23. Chronic hepatitis, familiar liver diseases in dogs

Question 1

chronic heapatopathy in general

Answer 1

toxins; drugs —> chronic liver failure –> end stage liver

Question 2

liver fibrosis definition

Answer 2

reversible
non regenerative nodule

Question 3

Liver cirrhosis definition

Answer 3

irreversible
fibrosis and regenerative nodules

Question 4

Clinical signs of chronic hepatopathy

Answer 4

anorexia
weight loss
ascites
PU/PD
Icterus
coagulopathy
CNS signs

Question 5

Lab D of chronic hepatopathy

Answer 5

Increased ; ALT, ALP, BA, NH3
Decreased ; Albumin, BUN, microcyctosis

Question 6

Biopsy of chronic hepatopathy

Answer 6

Piecemeal Necrosis
Bridging Necrosis
Chronic Active hepatitis
Lobular dissecting hepatitis

Question 7

What is piecemeal necrosis

Answer 7

necrosis of hepatocyte layer adjacent to portal tract

Question 8

What is bridging necrosis

Answer 8

tracts of necrosis across the hepatic lobule from portal areas –> central veins

Question 9

What is chronic active hepatitis

Answer 9

Periportal inflammation
& piecemeal necrosis

Question 10

What is lobular dissecting hepatitis

Answer 10

Lobular hepatitis associated with dissecting tracts of fibrosis

Question 11

what characterises chronic hepatitis

Answer 11

mononuclear/ mixed infiltrate in the liver with accompanied periportal necrosis & fibrosis

Question 12

what can chronic hepatitis lead to

Answer 12

hepatic cirrhosis

Question 13

Predisposition to chronic hepatitis

Answer 13

bedlington terrier
doberman
westies
cocker
dalmatian
poodle
lab

Question 14

Pathophys of chronic hepatitis

Answer 14

poorly understood

Question 15

causes of chronic hepatitis

Answer 15

toxins / drugs
copper
infectious agents - lepto, helicobacter
Immune mediated
idiopathic

Question 16

clinical signs of chronic hepatitis

Answer 16

anorexia
weight loss
vomiting
weakness
mild gi signs
PU/ PD
ascites
jaundice
depression

Question 17

Lab d of chronic hepatitis

Answer 17

increased ; ALP. ALP. BA. Br
Decreased ; albumin
Non regen anaemia

Question 18

Diagnosis of chronic hepatitis

Answer 18

Biopsy - definitvie diagnosis
US - nodular in cirrhosis

Question 19

Treatment of chronic hepatitis

Answer 19

immunosuppression
Avoid corticosteroids
Treat underlying cause

Question 20

location of primary Copper- caused chronic hepatitis (CUCH)

Answer 20

centrilobular

Question 21

location of secondary CUCH

Answer 21

Periportal

Question 22

where is copper stored

Answer 22

stored and encapsulated in hepatocyte lysosomes
therefore inaccessible by chelating drugs

Question 23

when does CUCH become clinically significant

Answer 23

Rupture of lysosomes –> free IC copper —> necrosis
when copper > 2000ppm

Question 24

diagnosis of CUCH

Answer 24

histology
histochem copper staining

Question 25

treatment of CUCH

Answer 25

Chelating drugs actively bind to extracellular copper

Question 26

Copper storage disease in Bedlington terrier

Answer 26

progressive accumulation of copper resulting from failure of normal hepatic biliary excretion

Question 27

3 forms of homozygous genotype of Copper storage disease in Bedlington terrier

Answer 27

Asymptomatic form Acute form Chronic form

Question 28

Asymptomatic form of homozygous genotype of Copper storage disease in Bedlington terrier

Answer 28

Only affects young animals copper in lysosomes increased ALT No structural damage

Question 29

Acute form of homozygous genotype of Copper storage disease in Bedlington terrier

Answer 29

Young adults Rare lethargy vomiting depression anorexia death within 2-3 days

Question 30

Chronic form of homozygous genotype of Copper storage disease in Bedlington terrier

Answer 30

Young/ middle aged Focal random hepatic necrosis increased ALT

Question 31

heterozygous genotype of Copper storage disease in Bedlington terrier

Answer 31

transient increase in copper

Question 32

autosomal recessive genotype of Copper storage disease in Bedlington terrier

Answer 32

remove from breeding

Question 33

Copper storage of dobermanns

Answer 33

2 types of chronic hepatitis Primary Cu toxicosis and CuCH develop it at a much lower level than in bedlingtons

Question 34

Treatment of abnormal copper storage diseases

Answer 34

Copper chelators D - penicillamine Zn salt Antioxidants - SAMe, Vit E, Silymarin

Question 35

D- penicillamine drug

Answer 35

not to be used with Zn decreased copper in liver increase liver metallothionine

Question 36

Zn salts drugs

Answer 36

dont use with chelators or d- penicillamine decrease intestinal absoprtion of copper good in case of cholestasis

Question 37

what are the normal leverls of copper

Answer 37

<400 ug/ g

Question 38

Lobular Dissecting Hepatitis

Answer 38

thought to be a response of the liver to insults at juvenile age

Question 39

Consequences of Lobular Dissecting Hepatitis

Answer 39

Portal hypertension --> ascites, APSS Lymphocytes, plasma cells scattered throughout hepatic lobule Bands of collagen and reticulin fibres around hepatocytes

Question 40

cause of Non specific reactive hepatitis

Answer 40

consequence of extrahepatic diseases metabolic - cushings, DM, hyper/ o thryoidism IBD, PLE Pancreatitis, sepsis, IHA, FIP, toxoplasma

Question 41

Clinical signs of Non specific reactive hepatitis

Answer 41

increased; AKT, AKP Hypoxia Anorexia No nerosis

Question 42

cause of Nodular Hyperplasia

Answer 42

unknown

Question 43

predisposition to Nodular Hyperplasia

Answer 43

older dogs usually seen PM

Question 44

Lab D of Nodular Hyperplasia

Answer 44

Increased ; alp, alt

Question 45

Histopath of Nodular Hyperplasia

Answer 45

vacuolised hepatocytes Normal lobular structure no fibrosis, necrosis, inflammation

Question 46

Treatment of chronic hepatopathies

Answer 46

Prednisolone Immunosuppressants Choleretic Antifibrotic Antioxidants

Question 47

Prednisolone in chronic hepatopathies

Answer 47

Immunosuppressive dose Improvement of necrotic inflammation and coagulopathy decreases inflammation

Question 48

other immunosuppressants in chronic hepatopathies

Answer 48

cortico steroids dex cyclosporine azathioprine

Question 49

Choleretics for chronic hepatopathies

Answer 49

UDCA hepatoprotective, anti inflam, anti fibrotic Helps elimination of toxin

Question 50

Antifibrotics for chronic hepatopathies

Answer 50

colchicine prednisolone D - penicillamine vit e UDCA