General Concepts in Hepatobiliary Disease

Question 1

what does the lobular model divide the liver lobes into?

Answer 1

centrilobular
midzonal
periportal

Question 2

what makes up bile?

Answer 2

bile salts
bilirubin
cholesterol
protein
fatty acids
phospholipids

Question 3

what can cause hyperbilirubinemia?

Answer 3

pre-hepatic
hepatic cholestasis
post-hepatic cholestasis

Question 4

what are the consequences of cholestasis?

Answer 4

failure to excrete cholesterol into bile
fat malabsorption
retain cytotoxic substances
increased toxicity of drugs normally excreted in bile

Question 5

will bile acids increase or decrease with liver disease?

Answer 5

increase

Question 6

when does hypoglycemia occur with liver disease?

Answer 6

severe liver disease: acute liver failure
congenital portosystemic shunt dogs

Question 7

why does BUN decrease and ammonia increase with severe liver disease or a congenital portosystemic shunt?

Answer 7

loss of urea cycle function

Question 8

when does hepatic encephalopathy occur?

Answer 8

portosystemic shunts
acute liver failure
end stage (fibrotic) liver

Question 9

where is albumin made?

Answer 9

only liver

Question 10

when might vitamin K absorption be impaired?

Answer 10

cholestasis

Question 11

what can cause prehepatic portal hypertension?

Answer 11

portal vein thrombosis

Question 12

what leads to multiple acquired portosystemic shunts?

Answer 12

persistent portal hypertension: opening of embryonic vessels
collateral circulation direct into systemic circulation

Question 13

what is the mechanism of ascites due to portal hypertension?

Answer 13

increased interstitial fluid
overwhelms lymphatics

Question 14

what is fine needle aspirate more useful for?

Answer 14

diffuse disease: hepatocyte vacuolization or neoplasia (lymphoma)

Question 15

what is the least invasive type of biopsy?

Answer 15

ultrasound guided needle biopsy

Question 16

what are the pros of laparotomy?

Answer 16

no special equipment
can visualize most regions of liver
can remove lobectomy for larger masses or abscesses

Question 17

what can cause glycogen deposition?

Answer 17

steroids: cortisol

Question 18

in whom is lipid accumulation most common?

Answer 18

cats
ruminants
ponies
ferrets
diabetic dogs, toy puppies

Question 19

what stains lipid accumulation?

Answer 19

oil red O

Question 20

what type of inflammation/cellular infiltrates do most bacteria cause?

Answer 20

neutrophils

Question 21

what is the most common zonal lesion?

Answer 21

centrilobular necrosis

Question 22

what is hepatitis?

Answer 22

inflammation of liver: hepatocytes

Question 23

what is cholangitis?

Answer 23

inflammation of bile ductules

Question 24

what are the sequelae of injury?

Answer 24

regeneration
bile duct hyperplasia
fibrosis
end stage liver/cirrhosis

Question 25

how much of the hepatic blood flow is from the arterial circulation?

Answer 25

30% hepatic artery

Question 26

what is the reserve and regenerative capacity like of the liver?

Answer 26

tremendous: can remove 75% in healthy animal

Question 27

what are the functions of the periportal zone?

Answer 27

gluconeogenesis oxidation of fatty acids ureagenesis

Question 28

what are the functions of the centrilobular zone?

Answer 28

drug metabolizing enzymes glycolysis liponeogenesis

Question 29

what cells are in the lobules?

Answer 29

hepatocytes, sinusoidal endothelium kupffer cells stellate (ito) cells

Question 30

what is the enterohepatic circulation?

Answer 30

bile acids actively absorbed in ileum delivered to portal circulation actively taken up by hepatocytes from sinusoidal surface re-secreted into canaliculi

Question 31

what causes hepatic cholestasis?

Answer 31

loss of hepatic mass obstruction of canaliculi sepsis: interference with transporters

Question 32

why is there an increase in bile acids with liver disease?

Answer 32

shunting failure of removal from portal circulation

Question 33

why might you see hypoglycemia with severe liver disease?

Answer 33

decreased insulin clearance decreased hepatic gluconeogenesis

Question 34

if there is hepatic atrophy or cirrhosis, should cholesterol go up or down?

Answer 34

down: loss of ability to make lipoproteins

Question 35

what can you treat hepatic encephalopathy with?

Answer 35

low protein diet antibiotics to change bacterial flora lactulose: changes flora and pH

Question 36

which globulins are not made in the liver?

Answer 36

immunoglobulins

Question 37

what with clotting is a poor prognostic indicator with liver disease?

Answer 37

elevated PT/PTT

Question 38

what can cause intrahepatic portal hypertension?

Answer 38

end-stage liver granulomatous inflammation arteriovenous shunts

Question 39

what can cause posthepatic portal hypertension?

Answer 39

occlusion at hepatic veins, vena cava, right heart congestive heart failure: especially right constrictive pericarditis

Question 40

in whom is ascites due to portal hypertension common?

Answer 40

dogs and cats rare in horses and cattle

Question 41

what causes primary photosensitization?

Answer 41

ingest preformed photodynamic agents

Question 42

which biopsy has the highest risk of being non-diagnostic?

Answer 42

ultrasound guided needle biopsy

Question 43

which biopsy method is associated with higher patient mortality?

Answer 43

laparotomy

Question 44

what makes taking a biopsy contraindicated?

Answer 44

coagulation disorder hepatic abscess or vascular tumor

Question 45

what is vacuolation due to glycogen like?

Answer 45

indistinct, hazy vacuolation

Question 46

what causes hydropic degeneration?

Answer 46

reverible cell injury: decreased ATP, influx of water, cellular swelling

Question 47

what is lipofuscin?

Answer 47

wear and tear: fine, tan granules in hepatocytes

Question 48

is hemosiderin normal in hepatocytes?

Answer 48

small amounts normal

Question 49

what can be used to stain for copper?

Answer 49

rhodanine

Question 50

what are some connective tissue stains?

Answer 50

trichrome reticulin silver sirius red

Question 51

what type of cellular infiltrates are seen with Salmonella?

Answer 51

lymphocytes macrophages

Question 52

what is choledochitis?

Answer 52

inflammation of common bile duct

Question 53

what percentage of the body weight in dogs/cats is made up of the liver?

Answer 53

3-4%

Question 54

how much of the hepatic oxygen is provided by the hepatic artery and how much by the portal circulation?

Answer 54

50% by each

Question 55

what do stellate/ito cells do?

Answer 55

fat soluble vitamin storage transform into myofibroblasts to contribute to fibrosis

Question 56

what cells are at the junction?

Answer 56

oval cells: bipotential stem cells

Question 57

what is a pre-hepatic cause of hyperbilirubinemia?

Answer 57

increased red cell breakdown

Question 58

why is hypoglycemia seen with congenital portosystemic shunts?

Answer 58

atrophied liver with poor glycogen stores

Question 59

when might globulins be low?

Answer 59

severe loss of functional mass

Question 60

what are some causes of portal vein thrombosis?

Answer 60

local inflammation hypercoagulable state secondary to tumor emboli

Question 61

what is seen in an end stage liver that leads to intrahepatic portal hypertension?

Answer 61

fibrosis nodular regeneration capillarization of sinusoids

Question 62

what contributes to gastric ulceration?

Answer 62

portal hypertension: relative ischemia bile acids cytotoxic increased gastric levels?

Question 63

what is seen with hepatocutaneous syndrome?

Answer 63

erosions and ulceration of muzzle, pressure points, mucocutaneous junctions

Question 64

what accumulates in skin in photosensitization?

Answer 64

photodynamic substance

Question 65

what is inherited porphyria?

Answer 65

defects in hemoglobin synthesis

Question 66

what are some rare complications of a liver biopsy?

Answer 66

infections perforation of gallbladder pneumothorax vasovagal response

Question 67

is it expected to see bile in a biopsy?

Answer 67

no

Question 68

what is interface necrosis/apoptosis usually seen with in dogs?

Answer 68

idiopathic hepatitis