Metabolic Diseases of the Liver Flashcards
Which breed is known to have glycogen-like vacuolar hepatopathy?
Scottish Terriers in the USA and France
What are the clinical signs associated with glycogen-like vacuolar hepatopathy?
- they look like they have Cushing’s (pot belly, hepatomegaly, PU/PD) but the endocrine status is variable
- can have profound side effects if treating with ketoconazole/mitotane, triclosan is not effective
- need to avoid hepatotoxic drugs like NSAID
- tx = supportive therapy (SAMe)
What can cause Ito cell proliferation in cats?
- vitamin A toxicosis
- hepatic injury
What are the clinical signs associated with feline hepatic lipidosis?
- anorexia
- vomiting
- weakness
- weight loss
What’s the treatment principles for feline hepatic lipidosis?
- enteral feeding
- fluid resuscitation
- mirtazapine not effective enough.
- cobalamin supplementation
- anti-oxidant supplementation
- GI supportive therapy
How is feline hepatic lipidosis diagnosed?
ultimately, histology
- but need to have normal coagulation times (often abnormal, but clinically significant bleeding = rare)
- manual TruCut
- wedge biopsy – can also sample other organs
FNA
- false positive possible, but it’s a quick, relatively safer option compare to biopsy
Biochem
- hypokalemia
- elevated bilirubin, ALP, ALT
- GGT = normal in primary hepatic lipidosis
- hyperglycemia (common but transient)
What’s the pathophysiology of superficial necrotizing dermatitis?
Amino acid deficiency
- upregulation of hepatic metabolic activities (glucagon?) leading to increased consumption of amino acids
What are the clinical signs of superficial necrotizing dermatitis?
- hyperkeratotic, erythematous, crusting skin lesions, often on extremities
- lesions can develop fissures leading to secondary bacterial infection
- diabetes mellitus may develop due to high glucagon level leading to insulin resistance
- dogs often older (>10yo), small breeds (but Goldens, Border Collies also reported)
How is superficial necrotizing dermatitis diagnosed?
Histology
- elevation in ALP and ALT; hypoalbuminemia
- Classic appearance on AUS – Swiss cheese like appearance
How is superficial necrotizing dermatitis treated?
poor prognosis - euthanasia within 6m
- if there is no glucagonoma, can try supportive therapy: high quality protein, lots of protein, supplemental zinc, essential amino acids, egg yolk?
What’s the most common form of alpha 1 anti-trypsin deficiency?
Intermediate
- there are 3 forms in dogs: fast, intermediate, and slow
- signs of chronic hepatitis
really only noted in Cockers in the 90s
What’s the clinical signs in humans with alpha 1 anti-trypsin deficiency?
most common signs = emphysema, liver involvement = small portion of affected patients
What’s the most common form of amyloid in amyhloidosis?
serum amyloid A
- it’s an acute phase protein produced by the liver in the face of inflammation
- an increase in serum amyloid A is necessary to develop subsequent amyloidosis
In which cat breed is hepatic amyloidosis most common?
Siamese!
Abyssinians actually get amyloidosis very commonly, but it effects the kidneys
What’s the clinical presentation of feline amyloidosis?
hepatic amyloidosis –> makes the liver friable –> fractures –> bleeding
- often presents with intrabdominal bleeding, hypotension, anemia; can be fatal
- jaundice, hepatomegaly
