GI Medicine - Liver Disease Flashcards by Em Chambers

what is failure of liver detoxification due to?

hepatic dysfunction and/or abnormal blood supply (PSS)

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what does build up of ammonia lead to?

hyperammonaemia

hepatic encephalopathy

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what is caused by hepatic dysfunction and/or abnormal blood supply (PSS)?

failure of conversion of ammonia to urea

failure of drug detoxification

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what is a key effect of the failure of drug detoxification in the liver?

anaesthetic agents have a prolonged effect

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what is the effect of encephalopathic toxins?

forebrain dysfunction

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when is hepatic encephalopathy made worse?

following high protein meal

GI haemorhage

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why is hepatic encepalopathy worse after a high protein meal?

increased ammonia produced due to bacterial fermentation and enterocyte glutamine metabolism

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what are the precipitating events for hepatic encepalopathy?

feeding high protein meal
vomiting diarrhoea
diuretics (lead to dehydration)

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what laboratory tests are used to diagnose liver disease?

liver enzymes (may be primary or reactive)
bilirubin 
bile acids
blood glucose
blood clotting parameters

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what is bilirubin a marker of?

jaundice

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what are bile acids a measure of?

liver function

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what diagnostic tests are used in liver disease?

laboratory tests
imaging
liver cytology (FNA)/biopsy

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what are the most common causes of acute liver disease?

toxins or infections

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what are the most common toxins which cause liver disease?

xylitol
mushrooms
blue green algae
aflatoxins

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what are the most common drugs which cause acute liver disease?

phenobarbitone
paracetamol
azathioprine
doxycycline
lomustine (CCNU)

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what are the most common bacteria which cause acute liver disease?

leptospirosis

ascending biliary infection

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what is the most common virus which causes acute liver disease in dogs?

canine adenovirus

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what happens during ascending biliary infection?

bacteria from the gut move into bile duct and cause infection

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what are the main nursing considerations associated with acute liver disease?

management of hepatic encephalopathy
anti-emetics for nausea
manage hypoglycaemia
consider implications for venepuncture due to coagulopathy risk
specific therapies 
barrier nursing?

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how is hepatic encephalopathy managed in acute liver failure?

lactulose
seizure management if needed
maintain and monitor hydration and electrolytes (esp. K+)

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how may lactulose be administered?

oral

retention enema

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how does retention enema work?

foley catheter used to introduce and hold Lactulose in the colon

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what must be remembered about drug dosing in patients with acute liver disease?

dose will need to be reduced due to reduced liver function

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how can hypoglycaemia be managed?

glucose infusion

feed complex carbohydrates little and often

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what are the specific therapies for acute liver disease?

antioxidants | antibiotics

describe nutritional management of acute liver disease

restricted animal protein diet copper restricted diet antioxidant supplementation

what si the best diet for acute liver disease?

replete protein, plant or soy based (e.g. Purina HA)

why is reduced or alternative to animal protein diet needed in liver disease patients?

to reduce ammonia

what diet can be used if plant (soy) based diets cannot be used?

hepatic (or less ideally renal) prescription diets are appropriate cottage cheese added to give more, safe protein

what are the overarching causes of inflammatory liver disease?

sterile | infectious

what are the sterile causes of inflammatory liver disease?

``` chronic hepatitis (dogs) lymphocytic cholangitis (cats) ```

what causes chronic hepatitis?

idiopathic | copper

why does copper cause inflammatory liver disease?

toxic to hepatocytes

what happens during lymphocytic cholangitis (cats)?

immune system attacks bile ducts

what are the infectious causes of inflammatory liver disease?

cholangitis / cholangiohepatitis (chronic and acute) leptospirosis chronic FIP

what are the specific treatments for inflammatory liver disease?

de-coppering therapy for copper excess | antibiotics - if indicated

what are the general treatments for inflammatory liver disease?

``` dietary moification liver supportive therapies (anti-oxidants) steroids choleretics hepatic encephalopathy therapies ascites management (spironolactone) ```

what do choleretics do?

support bile flow

what is involved in de-coppering therapy?

chelating agent | restrict copper intake

what chelating agents may be given during de-coppering therapy?

D-penicillamine | zinc therapy - long term use

how does zinc aid de-coppering?

competes with copper for uptake into liver

how can copper intake be restricted?

diet (prescription and avoid red meat, offal, eggs and cereals) check water source doen't have copper pipes

what is the role of antioxidants?

facilitate repair and recovery of hepatocytes

what are the main antioxidants given to inflammatory liver disease patients?

Silymarin / silibinin / sylibin | S-Adenosyl-L-methionine (SAMe)

what is the most commonly used choleretic?

ursodeoxycholic acid (UDCA)

what is UDCA?

hydrophilic, beneficial bile salt

how is UDCA derived?

synthetic

how does UDCA work as a choleretic?

stimulates bile flow (reduces viscosity) | modulates inflammatory response in liver

what animal should not be given UDCA?

rabbits - not safe

what are 2 examples of metabolic liver disease?

gall bladder mucocoeles | feline hepatic lipidosis

what happens in the gall bladder during gall bladder mucocoeles?

gall bladder is full of inspissated bile and mucus

what does the gall bladder of a patient with gall bladder mucocoeles look like?

kiwi fruit

what are the signs of gall bladder mucocoeles?

asymptomatic obstruction of bile flow rupture of gall bladder

how are gall bladder mucocoeles managed?

medical | surgical

what happens during feline hepatic lipidosis?

triglyceride deposition within hepatocytes leading to liver failure

what are the reasons for feline hepatic lipidosis?

primary | secondary

what predisposes a cat to feline hepatic lipidosis?

``` obesity high fat diet high carbohydrate diet systemic illness DM ```

what does feline hepatic lipidosis lead to?

massive intracellular fat accumulation liver failure death

what are the risks associated with diagnosis of feline hepatic lipidosis?

coagulopathies may mean that clotting is slow - risk of bleeding during FNA

how can risk of bleeding in a patient with coagulopathy be reduced?

check clotting provide vitamin K therapy (aid clotting factor production) monitor CVS parameters closely during and after procedure

how is feline hepatic lipidosis treated?

treat underlying cause (primary vs secondary) lipidosis treatment 6-8 weeks of home tube feeding

what is the most essential part of FHL treatment?

nutritional support

how should cats never be fed?

syringe or force

what nutritional support may be needed for FL patients?

``` tube feeding high protein antioxidants UDCA L-carnitine ```

how much food should FHL patients receive per day?

40-60 kcal/kg/day

what are the signs of congenital PSS?

``` small dull lethargic inappetant history of waxing and waning GI signs picky eater ```

what abnormal liver findings would you expect in a patient with congenital PSS?

low albumin low cholesterol high bile acids high ammonia

what is a portosystemic shunt?

bypassing of liver by blood due to a shunt (extra vessel)

what are the 2 types of PSS?

single congenital | multiple aquired

how are multiple PSS acquired?

chronic hepatitis leads to increased resistance to blood flow in portal vein leading to opening of shunts

what is happening in portovascular anomalies?

blood from GI tract bypasses liver and goes straight into systemic circulation toxins are not removed and liver does not receive nutrients

what does lack of nutrient supply to the liver during PSS lead to?

liver dysfunction

what is the result of blood from GI tract not being filtered by the liver if a PSS is present?

toxins will accumulate | hepatic encephalopathy and so brain dysfunction

how is PSS treated?

``` ensure hydration ensure serum K+ normal restricted protein or plant based protein diet Lactulose antibiotics anti seizure surgical closure of shunting vessel ```

how does lactulose work?

traps ammonia in the colon

what are the signs of hepatic neoplasia?

asymptomatic primary hepatic or obstructive signs rupture leading to haemoabdomen

what may be obstructed by a hepatic tumor?

vessels or ducts

what are the 3 main types of liver neoplasia?

primary tumors inflitrative metastatic

how are primary liver tumors treated?

surgery

what is an example of infiltrative liver neoplasia?

lymphoma

how is infiltrative liver neoplasia treated?

chemo

what is an example of metastatic liver neoplasia?

carcinoma

how is metastatic liver neoplasia treated?

no treatment as secondary to tumor elsewhere

GI Medicine - Liver Disease Flashcards

(83 cards)