Vascular Diseases of the Liver

Question 1

what is multiple portosystemic shunts often associated with?

Answer 1

ascites

Question 2

how many vessels usually make up a congenital portosystemic shunt?

Answer 2

single, large caliber vessel

Question 3

who primarily gets intrahepatic congenital portosystemic shunts?

Answer 3

large breed dogs

Question 4

what is a major consequence of congenital portosystemic shunts?

Answer 4

decreased hepatic perfusion

Question 5

what are the general clinical signs of congenital portosystemic shunts?

Answer 5

stunted growth/failure to thrive
gastrointestinal signs
neurological signs
urinary signs
ptyalism
copper irides

Question 6

what can be seen on clinical pathology to diagnose a congenital portosystemic shunt?

Answer 6

fasting hyperammonemia
elevated SBA
synthetic failure
microcystic anemia
ammonium biurate crystalluria/urolithiasis

Question 7

what things are low on a blood panel with a congenital portosystemic shunt?

Answer 7

albumin
cholesterol
glucose
BUN

Question 8

what characterizes primary hypoplasia of the portal vein?

Answer 8

congenital: abnormally small extra- or intrahepatic portal veins

Question 9

can the liver be grossly normal with primary hypoplasia of the portal vein?

Answer 9

yes

Question 10

what is primary hypoplasia of the portal vein with portal hypertension accompanied by?

Answer 10

portal hypertension
ascites
multiple shunts

Question 11

who is passive hepatic congestion common in?

Answer 11

all species with right congestive heart failure

Question 12

what does telangiectasia result from?

Answer 12

dilated sinusoidss in areas where hepatocytes have been lost

Question 13

what is a intrahepatic arteriovenous fistula?

Answer 13

direct anastomosis between the hepatic artery and branches of the portal vein
congenital or acquired

Question 14

what is portal vein thrombosis associated with?

Answer 14

hypercoagulable states

Question 15

where is hepatic infarction more common?

Answer 15

margins of liver

Question 16

what is seen histologically with hepatic infarctions?

Answer 16

zone of coagulative necrosis bordered by inflammatory cells and congestion

Question 17

what are some common vascular lesions?

Answer 17

portosystemic shunts
chronic passive congestion
telangiectasia

Question 18

do the two blood sources to the liver mix?

Answer 18

yes: sinusoids

Question 19

what is prehepatic hypertension?

Answer 19

impaired flow prior to liver
thrombus/embolys
external compression

Question 20

what is intrahepatic portal hypertension?

Answer 20

increased sinusoidal resistance

Question 21

what are some causes of portal hypertension?

Answer 21

portal vein thrombosis
portal vein hypoplasia
chronic passive congestion
veno-occlusive disease
hepatic AV fistula

Question 22

what are the two types of extrahepatic congenital portosystemic shunts?

Answer 22

portocaval: caudal vena cava
porto-azygous: azygous vein

Question 23

what does abnormal ammonia metabolism lead to?

Answer 23

hepatic encephalopathy
ammonium biurate crystalluria/urolithiasis

Question 24

what imaging can be done to diagnose a congenital portosystemic shunt?

Answer 24

AUS especially intrahepatic
trans-splenic portal scintigraphy
CT angiography

Question 25

is primary hypoplasia of the portal vein associated with portal hypertension?

Answer 25

sometimes: non-cirrhotic portal hypertension

Question 26

what does chronic hepatic congestion look like?

Answer 26

central vein/sinusoidal distension/congestion persistent hypoxia replacement fibrosis nutmeg liver: sinusoidal congestion with fibrosis

Question 27

how are intrahepatic arteriovenous fistulas classified?

Answer 27

branching pattern

Question 28

what leads to intrahepatic portal hypertension?

Answer 28

any chronic process that induced extracellular matrix deposition: inflammation, amyloid

Question 29

what are some causes of hepatic hypoperfusion?

Answer 29

congenital portosystemic shunts portal vein hypoplasia chronic passive congestion veno-occlusive disease portal vein thrombosis hepatic infarction

Question 30

how can an intrahepatic congenital portosystemic shunt be addressed?

Answer 30

thrombogenic coils

Question 31

how can an extrahepatic congenital portosystemic shunt be addressed?

Answer 31

ameroid constrictors/cellophane bands

Question 32

is there ascites with congenital portosystemic shunts?

Answer 32

no: normal portal vein pressure

Question 33

what neurologic signs are seen with congenital portosystemic shunts?

Answer 33

especially postprandial weakness somnolence head pressing cortical blindness aggression seizures

Question 34

who usually gets primary hypoplasia of the portal vein with portal hypertension?

Answer 34

young large breed dogs

Question 35

what is histology of primary hypoplasia of the portal vein with portal hypertension indistinguishable from?

Answer 35

congenital portosystemic shunts