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From Flashcardlet > Hepatobiliary > Flashcards

Hepatobiliary Flashcards

1
Q

Which breeds are predisposed to copper-associated hepatopathy?

A 
Bedlington Terrier
Cocker Spanial
Dalmation
Doberman Pinscher
Labrador Retriever
Skye Terrier
WHWT
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2
Q

What medications can be used for copper chelation?

A

d-penicillamine

trientine

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3
Q

Infectious canine hepatitis is caused by…

A

adenovirus type 1

intranuclear inclusion bodies in hepatocytes and Kupffer cells; multifocal coagulative necrosis and neutrophilic inflammation

Corneal edema and anterior uveitis if recovers

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4
Q

Bartonella species that can cause hepatic dz in dogs…

A

B. henselae and B. clarridgeiae

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5
Q

What is the histologic lesion common from drug or toxic hepatopathy>

A

centrilobular necrosis

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6
Q

Complications associated with ALF.

A

GI ulceration, bacterial sepsis, cardiopulmonary dyxfxn, ascites

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7
Q

HE occurs when…

A

70% liver lost

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8
Q

ALT half life

A

24-60 hrs

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9
Q

Albumin half life

A

8 days

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10
Q

What percent of cholesterol made in liver?

A

50%

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11
Q

Hypoglycemia occurs when….

A

> 70% liver fxn lost

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12
Q

Bilirubinuria in dog vs cat?

A

Can be normal in dog b/c can conjugate bilirubin in renal tubules (small amt)

Cats can’t conjugate in their kidneys and threshold 9x higher than dogs, so bilirubinuria in cat ALWAYS abnormal

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13
Q

Hypokalemia common in liver failure d/t ____. What worsens?

A

D/t inadequate intake, vomiting, K wasting diuretics

Centrally induced hyperventilation and respiratory alkalosis may encourage renal K excretion, worsening the hypokalemia

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14
Q

What else happens with hypocapnia in liver failure related to phosphate?

A

Hypocapnia results in a shift of intracellular CO2 into extracellular space, raising intracellular pH and accelerating utilization of phosphate to phosphorylated glucose with resulting hypophosphatemia

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15
Q

Toxins implicated in HE

A

ammonia, decreased alpha-ketoglutaramate, glutamine, aromatic amino acids, short chain fatty acids

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16
Q

False neurotransmitters with HE

A 
tyrosine to octopamine
phenylalanine to phenylethylamine
methionine to mercaptans
tryptophan
phenol (from phenylalanine and tyrosine)
bile acids
GABA
Endogenous benzodiazepines
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17
Q

What are the branched chain AAs?

A

valine, leucine, isoleucine

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18
Q

SAMe effects

A

hepatoprotective, antioxidant, antiinflammatory, serves as precursor to glutathione

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19
Q

Milk thistle MOA

A

silymarin = active extract

antioxidant, free radical scavenger, inhibits lipid peroxidation, retard hepatic collagen formation

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20
Q

Ursodeoxycholic acid MOA

A

antiinflammatory, immunomodulation, antifibrotic, promotes choleresis, decreases toxic effects of bile acids

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21
Q

Zinc MOA

A

essential trace mineral, enhances ureagenesis, glutathione metabolism, copper chelation, and immune fxn, antifibrotic

22
Q

Poor prognostic indicators with ALF

A

PT > 100s, very young or old, viral or idiosyncratic drug reaction, markedly increased bilirubin

23
Q

What are antifibrotic liver meds?

A

D-penicillamine, colchicine, prednisone

24
Q

How is ammonia produced?

A

end product of AA, purine, and amine breakdown by bacteria, metabolism of glutamine by enterocytes, and breakdown of urea by bacterial urease

25
Q

Ammonia is rapidly converted to ____ in the liver.

A

urea or glutamine

26
Q

How does ammonia decrease both excitatory and inhibitory neurotransmission.

A

Down regulates NMDA (excitatory receptors)

Blocks chloride extrusion from postsynaptic neuron (decreasing inhibitory transmission)

27
Q

How is urea removed from brain?

A

transamination of glutamate into glutamine in astrocytes

28
Q

Glutamine is exchanged across the BBB for…

A

tryptophan

29
Q

What are tryptophan metabolites that are important agonists of inhibitory and excitatory neurotransmission?

A

serotonin and quinolinate

30
Q

Glutamine is transported from astrocytes into neurons where it it converted to…..

A

glutamate

31
Q

Dogs with portocaval shunts have decreased _____:______ amino acids.

A

Branched (valine, leucine, isoleucine) to aromatic (phenylalanine, tyrosine, tryptophan)

32
Q

Because of the relative increase in aromatic AAs, it increases synthesis of…

A

false neurotransmitters and reduction in synthesis of dopamine and norepinephrine

33
Q

What are liver fxn tests?

A

pre and post BA, ammonia tolerance test, sulfobromophthalein dye retention test

34
Q

What does alkalosis cause with HE?

A

Increases ammonia diffusion into CNS

35
Q

What does hypokalemia cause with HE?

A

Increased renal ammonia production

36
Q

What should HE patients be transfused with if transfusion needed?

A

Fresh blood of plasma b/c stored has increased ammonia

37
Q

Lactulose MOA

A

nonabsorbable disaccharide, osmotic cathartic. Intestinal bacteria hydrolyze laculose-producing organic acids that lower colonic pH. The acidification of the colon traps ammonia in its NH4+ (ammonium) form

38
Q

What AA is essential for cats for urea cycle?

A

arginine

39
Q

KBr in cats associated with….

A

allergic airway dz

40
Q

Portal pressure should not increase more than ___ with proper PSS attenuation in sx.

A

10 cm H20

41
Q

3 most important postop complications of PSS sx

A

portal hypertension, coagulopathy, neurologic abnormalites

42
Q

In cats, bile acids conjugated to….

A

taurine

43
Q

In dogs, bile acids conjugated to….

A

taurine and glycine

44
Q

Alkalinization and ductular secretion of bile under influence of ….

A

secretin

45
Q

Bile is made of…

A

bile salts, cholesterol, polyunat phosphatidylcholine

46
Q

____% of albumin located extravascularly with highest concentration in _____.

A

50-70%, skin and muscle

47
Q

What is the Cori cycle?

A

lactate generation by RBC, brain, and skin with subsequent gluconeogenesis by liver and kidneys

48
Q

Why is metabolic alkalosis bad with HE?

A

facilitates NH3 trapping in brain

49
Q

Why is hypokalemia bad with HE?

A

promotes renal ammoniagenesis and H+ loss promoting metabolic alkalosis and increasing renal tubular NH3 reabsorption

50
Q

What pressor contraindicated in hypotensive liver failure patient?

A

vasopressin

51
Q

Cats with HL have an increased insulin:glucagon. T/F

A

F

52
Q

Findings of JAVMA, 2011, cats with cellophane banding?

A

3 year survival 66%; uncontrolled seizures most common cause of death after surgery; common c/s ptyalism, seizures, lethargy, 2/9 had copper irises, 3/9 had urinary signs, 1/9 prolonged anesthetic recovery; portocaval shunt most common; none were hypoglycemic preop or post op

From Flashcardlet (19 decks)

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