Clinical Manifestation and Screening of Liver Disease (Rudinsky In Class Feb 3rd)

Question 1

Definition:
A nervous system disorder brought on by severe liver disease

Answer 1

Hepatic Encephalopathy

Question 2

Physical Examination:
- Ascites
- Jaundice
- Skin and mucous membranes
- bilirubinuria
- acholic feces
- Encephalopathy
- Hepatomegaly
- Dehydration
- Poor body condition
- Evidence of bleeding
This is …

Answer 2

Hepatobiliary Disease

Question 3

What are the initial screening diagnostics for hepatobiliary disease?

Answer 3

• CBC
  - Hemogram
  - Leukogram
  - Thrombogram
• Biochemical Profile
• Urinalysis

Question 4

Which of the initial screening diagnostics for hepatobiliary disease is the least specific?

Answer 4

CBC
- However, Anemia can develop (Blood loss or Chronic disease)
- And may give clues

Question 5

From which of the initial screening diagnostics for hepatobiliary disease do we get the most utility?

Answer 5

Biochemical Profile
- Liver enzymes

Question 6

When does an increase in liver enzymes get clinically significant?

Answer 6

> 2-3x normal

Question 7

(T/F) Looking at liver enzymes activity tests for liver function

Answer 7

False, NOT liver function tests

Question 8

Increased Liver Enzymes:
- Inflammation
- Necrosis
- Lipidosis
- Vacuolar hepatopathy
- Congestion
- Neoplasia
- Biliary Obstruction
These are …

Answer 8

1 degree liver Disease

Question 9

Increased Liver Enzymes:
- Pancreatic disease
- Intestinal disease
- Endocrine disease
- Hyperthyroidism in cats
- Diabetes Mellitus
- Cushing’s disease
- Heart failure
- Sepsis & endotoxemia
- Others
These make …

Answer 9

Liver disease a secondary disease

Question 10

List disorders with Increased ALT:

Answer 10

• Hepatic disease
  - Hepatic necrosis
  - hepatic inflammation (hepatitis)
  - Hepatic hypoxia
  - 2 to cholestasis
  - Hepatocyte regeneration
  - Enzyme induction (some drugs)
• Skeletal muscle disorders (infrequent)

Question 11

• Aspartate aminotransferase
• Hepatocyte cytoplasm and Mitochondria (leakage)
• Not liver-specific
  
  • Muscle**, heart, brain, kidney
    This is describing …

Answer 11

Serum AST Activity

Question 12

(T/F) If AST > ALT, consider muscle, severe necrosis (mitochondrial)

Answer 12

True

Question 13

Mechanisms of Increased Activity: Liver enzymes
- It can be intrahepatic (in liver) or extrahepatic (out liver)

Answer 13

Cholestasis

Question 14

• Alkaline phosphatase
• Many tissue sources/isoenzymes
• Cholestasis or drugs

Answer 14

ALP
- Dog serum ALP&raquo_space;> cats (short t1/2)

Question 15

• Corticosteroid-induced ALP
  
  • Dogs (not cats)
• Hypercortisolism (endogenous or exogenous)
  
  • Individual variation in severity
• “Steroid hepatopathy” in dogs

Answer 15

ALPCAP

Question 16

Liver Enzymes
- Corticosteroids (dogs)
- Increased ALPCAP/Increased Total ALP
- Phenobarbital (dogs)
- Increased ALP (+/- ALPCAP; +/- ALT)

Answer 16

Drug Induction

Question 17

How much (%) would you have to lose of your liver function for hypoglycemia to develop?

Answer 17

70% of liver function

Question 18

Liver Disease:
- Liver failure
- Severity
- Mechanisms
- Impaired gluconeogenesis
- Dec glycogen stores
- Dec insulin degradation
- Poor prognosis
- Hepatic neoplasia
- Secrete insulin-like factors
This is describing …

Answer 18

Hypoglycemia

Question 19

What is considered a. failure marker for liver disease?

Answer 19

Hypoglycemia

Question 20

Altered Fat Metabolism
Increase serum cholesterol –>

Answer 20

Increased synthesis secondary to cholestasis

Question 21

Altered Fat Metabolism
Decreased serum cholesterol –>

Answer 21

Decreased hepatic synthesis

Question 22

(T/F) Albumin synthesized only in liver

Answer 22

True

Question 23

List Bleeding disorders that can develop in liver patients:

Answer 23

• Decreased synthesis of clotting factors
• Marked inflammatory disease
• Vit K deficiency
  - Fat-soluble vitamin
  - If bile salts aren’t excreted, it can’t absorb fats

Question 24

Liver Disease
What may you see in a urinalysis?

Answer 24

• Bilirubinuria
• Crystals
  - NH4 biurate
  - associated w/ shunts & liver failure
  - Bilirubin
  - marked cholestatic disease

Question 25

Liver Function Tests: What are the two primary methods?

Answer 25

- Serum bile acids - Blood ammonia levels

Question 26

- Liver function test - Sensitive and specific - Increase w/ all types of liver disease - Hepatocellular dysfunction - Cholestasis - Portosystemic shunting - No additional info gained when bilirubin already increased - Fasting vs post-prandial SBA

Answer 26

Serum Bile Acids - manipulating to see how well the liver is doing its job

Question 27

When does the gallbladder contract?

Answer 27

After eating

Question 28

Definition: during or relating to the eating of food

Answer 28

Prandial

Question 29

- Liver-specific function test - Portosystemic shunting - Severe hepatocellular dysfunction - Urea cycle abnormality - Primarily an indicator of portosystemic shunting*** - Not as helpful as SBA for most hepatobiliary disorders

Answer 29

Blood Ammonia test

Question 30

Drug definition: An anticonvulsant that can prevent seizures in dogs

Answer 30

Phenobarbital

Question 31

(T/F) The liver plays the single most important role in detoxification/clearance of many different substances: Drugs, toxins, hormones, metabolites

Answer 31

True