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Digestive System Exam 2 > 21:00 min Clinical Manifestation and Screening of Liver Disease (Rudinsky In Class Feb 3rd) > Flashcards

21:00 min Clinical Manifestation and Screening of Liver Disease (Rudinsky In Class Feb 3rd) Flashcards

(65 cards)

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1
Q

Notes Card
SBA Testing:

A
  • 2 hr post-prandial SBA (PPSBA)
    • Stimulates EHC
    • Endogenous challenge test
  • Food considerations
    • protein and fat content (release CCK)
    • < 10 lbs … > 2 tsp
    • > 10 lbs … > 2 tbsp
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2
Q
  • Liver-specific function test
    • Portosystemic shunting
    • Severe hepatocellular dysfunction
    • Urea cycle abnormality

What test is this?

A

Blood Ammonia

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3
Q

The liver plays the single most important role in the detoxification/clearance of many different substances such as:

A
  • Drugs
  • Toxins
  • Hormones
  • Metabolites
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4
Q

Hepatic Drug Metabolism:
- Primary oxidation
- Enzymes of SER (microsomal)
- Usually inactivates drugs
- May convert active to active
- May convert pro-drug to active drug
- May bioactivate to toxic compound

A

Phase I

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5
Q

Hepatic Drug Metabolism:
- Primary conjugation
- Occurs in ER or cytosol
- Renders H2O soluble/less toxic/readily excreted
- Species differences
- Glutathione conjugation**
- Less susceptible (than Phase I) to the effects of disease and other drugs

A

Phase II
- Making things less toxic

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6
Q

(T/F) Hepatic dysfunction and effects of clearance can be predicted

A

False, unpredictable & complex

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7
Q

Characterize features:
- decreased albumin, decreased BUN, decreased cholesterol, decreased glucose
- increased SBA; coagulopathy not responsive to Vit K

A

Hepatocellular dysfunction (Metabolic dysfunction)

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8
Q

Characterize features:
- increased ALT/AST&raquo_space;> ALP

A

Hepatocellular injury

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9
Q

Characterize features:
- Increased ALP&raquo_space;> ALT
- Hyperbilirubinemia, bilirubinuria
- Increased cholesterol, Increased SBA, Vit K response coagulopathy

A

Cholestatic Disorder

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10
Q

Characterize features:
- Increased NH3; N to Increased FSBA/Increase PPSBA

A

Possible portosystemic shunting

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11
Q

** FILLER CARD **

A

Hepatobiliary Vascular Disorders and Hepatic Encephalopathy (Rudinsky - Feb 7th - In Class)
- These are the following cards after this

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12
Q
  • Anorexia - Dull
  • Lethargy - Difficulty training
  • Disorientation - Behavioral changes
  • Head-pressing* - Blindness
  • Circling, pacing - Hypersalivation
  • Ataxia - Seizures
  • Weakness - Coma
A

Hepatic Encephalopathy
- metabolic encephalopathy = signs can wax and wane; may be normal at times

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13
Q

(T/F) Brain effects of substances normally metabolized by the liver

A

True

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14
Q

Hepatic Encephalopathy: Neurologic disorder
Portosystemic Shunts:
- Single shunting vessel
- Intrahepatic (large breed dogs)
- Extrahepatic (cats, small dogs)

A

Congenital
- young animal showing early signs

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15
Q

Portosystemic Shunts:
- Multiple (2 degree to portal hypertension)
- Much less common

A

Acquired shunts

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16
Q

List the Clinical findings for PSS:

A
  • CNS signs
    • Hepatic encephalopathy
    • Hypersalivation (CATS)
  • GI signs
    • Intermittent vomiting/diarrhea
    • Pica/repeated FB ingestion
  • Urinary tract signs
    • pU/pD
    • Hematuria, dysuriaa, pollakiuria (urate stones)
  • Other
    • stunted growth, drug intolerance; prolonged anesthetic recovery
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17
Q

Hepatic Blood Flow (HBF)
- 20% of HBF

A

Arterial blood flow

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18
Q

Hepatic Blood Flow (HBF)
- 80% of HBF

A

Portal blood flow

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19
Q
  • Vascular communication between the portal and systemic venous systems
  • Portal blood bypasses the liver
A

Portosystemic Shunt

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20
Q

The portal blood drains from:

A
  • Intestines
  • Stomach
  • Pancreas
  • Spleen
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21
Q

If you see elevated bilirubin, is it useful to then go on and do Serum Bile acids testing?

A

No, because it’s the same saturable system
- Bilirubin is pulled out by hepatocytes from the blood & sent to excreted in the bile
- If bilirubin is increased, you will automatically have abnormal bile acids

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22
Q

** FILLER CARD **

A

Hepatobiliary Vascular Disorders and Hepatic Encephalopathy (Rudinsky - Feb 7th - In Class)

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23
Q
  • Radiography **
  • Ultrasonography (very dependent on the user, sensitivity is bad for this (inconclusive))
  • Angiography
    - Portogram
    - Arteriogram
    - Venogram
  • Portal scintigraphy (referral center)
  • CT/MRI (referral center)
    These are …
A

Imaging for Hepatobiliary disease

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24
Q

What are the treatments for Congenital PSS?

A
  • Medical management of HE
    - Protein-restricted diet
    - Lactulose, antibiotics
    - Correct precipitating events
  • Shunt attenuation (Surgery)
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25
Congenital PSS Definition: - Is an inner ring of casein that is surrounded by a stainless steel sheath - Slow closure --> gradual closure
Ameroid Constrictor Complications: - Portal Hypertension - Seizure - Hemorrhage - Hypoglycemia - Treatment Failure
26
**** FOLLOWING CARDS ****
***** Hepatobiliary Disease Cholestatic Liver Dz, LECTURE 3 ****
27
Cat with Yellow ear What's with the yellow?
Icterus or Jaundice - Indicates that T bili > 2.5 mg/dl - Bilirubinuria - Rarely Acholic feces (complete bile duct obstruction)
28
- RBCs are broken down into three components and are repackaged and reutilized - HEME has to be ______________
Metabolized
29
Definition: - excess unconjugated bilirubin is produced faster than the liver is able to conjugate it for excretion - anything that lyses RBCs - Elevated unconjugated bilirubin in serum
Prehepatic (hemolytic) Jaundice - IMHA - Cats less common...
30
What can you do to determine where the bilirubin is coming from?
- PCV/TS ** - CBC - Clin Path
31
Cats - Anemia signs predominate - Anemia is usually regenerative (4-6 day lag time) - Infectious Ddx - Noninfectious Ddx This describes ...
Pre-hepatic Cats
32
Definition: - Hepatocytes can't do their job, because something is blocking it - Problem with liver - Both conjugated and unconjugated bilirubin may be elevated in serum
Intrahepatic Jaundice (Hepatic)
33
Definition: - Impaired excretion due to mechanical obstruction to bile flow - Elevated conjugated bilirubin in serum
Extrahepatic Jaundice (Post-hepatic)
34
Variable appearance: - Diffuse enlarged, hyperechogenicity
Hepatic lipidosis
35
Variable appearance: - Hypi/Iso/Hyperecho
Cholangiohepatitis
36
Variable appearance: - Nodules, diffuse hyper/ hypoechogenicity, mixed patterns
Neoplasia
37
List the top three most common Cholestatic Liver Diseases:
- Hepatic Lipidosis (30%) - Idiopathic - Secondary - Cholangitits (29%) - Neoplasia (23%)
38
List the Diagnostics for Cholestatic Liver Disease:
- Blood work - Imaging - Aspirates - Biopsy - Empirical treatment
39
- Most common feline liver disease - Obese cats, anorexia, wt loss - Massive hepatic fat accumulation - Intrahepatic cholestasis *** - Hepatic failure - Fatal without treatment, curable with food
Feline Hepatic Lipidosis
40
- Stressful Triggers ("Primary") - Diet change - Boarding - Social environment (new pets, people, or home) - Nonhepatic catabolic illnesses ("Secondary") These are Clinical Associations for ...
Feline Hepatic Lipidosis
41
- Middle-ag or older cats - No breed or sex predisposition - Prior obesity - Prolonged anorexia (> 2 weeks) - Weight loss (often >25%) - Vomiting, lethargy, diarrhea or constipation, hepatic encephalopathy infrequent - PE: icterus, hepatomegaly, dehydration, muscle wasting; ventroflexion of head/neck These are Clinical Findings for ...
Feline Hepatic Lipidosis
42
- Cholestatic pattern - Increase ALP > Increase ALT - But normal GGT - Hyperbilirubinemia - Bilirubinuria - Increase serum bile acids - Vit K responsive coagulopathy These are Lab Findings for ...
Feline Hepatic Lipidosis
43
What is the "key" for hepatic lipidosis?
You feed them! - once you put nutrients back into the system, it reverses it
44
- There are 3 types (rare disease) - Neutrophilic - Most common primary disease - Liver lobe involvement variable - Confusing literature - Different classification schemes
Feline Cholangitis
45
- Ascending biliary bacterial infection - Gram neg - anaerobes - Inflammation focused on bile ducts - Necrosis of hepatocytes beyond limiting plates This is describing ...
Feline Cholangitis - Neutrophilic
46
- Pancreatitis - IBD - Cholecystitis - Cholelithiasis - Sludged bile - Biliary obstruction These are Associated Conditions for ...
Neutrophilic Cholangitis
47
- Liver biopsy - Bacterial culture** better - Aerobic - Anaerobic - Liver or *BILE* - Surgery - If biliary obstruction These are Diagnoses for ...
Neutrophilic Cholangitis
48
- *Chronic* signs (tends to be less severe) - Middle-aged/older - Signs - Vomiting, diarrhea, jaundice - May be episodic - Hepatomegaly This is describing ...
Cholangitis - Lymphocytic
49
List the indications for Liver Biopsy: Methods - ULS-guided (small samples) - Laparoscopy - Surgery
- Persistent increase in liver enzymes or SBA - Abnormal hepatic parenchyma including liver mass(es) - Acute versus chronic - It is going to be better for Chronic disease evaluation - Obtain quantitative Cu - Monitor therapy
50
Liver Biopsy What are the Pre-biopsy Considerations (liver patients can bleed)?
- Hemostasis evaluation - Method of biopsy - Pre-biopsy treatment - Vitamin K1 - Plasma transfusion
51
Liver Biopsy What are your post-biopsy evaluations?
Monitor - PCV - TPP - ULS - Other
52
When doing a liver biopsy, what evaluations are you doing?
- Cytology - Histopathology - Culture - Chemical analysis - test for heavy metals
53
What is a nutrient class that is most effective at reducing lipid accumulation in neg energy balance?
Protein
54
What do fats and fat-soluble vitamins require for absorption?
Micelle formation
55
Vitamin K Deficiency: Liver Disease **Treatment**: What route of administration is essential to treat vitamin K deficiency due to biliary obstruction?
Parenteral (IV, IM, SC not PO)
56
Hepatoprotectants: - Synthesized and found in almost every cell type - Hepatocytes maintain particularly high levels - Physiologic and metabolic functions - **Antioxidant**
Glutathione
57
Hepatoprotectants: - Provide glutathione (antioxidant) - Enteric-coated - Empty stomach - Nontoxic - May cause upset stomachs
S-Adenosylmethionine (SAMe)
58
Hepatoprotectants: - Acts as a nutritional antioxidant
Vitamin E (alpha-Tocopherol)
59
Hepatoprotectants: - Flavonoid mixture - Derived from seeds of Silybum marianum - Natural liver remedy for >2000 years (ancient Greece) - Variable amounts in products - Variable absorption - Herbal supplement (Antioxidant) - Antifibrotic - Anti-inflammatory - Decrease hepatic uptake of Amanita mushroom toxicity
Milk Thistle (Silybin)
60
Hepatoprotectants: - Ursodeoxycholic acid - 1-degree bile acid in Chinese Black Bear - Hydrophilic bile acid - Healing powers - Now commercially synthesized - Marketed for dissolution of cholesterol gallstones (man) - Other effects on liver
Ursodiol (Actigall) - Fav used in tOSU
61
Hepatoprotectants: What do we get from Ursodiol (Actigall)?
- Anti-inflammatory - Anti-fibrotic - Immunomodulatory - Choleresis Mechanisms: - Replace hepatotoxic hydrophobic bile acids
62
"Dog" Extrahepatic Cholestasis EHBDO: - Is an inappropriate accumulation of mucus or inspissated bile in the gallbladder lumen
Gallbladder Mucocele - Kiwi appearance
63
"Dog" Extrahepatic Cholestasis EHBDO: - Is a medical condition resulting from the formation of stones in the gallbladder
Cholelithiasis
64
"Dog" Extrahepatic Cholestasis EHBDO: - Tumors, etc
Biliary Obstruction
65
List what to do to manage Biliary Obstruction:
- Vitamin K - Parenteral - 24-48 hrs - Antibiotics - Exploratory surgery - Relive obstruction - Bacterial culture - Tissue biopsy

Digestive System Exam 2 (11 decks)

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