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pc vet > Jaundice/Liver Disease > Flashcards

Jaundice/Liver Disease Flashcards

1
Q

Define pre-hepatic jaundice

A

increased haem production in XS of liver’s ability to take up and process

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2
Q

Define hepatic jaundice

A

disturbed handling of bilirubin by the hepatocytes

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3
Q

potential causes of post-hepatic jaundice

A
  • sepsis or severe inflm disease (mild but can see jaundice)
  • hyperT in cats - mild inc. bili but not overt jaundice
  • fever + starvation = mild inc. bili but not overt jaundice
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4
Q

DDx pre-hepatic jaundice

A
  1. Haemolysis
    - IMHA: primary and secondary
    - Infections eg. Mycoplasma haemofelis
    - drugs/toxins eg. zinc, copper, lead, onions
    - congenital haemolytic anaemias
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5
Q

name an infectious cause of haemolysis

A

mycoplasma haemofelis

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6
Q

ddx (4) for primary hepatic jaundice in dogs

A 
D
A
M
N: hepatobiliary neoplasia
I: chronic hepatitis, leptospirosis
T: toxin/drug induced
V
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7
Q

ddx (7) for primary hepatic jaundice in cats

A 
D
A
M: hepatic lipidosis + amyloidosis
N: hepatobiliary neoplasia (lymphoma)
I: cholangitis/cholangiohepatitis (+/- post hepatic), FIP, lymphocytic cholangitis
T: toxic/drug induced
V
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8
Q

2 major causes of post-hepatic jaundice

A
  • intrahepatic biliary compression

- extrahepatic obstruction (dz of gall bladder, bile duct, duodenum or pancreas

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9
Q

4 ddx of extra-hepatic obstruction

A
  • pancreatitis
  • neoplasia: bile duct, pancreas, duodenum
  • bild duct occlusion: cholelithiasis, sludged bile
  • bile duct or gall bladder rupture
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10
Q

2 characteristics of prehepatic jaundice on bloods

A
  1. sig. + regenerative (or pre-) anaemia

2. mild to mod liver enzyme increases

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11
Q

how can hepatic/biliary tract US be useful in differentiating causes of jaundice?

A

reveals bile duct obstruction and dilatation, may show abnormal parenchyma

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12
Q

3 causes of chronic liver disease

A
  1. canine chronic hepatitis (+ copper-assoc. hepatitis)
  2. feline cholangitis/cholangiohepatitis
  3. hepatobiliary neoplasia
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13
Q

CS of acute liver injury/failure

A

anorexia, vom, neuro signs, PU/PD

w/ varying degrees of icterus, coagulopathy, hepatic encephalopathy

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14
Q

list 5 toxic causes of acute liver failure

A
  • aflatoxins
  • amanita mushrooms
  • blue-green algae
  • cycad palms
  • xylitol
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15
Q

list 4 drugs assoc. w/ acute liver failure

A
  • oral benzos in cats
  • carprofen
  • sulfonamides
  • phenobarbitol
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16
Q

list 6 infectious causes of acute liver disease

A
  • infectious canine hepatitis
  • FIP
  • lepto
  • Platynosum fastosum
  • Salmonella
  • Toxoplasmosis
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17
Q

Diagnosis of acute liver failure

A
  1. Biochemical evidence of reduced liver function + increased PT and/or PTT (>1.5x)
  2. Liver US
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18
Q

6 branches of acute liver disease management

A
  1. stop any existing meds
  2. IVFT + lytes (usu. low in potassium)
  3. Plasma transfusion (clotting factors)
  4. Treat hepatic encephalopathy
  5. Antimicrobials: amoxicillin 20mg/kg q8h IV
  6. Vit.K 1mg/kg q24h SC
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19
Q

explain the aetiology of hepatic lipidosis in cats

A
  1. Acute - partial or complete anorexia 1-2wks –> a neg. energy balance
  2. assoc. w/ poor appetite (stressful event/other disease)
  3. Reversed by nutrition and correction of underlying disease
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20
Q

US appearance of hepatic lipidosis

A
  • hepatomegaly characterised by hyperechoic appearance of liver by US
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21
Q

6 branches of treatment of hepatic lipidosis in cats

A
  1. IVFT + lytes
  2. Feeding tube: N-tube initially (2-3d), then GA and place O/G- tube for proactive nutrition
  3. Correct underlying disorder (that caused the anorexia)
  4. Maropitant 1mg/kg
  5. Tx hepatic encephalopathy if present
  6. +/- L-carnitine 250mg/cat q24h PO
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22
Q

Later signs of chronic hepatopathies

A
  • prolonged recovery from sedation/GA
  • icterus
  • ascites
  • hepatic encephalopathy
  • bleeding tendencies (bruising, melena)
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23
Q

what test should you perform prior to liver biopsy?

A

coag - PT and APTT often prolonged by liver disease

24
Q

how many g of liver issue are needed for diagnostics?

A

4g - culture, copper assessment, histopath

25
Q

ALT is elevated in liver disease but also elevated w/ …..

A

…many rel. benign disorders - anaemia, hypoxaemia, trauma

26
Q

ALP activity is elevated in liver disease but also induced by:

A
  1. corticosteroids (iatrogenic, cushing’s, phenobarbitol)
  2. young animals (<6m)
  3. infection/sepsis
  4. Even mild bile duct dx (IBD, pancreatitis)
  5. Bone disease
27
Q

average age of dog w/ chronic hepatitis

A

6-8ys (range 2-14ys)

28
Q

5 arms of tx of chronic hepatopathies in dogs

A
  1. reduce inflam: immunosuppressant, anti-ox, reduce cholestasis
  2. inhibit/reduce fibrosis
  3. reduce Cu accumulation by enhancing its excretion
  4. Manage the complications - reduce ascites, control and reduce gastric bleeding, and prevent and control hepatic encephalopathy
  5. Monitor progress - rpt bloods +/- biopsy
29
Q

what is UDCA?

A

ursodeoxycholic acid - a natural hydrophilic bile acid which improve flow of bile and is an antioxidant which reduces inflammation

30
Q

when is UDCA contraindicated?

A

in bile duct obstructions

31
Q

UDCA dose

A

10-15mg/kg q24h PO

32
Q

when can you use prednisolone in chronic hepatopathies?

A
  • rule out infectious causes

- 1mg/kg q24h PO taper over time

33
Q

give 4 anti-ox. compounds used for chronic hepatopathies

A
  1. S-adenosyl-L-methionine
  2. Silymarin
  3. Vit E
  4. Vit C
34
Q

SAMe dose

A

20mg/kg q24h PO

35
Q

milk thistle dose

A

50-200mg/dog q24h PO

36
Q

3 dietary changes to manage a dog w/ chronic hepatopathy

A
  1. mod restricted protein
  2. reduce copper
  3. increase anti-ox (Vit.E/C, selenium)
37
Q

why restrict protein in chronic hepatopathies?

A
  • reduces ammonia formation —> hepatic encephalopathy
38
Q

what are the 3 clinically recognised forms of feline inflammatory liver disease?

A
  1. neutrophilic cholangitis (NC)
  2. Lymphocytic cholangitis (LC)
  3. Chronic cholangitis (caused by liver fluke)
39
Q

what causes neutrophilic cholangitis?

A

ascending bacterial infection of biliary tract from intestine

40
Q

CS of neutrophilic cholangitis

A

cats are yellow and unwell

41
Q

Tx of neutrophilic cholangitis in cats

A
  1. Antibiotics: aminopen + pradofloxacin 4-8wks
  2. UDCA 10-15mg/kg q24h PO
  3. Opioids
  4. Supportive care
42
Q

Tx of lymphocytic cholangitis in cats

A
  1. Prednisolone 2mg/kg q24h PO
  2. UDCA 10-15mg/kg q24h PO
  3. Supportive care
43
Q

HE is caused by?

A

failure to detoxify ammonia from the GIT by the liver in the urea cycle

44
Q

HE causes signs assoc. w/ which anatomical part of the brain?

A

symmetrical forebrain signs

45
Q

2 causes of a young animal with HE

A
  1. Congenital PSS

2. Congenital hepatic fibrosis –> acquired shunts + ascites

46
Q

2 causes of adults w/ HE

A
  1. Portal hypertension assoc. w/ liver disease and acquired shunts
  2. Acute loss of liver function (acute hepatitis)
47
Q

3 forebrain signs assoc. w/ HE

A
  1. Altered mentation: obtundation, aimless pacing, stargazing, head pressing
  2. Seizures (less common)
  3. Central blindness
48
Q

list 5 exacerbating factors of HE

A
  1. Protein in the GIT
  2. Hypokalaemia
  3. Alkolosis
  4. Dehydration
  5. Sepsis/infection
49
Q

immediate management plan for HE

A
  1. tx dehydration
  2. tx GIT ulceration
  3. Manage coagulopathies
  4. Empty the GIT
  5. Avoid drugs that reg. hepatic metabolism
50
Q

technique for emptying the GIT in acute management of HE

A
  1. Colonic lavage (under propofol/iso GA if needed) –> warm water enemas followed by retention enemas until signs stop (lactulose and water mixture 3:7 q6h per rectum).
51
Q

what drugs do you avoid w/ HE?

A

those which require hepatic metabolism eg. diazepam and barbiturates

52
Q

ongoing management of HE

A
  1. Lactulose
  2. Antimicrobials
  3. Dietary protein restriction
53
Q

what is the MOA of lactulose in management of HE

A

Lactulose lowers colonic pH + increased GIT transit time reduces bacterial loads

54
Q

admin/dose of lactulose

A

titrate to effect - soft stool consistency
2-5ml q12-24h in small dogs
10-20ml q12-24h in large dogs

55
Q

name an antimicrobial used to decrease bacterial load (and toxins) in HE management

A

amoxicillin

pc vet (16 decks)

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