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SAM Final > 24. Vascular liver diseases, portosystemic shunt in dogs and cats. Hepatic encephalopathy > Flashcards

24. Vascular liver diseases, portosystemic shunt in dogs and cats. Hepatic encephalopathy Flashcards

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1
Q

Normal blood pressure in the portal system

A

5-10mmHg

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2
Q

Definition of portal hypertension

A

When the portal blood pressure is 5mmHg higher than the BP in the inferior vena cava

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3
Q

Composition of the portal system

A

Portal vein
superior mesenteric vein
inferior mesenteric vein
splenic vein
left gastric vein
umbilical vein

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4
Q

Aetiology of Portal Hypertension

A

when the blood flowing from portal system to inferior vena cava meets resistance

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5
Q

3 Causes of Portal Hypertension

A

Pre-hepatic
Intra- hepatic
Post - hepatic

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6
Q

Prehepatic Causes of Portal Hypertension

A

Occurs before blood arrives to liver
- Portal vein thrombosis
- Splenic vein thrombosis
- Arteriovenous malformation
- Splenomegaly

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7
Q

Intrahepatic Causes of Portal Hypertension

A

Occurs due to causes affecting the liver specifically
- Cirrhosis by viral hepatitis; metabolic disease; (alcohol)
- Primary sclerosing hepatitis
- Schistosomiasis
- Nodular regenerative hyperplasia

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8
Q

Post hepatic Causes of Portal Hypertension

A

due to problems involving the vena cava
- Inferior vena cava obstruction
- RS-HF
- Hepatic vein thrombosis

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9
Q

Clinical signs of Portal Hypertension

A

May be asymptomatic, usually related to underlying disease
- Hepatosplenomegaly
- Fatigue
- Nitric oxide release
- Pruritis
- Swollen capillaries
- Oedema
- Caput medusae
- Ascites
- Palmar erythema
- Jaundice

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10
Q

Portosystemic Shunt definition

A

Abnormal vascular communication between the portal and systemic venous system

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11
Q

Causes of PSS

A

acquired / congenital
Intrahepatic / extrahepatic

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12
Q

Consequences of PSS

A

Increased toxins in systemic circulation
decreased hepatic blood flow —> atrophy

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13
Q

Congenital PSS

A

75% of cases
can be intrahepatic or extra hepatic
young > old

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14
Q

cause of congenital PSS

A

abnormal embryonal blood vessels

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15
Q

Intra hepatic congenital PSS

A

solitary
persisten embryonal ductus venous
large > small dogs - wolfhound, settler, retriever, lab

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16
Q

extrahepatic congenital PSS

A

solitary
anatomically abnormal communication btw portal system and v. cava caudalis / azygous
small & toy dogs
cats, yorkies

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17
Q

Acquired PSS

A

multiplex, collateral vessels, narrowing and twisting
Protective compensatory response to portal hypertension
old > young

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18
Q

Hepatic Microvascular Dysplasia

A

congenital hypoplasia to portal vein
formation of intralobular microvascular shunts

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19
Q

Predisposition to Hepatic Microvascular Dysplasia

A

Small > large
cairn terrier, yorkie

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20
Q

Clinical signs of Hepatic Microvascular Dysplasia

A

mild / none

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21
Q

Diagnosis of Hepatic Microvascular Dysplasia

A

Increased ; BA
US
Biopsy

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22
Q

Treatment of Hepatic Microvascular Dysplasia

A

Diet
lactulose

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23
Q

Arterioportal fistula

Study These Flashcards
A

connection forms between a. hepatica & v. portae

24
Q

what does Arterioportal fistula lead to

Study These Flashcards
A

Portal hypertension
ascites
acquired pss
gi oedema

25
clinical signs of Arterioportal fistula
continuous murmur gi oedema ascites
26
diagnosis of Arterioportal fistula
hepatic AV fistula - distended, echo loose portal branch within liver lobe hepatofungal blood flow above liver lobe
27
Treatment of Arterioportal fistula
Lobectomy treat hypertension
28
Hepatic venous outflow obstruction
abnormal development of vessels before differentiation into veins & arteries
29
diagnosis of Hepatic venous outflow obstruction
colour doppler ex lap celiac arteriogrphay
30
Lab D of Hepatic venous outflow obstruction
mild anaemia Leucocytosis Hypoproteinaemia Normal liver enzymes increased ; BA
31
Hepatic Encephalopathy definition
metabolic dysfunction of brain due to liver dysfunction
32
Hepatic Encephalopathy in younger animals
caused mostly by shunts
33
Hepatic Encephalopathy in older animals
caused mostly by neoplasia or cirrhosis
34
Acute Hepatic Encephalopathy
Rare <10% of cases
35
Cause of Hepatic Encephalopathy
Liver necrosis
36
Clinical signs of Hepatic Encephalopathy
Seizures semi - coma, com increased intracranial pressure
37
Lab D of acute Hepatic Encephalopathy
increased ; NH3
38
Chronic Hepatic Encephalopathy
More common PSS and decreased liver function
39
Pathophys of Chronic Hepatic Encephalopathy
PSE ---> Chronic Hepatic Encephalopathy ---> portosystemic vascular anastomosis ---> HE
40
Chronic Hepatic Encephalopathy in dogs
high reserve capacity
41
Chronic Hepatic Encephalopathy in cats
lower reserve capacity arginine isnt synthesized in liver --> inadequate NH3 detoxification
42
Final consequence of Chronic Hepatic Encephalopathy
Deranged neurotransmitter systems
43
Clinical signs of Hepatic Encephalopathy
graded 1- 4 cns signs due to deranged neurotransmitter systems , brain oedema, hypoglycaemia
44
Grade 1 of Hepatic Encephalopathy
Lethargy Apathy Depression Personality Changed Anorexia PU
45
Grade 2 of Hepatic Encephalopathy
Ataxia Disorientation Compulsive pacing Head pressing Apparent blindness Personality changes Salivation PU
46
Grade 3 of Hepatic Encephalopathy
Stupor Severe salivation seizures
47
Grade 4 of Hepatic Encephalopathy
Coma Non responsive
48
Other clinical signs of Hepatic Encephalopathy
- Anorexia - Vomiting Weight loss - Ptyalism - Diarrhoea - PU/PD - Urolithiasis - Cystitis - Stranguria - Dysuria - Haematuria - Pollakiuria - Crystalluria
49
Haematology of HE
Non regen microcytic anaemia acanthocytes poikilocytosis
50
Biochem of HE
increased ; ALP, ALT, AST, GGT, Br, BA, NH3 Decreased ; BUN, Urea, Chol, Albumin, glucose Coagulopathy
51
Urinalysis of HE
Decreased ; USG PU/PD Ammonium biurate crystals Urolithiasis haematuria proteinuria pyuria
52
Liver function tests of HE
Ammonia tolerance test Post prandial ammonia tolerance test Fasting BA, post prandial BA Decreased protein C
53
US of HE
Doppler smaller liver decreased size of intrahepatic veins blood flow direction enlarged kidneys
54
Angiography of HE
used to locate anatomical location of PSS surgical catheterisation
55
Treatment of acute HE
treat seizures - propofol --> levetiracetam Treat brain oedema - mannitol fluids, electrolytes, acid - base control to decrease NH3 and toxins - enema, lactulose PO AB - metronidazole, amox Gi protectants
56
Treatment of chronic HE
AB Lactulose Dont alter dietary protein intake regular small meals

SAM Final (48 decks)

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