Diagnostic Evaluation of the Liver Flashcards
(55 cards)
How can you distinguish between congenital vs secondary copper storage disesae?
Location where the copper is stored:
- primary = centrilobular
- secondary = periportal parenchyma
Which breeds are more likely to have intra-hepatic shunts? extra-hepatic shunts?
Small/ toy breeds (ex. Yorkie, Havanese, Maltese) = intra-hepatic
large breeds (ex. Irish Wolfhounds, Lab, Golden) = extra-hepatic
In appropriate copper-coloured iris in cats can be an indication of?
Portal systemic shunts
What’s the presentation/ prognosis for congenital portal vein hypoplasia (PVH) without a macroscopic shunt? (aka microvascular dysplasia).
they usually present later in life, rarely associated with clinical signs, excellent long term prognosis.
- seem in similar breeds as the intra-hepatic PSS
What type of liver disease dose the Scottish Terriers have?
Progressive vacuolar hepatopathy
What are the difference types of portal hypertension?
Prehepatic, intrahepatic, and post-hepatic
- Prehepatic: increase resistance in extrahepatic portal vein –> young, signs of hepatic encephalopathy
- Intrahepatic: increased resistance in the microscopic portal vein, tributaries, sinusoids, or small hepatic veins –> ex. chronic hepatitis with fibrosis, or cirrhosis
-post-hepatic: secondary to obstruction of larger hepatic vein –> caudal vena cava, R sided heart failure
Which type of portal hypertension is associated with increased protein in the ascites?
Post-hepatic, post-sinusoidal, and sinusoidal/intrahepatic
What are the 2 form of hepatic encephalopathy?
acute vs chronic
Differentiate between acute vs chronic encephalopathy.
Acute - not as common, due to fulminant liver failure –> severe, die in a few days
Chronic - common, due to shunts (acquired multiple or congenital PSS) –> if reversible, can do do better
- most common toxin = ammonia
- the MOA in cats = lack of Arginine. they can’t produce arginine in the liver so relies on dietary intake. Less eating = depletion of arginine = can’t run the urea cycle = back up of ammonia
Is seizure a common clinical sign in hepatic encephalopathy?
no
Which liver enzymes represent hepatocyte membrane integrity?
ALT, AST
Which liver enzymes are associated with hepatocellular leakage?
ALT, AST
ALT = more liver specific
AST = also found in muscle and red blood cells
Which liver enzymes are inducible?
ALP, GGT
ALP is not inducible in cats
How is the elevation in liver enzymes classified?
mild (<5x upper limit), moderate (5-10x upper limit), and severe (>10x upper limit)
What’s the half life of ALT? AST?
ALT T1/2 = 48-60h in dogs, 6h in cats
AST T1/2 = 22h in dogs, 77min in cats
Which liver enzyme has the lowest liver specificity in dogs?
ALP; it’s more specific in cats (93%)
What’s the half life of ALP?
Dogs = 70h
Cats = 6h
Is it useful to separate C-ALP from L-ALP in dogs?
No, because many liver dysfunctions will also lead to an increase in C-ALP
What are some ddx for elevated B-ALP?
- growing animals
- bone condition: osteomyelitis, OSA, other bone tumours
- renal secondary hyper-parathryroidism
- cats: hyperthyroidism
The large elevation is ALP is usually seen with which liver disorder?
cholestatic disorder
- massive hepatocellular tumours
- bile duct carcinoma
- glucocorticoid administrations
Which enzyme is more liver specific in dogs, ALP or GGT?
GGT (87%, vs ALP = 51%)
but GGT is less sensitive (50%, vs ALP = 80%)
Which enzyme is more liver specific in cats, ALP or GGT?
ALP (93%, vs GGT = 67%)
but GGT is more sensitive (86% vs ALP = 50%)
In cats, if there is»_space;GGT but only >ALP, this is most likely indicating what type of hepatitis?
necro-inflammatory hepatobiliary disorders
Which liver enzymes can be increased in neonatal puppies ingesting colosturm?
GGT (not seen in cats)
