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Year 1/2 > Digestion & Metabolism 2: Feline Hepatic Dz > Flashcards

Digestion & Metabolism 2: Feline Hepatic Dz Flashcards

1
Q

CAUSES of…

  1. PRE-hepatic icterus?
  2. HEPATIC icterus?
  3. POST-hepatic icterus?
A
  1. PRE-hepatic icterus = HEMOLYSIS
  2. HEPATIC icterus = LIVER DYSFUNCTION
  3. POST-hepatic icterus = EXTRAHEPATIC BILE OBSTRUCTION
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2
Q

if an animal has a PORTOSYSTEMIC SHUNT & ICTERUS, what 2 clinical signs can we see?

A
  1. DYSURIA
  2. URATE UROLITHIASIS
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3
Q

6 main clinical signs of LIVER DISEASE in CATS?

A
  1. VOMITING
  2. D+
  3. HEPATIC ENCEPHALOPATHY
  4. PU/PD
  5. ABDOMINAL DISTENTION (hepatomegaly or ascites)
  6. DYSURIA
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4
Q

what 2 things can ABDOMINAL RADS tell you about the liver?

A

2 things?
1. the SIZE of the LIVER

  1. how/if it varies from normal based on the GASTRIC AXIS
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5
Q

= define the GASTRIC AXIS

A

= gastric acid should be on the plane PARALLEL to the RIBS and SHOULD NOT EXTEND BEYOND THE COSTAL ARCH

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6
Q

id SIZE of a certain organ…

A

HEPATOMEGALY

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7
Q

id SIZE of a certain organ…

A

MICROHEPATICA

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8
Q

for FELINE hepatic dz, what imaging modality is MOST helpful for LIVER?

this is (sensitive/specific), not (sensitive/specific)

A

LIVER ULTRASOUND MOST HELPFUL

this is SENSITIVE, not SPECIFIC

meaning that IF DZ IS THERE IT’S THERE, but if not could still be there

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9
Q

what KIND of biopsy do we usually perform on the liver?

A

often LAPAROSCOPIC biopsies because LESS INVASIVE but CAN STILL GET A GOOD CHUNK OF TISSUE

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10
Q

what is the MOST common LIVER DISEASE IN CATS?

A

HEPATIC LIPIDOSIS

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11
Q

HEPATIC LIPIDOSIS…

= definition?

____ cause is MORE COMMON

= pathophysiology

5 potential SECONDARY causes?

A

= HEPATOCELLULAR FAT ACCUMULATION following ANOREXIA or CONGENITAL

SECONDARY cause is MORE COMMON

pathophys?
–> IMBALANCE between MOBILIZATION OF PERIPHERAL FAT STORES to LIVER and METABOLISM of FAT WITHIN HEPATOCYTES for ENERGY

5 potential SECONDARY causes?
1. CHOLANGITIS
2. IBD
3. PANCREATITIS
4. NEOPLASIA
5. PYELONEPHRITIS

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12
Q

LIPOPROTEIN LIPASE…

OVERALL function is to do WHAT?

in WELL-FED animals…

in STARVED animals….

A

OVERALL function is to PROMOTE FAT UPTAKE & STORAGE

in WELL-FED animals = ACTIVE

in STARVED animals = DOWNREGULATED

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13
Q

HORMONE SENSITIVE LIPASE…

OVERALL function is to do WHAT?

stimulated by WHAT 3 hormones?

inhibited by WHAT?

what can PREVENT this INHIBITORY SYSTEM rom working?

A

OVERALL PROMOTES BREAKDOWN of TRIGLYCERIDE that’s STORED IN FAT for RELEASE OF FATTY ACIDS for ENERGY

stimulated by…
1. STRESS HORMONES
2. CATECHOLAMINES
3. THYROID HORMONE

inhibited by INSULIN

if an animal is MARKEDLY OBESE, can cause INSULIN RESISTANCE and CANNOT USE HORMONE-SENSITIVE LIPASE & CANNOT BREAK DOWN FAT

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14
Q

TRUE/FALSE

cats with hepatic lipidosis are ALWAYS overweight

A

FALSE

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15
Q

HEPATIC LIPIDOSIS…

4 common clinical signs?

2 signs in SEVERE disease?

what on CBC is most commonly ABNORMAL with this dz?

A

4 common signs?
1. anorexia
2. weight loss
3. lethargy/hiding
4. ICTERUS

2 signs in SEVERE disease?
1. HEPATIC ENCEPHALOPATHY
2. NEUROLOGIC SIGNS

on CBC = ALP ELEVATED

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16
Q

if we suspect HEPATIC ENCEPHALOPATHY secondary to ____ ____…

what clinical sign do we usually see first?

what diagnostic should we do?

A

HEPATIC ENCEPHALOPATHY secondary to HEPATIC LIPIDOSIS

usually see PTYALISM (excessive drooling)

should do AMMONIA level

17
Q

2 diagnostics for HEPATIC LIPIDOSIS?

what is the PREFERRED definitive diagnostic test?

what ELSE can we use for diagnostics/what should we see? what situation might this be preferred for?

A

2 diagnostics?
1. ABDOMINAL RADS
–> HEPATOMEGALY

  1. ABDOMINAL US
    –> ENLARGED, BRIGHT LIVER
    –> also allows us to look for INTESTINAL or PANCREATIC dz that could’ve caused this

PREFERRED definitive diagnostic test? = LIVER BIOPSY

we can also perform CYTOLOGY and look for HEPATIC VACUOLES; might be better for UNSTABLE CASES

18
Q

if we perform LIVER ASPIRATES (cytology) or BILE SAMPLES, what other diagnostic should we do/why?

A

ALWAYS CULTURE because MANY BACTERIALLY-INDUCED LIVER DISEASES IN CATS

19
Q

should cats with HEPATIC LIPIDOSIS have PROTEIN-RESTRICTED diets?

A

NO, unless they have HEPATIC ENCEPHALOPATHY

20
Q

HEPATIC LIPIDOSIS…

first, WHAT should we do for tx?

2 treatment options?

watch out for ____ syndrome

prognosis?

recovery time?

3 NEGATIVE prognostic indicators?

A

first, TREAT UNDERLYING DISEASE

2 treatment options?
1. IV FLUIDS until TOLERATING ORAL
2. ANTI-EMETICS

watch out for REFEEDING syndrome

prognosis is GUARDED, most tend to survive

recovery time = 4-6 WEEKS, PROLONGED

3 negative prognostic factors?
1. PANCREATITIS
2. COAGULOPATHY
3. HEPATIC ENCEPHALOPATHY

21
Q

FELINE CHOLANGITIS can include inflammation of….

A

the LIVER

22
Q

NEUTROPHILIC CHOLANGITIS

aka? (2 names)

what do we see on BIOPSY?

in CHRONIC cases, what 3 cells/type of inflammation can we see? what 2 pathologic processes?

A

aka ACUTE or SUPPURATIVE CHOLANGIOHEPATITIS

on BIOPSY = NEUTROPHILS within LUMEN or EPITHELIUM of BILE DUCTS

in CHRONIC cases, see these 3 cells…
1. NEUTROPHILS
2. LYMPHOCYTES
3. PLASMA CELLS
–> MIXED INFLAMMATION

in CHRONIC cases, see these 2 pathologic processes….
1. BILIARY HYPERPLASIA
2. FIBROSIS

23
Q

NEUTROPHILIC CHOLANGITIS…

etiology?

diagnosis is mostly based on SUSPICION of 2 CBC findings: HIGH ___ ___ & ____

two findings on US?

DEFINITIVE diagnosis based on… (2)

cytology on the liver is…

A

etiology? = ASCENDING BACTERIAL INFECTION from GUT BACTERIA IN BILE DUCTS

diagnosis mostly based on SUSPICION of 2 CBC findings: HIGH LIVER ENZYMES & HYPERBILIRUBINEMIA

findings on US?
1. THICKENED bile ducts
2. THICKENED gallbladder

DEFINITIVE diagnosis based on LIVER BIOPSY & CULTURE

CYTOLOGY on the liver is NOT HELPFUL

24
Q

lesion & dz!

A

THICKEND GALLBLADDER WALL

found in NEUTROPHILIC CHOLANGITIS

25
Q

2 TREATMENTS for NEUTROPHILIC CHOLANGITIS?

prognosis?

A
  1. ANTIBIOTICS –> can do BROAD-SPECTRUM pending a culture result
  2. SYMPTOMATIC & SUPPORTIVE therapy

prognosis = GENERALLY GOOD

26
Q

most of the bugs that cause NEUTROPHILIC CHOLANGITIS come from the ____ ____, so they have these 2 descriptors..

2 common examples?

A

come from the GI TRACT, so they are…
1. GRAM-NEGATIVE
2. ANAEROBE

2 common examples?
1. E. COLI
2. ENTEROCOCCUS

27
Q

LYMPHOCYTIC CHOLANGITIS..

aka? (2 names)

can see ?? inflammation, so might see WHAT 2 cells?

if CHRONIC, can see WHAT TWO things on biopsy?

we can see WHAT kind of neoplasia that resembles this in the LIVER? what 2 things could we do to confirm NEOPLASIA?

A

CHRONIC or NON-SUPPURATIVE CHOLANGIOHEPATITIS

can see MIXED inflammation
1. EOSINOPHILS
2. PLASMA CELLS

if CHRONIC, can see…
1. VARIABLE BILIARY HYPERPLASIA
2. FIBROSIS

SMALL CELL LYMPHOMA resembles LYMPHOCYTIC CHOLANGITIS
–> can do IHC & PARR on the LIVER BIOPSY SAMPLE to confirm

28
Q

LYMPHOCYTIC CHOLANGITIS…

etiology is UNKNOWN but LIKELY…

fever?

duration of illness is…

2 CBC findings?

we should perform WHAT 2 DIAGNOSTICS & why?

2 medications for treatment? what other therapy should be done?

prognosis generally…

A

LIKELY IMMUNE-MEDIATED

AFEBRILE

duration of illness is LONG

2 CBC?
1. HYPERBILIRUBINEMIA
2. INCREASED LIVER ENZYMES

we SHOULD perform LIVER BIOPSY & CULTURE bc many have BACTERIAL INFECTION

2 medications?
1. PREDNISOLONE
2. URSODIOL for ANTI-INFLAMMATORY effects
–> also DO SUPPORTIVE/SYMPTOMATIC therapy as needed

prognosis generally GOOD

29
Q

MAST CELL TUMORS…

commonality in cats?

tend to involve WHAT organ?

look for what 2 signs?

what surgical treatment could be recommended/why?

prognosis range?

prognosis depends on what 2 things?

A

RARE in cats

tends to involve SPLEEN > LIVER

2 signs…
1. LIVER FAILURE
2. GASTRIC ULCERATION

Sx treatment?
1. SPLENECTOMY if SPLENIC INVOLVEMENT

prognosis is FAIR to POOR

prognosis depends on…
1. LOCATION
2. AGGRESSIVENESS

30
Q

SOLITARY HEPATOILIARY NEOPLASIA…

commonly arises from…

most of the time, these are benign/malignant

but tumors arising from the ____ & ____ ____ are usually benign/malignant

A

commonly arises from INTRAHEPATIC BILE DUCTS

most of the time, these are BENIGN

but tumors arising from the GALLBLADDER and EXTRAHEPATIC DUCTS are usually MALIGNANT

31
Q

HEPATOCELLULAR CARCINOMAS ARE ____ IN CATS

A

RARE

Year 1/2 (139 decks)

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