73
What is the main treatment of hepatic lipidosis
feeeeeddddd (me Seymour)
74
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?
Hepatocutaneous syndrome (superficial necrolytic dermatitis), give him more protein (amino acids)
75
A can with chronic non-suppurative/mixed and lymphocytic portal hepatitis will have what clinical symptoms (because otherwise it looks like neutrophilic cholangitis)
Gradual weight loss, chronic disease, and hyperglobulinemia
76
What are the two choleretics we talked about
Ursodiol and Deoxycholic acid
77
What two veins may an extrahepatic portosystemic shunt attach to when coming from the portal system and bypassing the liver
the caudal vena cava or the azygous vein
78
What are the three main categories for clinical signs of an extra-hepatic portosystemic shunt
Neurological (head pressing, circling, seizures, lethargy)
Gastrointestinal (vomiting, weight loss, anorexia)
Urinary tract signs (ammonium bitrate stones causing strangularia, pollakiuria, and hematuria)
79
what are some special clinical signs that kitty cats with extra-hepatic portosystemic shunts have
drooling and copper eyes
80
what type of anemia do you see with an extra-hepatic portosystemic shunt
microcytic, normochromic nonregenerative anemia
81
What will the serum bile acids look like in an animal with an extra-hepatic portosystemic shunt
the post-prandial will be higher than the pre-prandial (normally the post-prandial shouldn't be significantly higher
82
What are the goals with medical management for an extra-hepatic portosystemic shunt
decrease absorption of toxins produced by intestinal bacteria
decrease interaction between bacteria and nitrogenous substrates in GI tract (so can't make ammonium)
83
What is the key part of a hepatic support diet in terms of medically managing an extra-hepatic portosystemic shunt patient
restricting protein amount and type- milk and vegetable proteins better than animal to reduce workload on liver
84
What disease is similar to an extra-hepatic portosystemic shunts but is typically diagnosed at an older age
Microvascular dysplasia- portal vein hypoplasia
85
Unlike an extra-hepatic portosystemic shunt, an intrahepatic shunt typically is seen in what type of dog
large breed (GSD, Goldens, labs, Irish wolfhounds)
86
What is the pathogenesis of a gall bladder mucocele
thick bile-->immobile--> stretch GB wall-->necrosis-->peritonitis
87
What are three predisopsing factors for developing a gall bladder mucocele
dyslipidemia, gall bladder dysmotility, endocrine disease/exogenous steroids
88
What would you see on clinpath with a gall bladder mucocele
cholestatic pattern, elevated bilirubin and ALT,
left shift if there is bile peritonitis
89
What are the three parts of medical treatment for a gall bladder mucocele
a choleretic (like ursodiol), an antioxidant (like SAMe or Silymarin), an antimicrobial (quinolone)
90
What is the composition typically of a cholecystolith (3 things)
Cholesterol, bilirubin (or derivatives), calcium
91
Why do cholecystoliths form
an imbalance between bile salts and cholesterol often secondary to hypercholesterolemia, hypertriglyceridemia, endocrine disease (diabetes, cushings, hypothyroidism), etc.
92
What would you see on the clinicopathologic findings of a cat with cholecystitis
elevated ALT and total bilirubin (dogs have a cholestatic pattern)
93
The treatment for cholecystitis is usually what
antimicrobials (quinolones)
94
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)
cholecystitis
95
What are the three main causes for Extrahepatic bile duct obstruction
choledocholiths, pancreatitis, cancer (of bile duct, pancreas, duodenum)
96
Most of the pancreas does what type of function
exocrine
97
How does the pancreas prevent autodigestion
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
What are the three major exocrine products of the pancreas (broad categories)
Proteases, amylases, and lipases
99
We give entyce to stimulate hunger, what pancreatic hormone does it mimic
Ghrelin
100
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?
exocrine pancreatic insufficiency
101
What are the two major causes of EPI
A lack of pancreatic ancinar cells (congenital, acquired, degenerative) or obstruction of the pancreatic duct
102
What vitamin is produced in the pancreas that needs to be supplemented in dogs with EPI
Vitamin B12
103
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)
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
How can you treat EPI
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
Do you need to restrict fat in the diet of a dog with EPI
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
Your EPI German shepherd friend isn't responding to the treatment, what steps should you take to try and help
1. evaluate the form of enzyme replacement
2. Look for concurrent conditions
3. proton pump inhibitor (acid may destroy supplemental lipase)
107
Dogs are more likely to have what type of pancreatitis compared to cats
dogs usually have the acute form more and cats often have the chronic form
108
Is a high fat diet a risk factor for pancreatitis
noooo
109
pancreatitis from bacteria and multi-organ inflammation is more common in what animal
cats (cause they always must be special)
110
What is a good test for pancreatitis (especially acute)
Pancreatic lipase immunoreactivity (PLI)
111
T/F pancreatitis patients are usually just a little painful and don't typically need pain meds
false, it is very painful and in severe cases may even be on a fentanyl CRI
112
Why is fresh frozen plasma helpful for pancreatitis patients
it provides albumin, coagulation factors, is anti-inflammatory, and has protease inhibitors
113
When is a low fat diet typically used for DOGS with pancreatitis
in cases with chronic pancreatitis
114
What negative prognostic indicator is often common with cats with chronic pancreatitis
having another inflammatory disease like IBD (2/3 of cats have concurrent disease)
115
What is the most common hepatic neoplasia in a dog
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
What are the 3 ways to categorize hepatic tumors
Massive (solitary mass in one lobe), Nodular (multifocal in more than one lobe), Diffuse (multifocal to coalescing in all lobes)
117
Hepatocellular carcinoma in dogs is most commonly what morphology and has what prognosis
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
What is the most common liver neoplasia in a cat and what morphology is it usually
Bile duct adenoma, can have variable morphology (mix of all three)
119
Can you ever surgically resect a diffuse morphological neoplasia
no, by definition is unresectable
120
Which morphologic subtypes typically have a higher metastatic rate
nodular and diffuse
121
Is it common to be able to palpate a cranial abdominal mass on physical exam of an animal with hepatic neoplasia
yes! Up to 75% of cases you can palpate a mass
122
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
false
123
If you were a surgeon and got to choose, what side would you want a liver tumor to grow on for easiest resection
the left side- less vessels here
124
Which has the higher metastatic rate the bile duct carcinoma in the cat or the hepatocellular carcinoma in the dog
bile duct carcinoma much higher metastatic rate and poorer prognosis
125
What is the metastatic rate and prognosis of the exocrine pancreatic carcinoma
very high metastatic rate and very poor prognosis
126
A cat presents with acute alopecia that started on its abdomen and is bilateral, the skin is shiny looking. What is going on
the cat may have an exocrine pancreatic carcinoma
