Hepatic Disease

Question 1

Thinking about the anatomy of how close the pancreas sits to the liver, what might happen as a result of pancreatitis?

Answer 1

Can directly irritate the liver.

Question 2

80% of blood supply to the liver comes from the _______ ______, while 20% comes from the ________ _______.

Answer 2

Portal vein and Hepatic artery

Question 3

The portal triad contains what 3 things?

Answer 3

1. Bile duct
2. Portal vein
3. Hepatic artery

Question 4

Which zone occurs around the portal triad?

Answer 4

Zone 1

Question 5

Zone 3 is nearest to the ______ _____.

Answer 5

Hepatic venule [where blood leaves before entering the vena cava].

Question 6

Which zone is most susceptible to sinusoidal congestion from right sided congestive heart failure?

Answer 6

Zone 3

Question 7

Which zone is most sensitive to hypoxia?

Answer 7

Zone 3 [this zone is already more hypoxic, being furthest away from the portal triad, but any decreases in oxygen conc. and zone 3 is most sensitive to it.]

Question 8

The 2nd largest organ in the body is the _______.

Answer 8

Liver

Question 9

The largest visceral organ in the body is the ________.

Answer 9

Liver

Question 10

Gluconeogenesis, glycogenolysis, urea synthesis, albumin synthesis, apolipoproteins, synthesis of coagulation factors, and degradation of drugs, hormones, RAAS and bacterial clearance are all functions of the almighty ______.

Answer 10

Liver

Question 11

The most common cause of hyperlactateaemia is what?

Answer 11

Hypoperfusion of the liver.

Question 12

Since the metabolism of ammonia to urea and branched chain amino acids occurs in the liver, if there is an issue with liver function you will see hyperammonemia. In these patients you may see head pressing which is referred to as _____ _______.

Answer 12

Hepatic encephalopathy [from high NH3 levels.]

Question 13

T/F: The liver has an incredible regenerative capacity of up to 80%.

Answer 13

True

Question 14

The hepatocytes excrete cholesterol and bile acids and bilirubin but then water, bicarbonate, and sodium ions are secreted how?

Answer 14

Via the lining of the ducts.

Question 15

How is bile flow regulated?

Answer 15

A # of enteric hormones (either drained via the portal system or in a paracrine fashion.) CCK, VIP/Vasoactive Intestinal Polypeptide, Somatostatin, and NYY/Neuropeptide YY, all tell the gall bladder to contract. Substance P causes relaxation of the sphincter.

Question 16

Hypothyroidism, dyslipidemias and pancreatitis all lead to________.

Answer 16

Dysmotility [inability of the gall bladder to contract.] In turn you get accumulation of bile in the gall bladder which in people causes gall stones but in dogs and cats causes biliary mucoceles.

Question 17

In the liver, hepatocytes function as the?

Answer 17

Work horse, whose most important function is gluconeogenesis.

Question 18

In the liver, Kupffer cells act as part of the ______ ______.

Answer 18

Immune System

Question 19

In the liver, Stellate cells aka ______ ______ act as _______ ______ _______.

Answer 19

Ito cells act as pluripotent stem cells.

Question 20

Stellate cells live within the _______ _______ ______ which is a potential space which is next to these rafts of hepatocytes and the bile ducts. when there is an inflamed environment (inflamm. mediators and cytokines), it will make the stellate cells angry and they transform into fibrocytes.

Answer 20

Space of Disse

Question 21

Hepatic encephalopathy, weight loss, vomiting/diarrhea, PU/PD, Jaundice, Ascites, Coagulopathies (bleeding disorders) are signs of ______ ______ or _______ ______.

Answer 21

Liver failure or liver injury

Question 22

Why might you see vomiting with liver failure/injury?

Answer 22

Can be from accompanying pancreatitis, or from CETZ activation or from gastric ulceration.

Question 23

What are some signs of hepatic encephalopathy?

Answer 23

Lethargy/depression, head pressing, circling, seizures, blindness, and ataxia.

Question 24

Hypoxia/hypotension, anemia, drugs (like steroids and phenobarbitone), bacteria/toxins/cytokines (sepsis) and endocrinopathies (like Cushing’s, Addison’s, Diabetes, Hyper and Hypothyroidism) can all lead to ______ ______.

Answer 24

Secondary hepatopathy

Question 25

Beddlington terriers along with other breeds have a genetic defect which leads to ______ _______ in the liver.

Answer 25

Copper accumulation

Question 26

T/F: Icterus is considered to be a hallmark feature of liver disease.

Answer 26

True

Question 27

If you are going to perform a liver biopsy, one of the first tests you should run is what?

Answer 27

aPTT/PT to check for a coagulopathy, if the pet does have a coagulopathy, consider giving FFP [fresh frozen plasma] transfusion.

Question 28

Why are GI ulcers a common finding with liver disease?

Answer 28

Decreased clearance of gastrin, should be suspicious if you're seeing melena [dark tarry feces] or hematemesis [vomiting of blood].

Question 29

Any time you have inflammatory liver disease you will develop ________.

Answer 29

Cholestasis

Question 30

T/F: Increases in ALT indicate there is impaired liver function.

Answer 30

False, ALT is a leakage enzyme and can only indicate if there is damage to the liver, not impaired function.

Question 31

Bile acids, ammonia, urea, glucose, albumin and coagulation factors are all good indicators of ______ _______.

Answer 31

Liver function

Question 32

Some reasons for pre-hepatic icterus include:

Answer 32

Hemolysis with hypoxia, necrosis or micro thrombi, mediated hepatopathy.

Question 33

Some reasons for hepatic icterus include:

Answer 33

Toxins (like mushrooms, blue-green algae, and cycad palm), infections (Leptospirosis) and Immune-Mediated /breed associated/Cu-storage (chronic hepatitis), neoplasia.

Question 34

Some reasons for post-hepatic icterus include:

Answer 34

EHBO [extra-hepatic biliary obstruction]- like (GM, cholelith, pancreatic tumor).

Question 35

What are 3 reasons for anemia in a liver failure patient?

Answer 35

1. Anemia of chronic disease 2. Microcytosis (from a PSS-portal systemic shunt) 3. Blood loss from gastric ulceration.

Question 36

If you suspect liver disease in a patient and the aPTT/PT is prolonged, what is the mean survival time at this point?

Answer 36

7 days, this is End Stage Liver Disease

Question 37

Ammonia tolerance test and Bile acid stimulation test are both about 97% sensitive in the diagnosis of portosystemic shunts (so they perform well in vascular anomalies) but when you have ______ _____ _______ (like cirrhosis) the bile acids don't perform as well and you'll rely on biopsy in these cases.

Answer 37

Liver parenchymal disease

Question 38

Patients with liver disease need to be on a high quality _____ diet.

Answer 38

Protein [the only time to restrict proteins is when they're showing signs of hepatic encephalopathies]. Feeding a plant based soy might be an alternative to animal protein.

Question 39

Which of the following is considered an indicator of liver failure (loss of function)? A. Elevated ALT +++ and AST ++ B. Elevated ALKP +++ C. Elevated BUN [with liver failure we'd expect a low BUN]. D. Abdominal transudate with normal [ALB]. E. Anemia with icterus [indicator of pre hepatic icterus] F. High [cholesterol]

Answer 39

D. Abdominal transudate with normal [ALB]. (=2 causes of developing an abdominal transudate; 1. ALB conc of below 15, low oncotic pressure, 2. so much pressure by portal vasculature that there is leakage.)

Question 40

``` Which etiology is not likely to be associated with liver failure due to fibrosis? A. Drugs e.g. Phenobarbital B. Endocrine e.g. Cushings C. Cu toxicity D. Toxicity e.g. cycads ```

Answer 40

B. Endocrine e.g. Cushing's Disease [can cause a grossly swollen liver from increased glycogen storage. Will cause an increased ALKP and to a lesser extent ALT.]

Question 41

``` What hematological abnormalities do we expect in cirrhotic liver failure and is a prognosticator of outcome? A. Polycythemia B. Prolonged aPTT C. Shortened aPTT D. Thrombocytosis E. Inflammatory leukogram ```

Answer 41

B. Prolonged aPTT [and PT in the face of liver dz, the estimated mean survival time is