Hepatic disease

Question 1

What is the overall approach to hepatic disease?

Answer 1

History
Physical exam
CBC
Biochem (liver enzymes/functional markers)
Function testing
Imaging
Sampling

Question 2

At what level would icterus be detectable on physical exam?

Answer 2

30-40umol/l of bilirubin

Question 3

What more specific clinical signs may be associated with hepatopathies?

Answer 3

Jaundice
Hepatic encephalopathy
Ascites

Question 4

What level of liver enzyme elevation are more specific to hepatic pathologies?

Answer 4

3-4x elevations in dogs

any in cats

Question 5

What can cause reactive hepatitis?

Answer 5

GIT or pancreatic inflammation

Question 6

After what period are liver enzymes expected to reduce in dogs with finite hepatic insults?

Answer 6

50% by day 4-6.

Question 7

ALT source and T1/2

Answer 7

• Mainly found in hepatocyte cytosol but minimally in skeletal muscle
• T1/2=
○ 45-60h dog
○ 3.5h cat

Question 8

ALP isoenzymes and T1/2

Answer 8

○ L-ALKP = hepatocytes and biliary epithelium
§ T1/2
□ 66h dog
□ 6h cats
○ B-ALKP = bone
§ Higher in young growing animals or in osteomyelitis/osteosarcoma
○ C-ALKP = steroid induced
n.b Can have a steroid isoenzyme induction vs steroid hepatopathy

Question 9

How does the level of GGT contrast to that of ALP in cholestatic disease?

Answer 9

It is usually more specific but often reaches a relatively lower elevation.

Question 10

What can be tested to assess hepatic function?

Answer 10

Bile acids
Ammonia
Coagulation times/Factors
Albumin
Cholesterol
Urea
Glucose

Question 11

What elevations of bile acids indicate hepatic pathology in dogs and cats

Answer 11

Fasting or post partial samples > 15-20umol/L in the cat or >25-30umol/l in the dog.

In PSS commonly elevations are >100umol/l

Question 12

What can hepatic ultrasound give an indication of?

Answer 12

Size
Architecture (discreet and diffuse pathology)*
Biliary tract
Portal vein
*ultrasonographic appearance is not always changed in pathology

Question 13

What are the 7 indications for liver sampling?

Answer 13

• Persistent elevations in liver enzymes with no determined cause
  
  • Evidence of hepatic dysfunction
  • Jaundice of hepatic origin
  • Ultrasound findings showing diffuse changes in echogenicity
  • Discreet hepatic lesion/lesions
  • Hepatomegaly of unknown aeitiology
  • Evaluation of a breed-specific hepatopathy.

Question 14

What can hepatic FNAs give good information about?

Answer 14

Lymphoma

Discreet lesions

Question 15

What should be performed prior to hepatic biopsy?

Answer 15

Coagulation times

Question 16

What are the main categories of hepatobiliary pathology?

Answer 16

Inflammatory/Infectious
Vascular
Metabolic
Toxic
Neoplastic
Biliary diseases (infectious, inflammatory, neoplastic, mucocele)

Question 17

DDx for infectious/inflammatory hepatic disease in the dog.

Answer 17

Acute Hepatitis
- CAV-1
- Lepto
- Clostridial
- Ehrlichia
- Toxins (mycotoxins, cyanobacteria -algae)
- Drugs
Chronic Hepatitis

Question 18

DDx for infectious/inflammatory hepatic disease in the cat

Answer 18

Neutrophilic cholangitis/cholangiohepatitis
Lymphocytic cholangitis/cholangiohepatitis
Bacterial
Parasitic
Viral diseases
Fungal disease

Question 19

DDx for vascular hepatic disease?

Answer 19

PSS congenital or acquired

Question 20

DDx for metabolic hepatic disease in dogs

Answer 20

Vacuolar, primary:
- Steroid
- Scottish terrier
- B12 deficiency
Vacuolar, secondary:
- CHF, neoplasia, GI disease, other hepatic dz
- Endocrine (hypothyroid, DM)
- familial hyperlipidaemia
Superficial Necrolytic Dermatitis
Storage
- Copper
- Iron
- Amyloid
- Lysosomal

Question 21

DDx for metabolic hepatic disease in cats

Answer 21

HL
HyperTH
SND
Amyloidosis

Question 22

What are the important ddx for diffuse hepatic nodular disease

Answer 22

Neoplasia vs nodular hyperplasia!

Question 23

What are the biliary disease DDx in small animals.

Answer 23

Cholelithiasis
Cholecytitis
Empyhysematous cholecystitis
Neoplasia (whithin or external to)
Parasitic disease
Mucocele
EHBDO