Hepatobiliary

Question 1

What percentage of dogs in a referral hospital setting have cholelithiasis identified incidentally and what percentage of those become symptomatic in the following 2 years?

Answer 1

incidental in 86.9% cases, 7.7% developed complications in following 2 yrs

Question 2

what percentage of dogs with EHBDO secondary to pancreatitis survive to discharge and what factors can imply negative px?

Answer 2

76% survive to discharge but following greater hazard for death:
- 9yr or older with azotaemia (9.9x)
- Dogs without subjective GB distension (4.4x)
- Temp >/=102.5F (39.2dc) (3.1x)

Question 3

what ultrasound finding can help to differentiate superficial necrolytic dermatitis caused by hepatocutaneous syndrome from pancreatic neuroendocrine neoplasia?

Answer 3

honeycomb liver expected in majority (98% in JAAHA review) of SND/HCS cases but none of SND/EN cases)

Question 4

Which gene mutation associated with copper hepatopathy in Labradors is also associated with the condition in Dobermans?

Answer 4

ATP7B (AT7PA also talked about but less clear that has an influence, particularly in American Dobermans)

Question 5

What proportion of dogs with chronic hepatitis treated with CsA entered remission and what was the median time?

Answer 5

79% of dogs in remission, median time 2.5 months.

Question 5

which clinicpathological changes are frequent in dogs with alpha-amanitin containing mushroom toxicity?

Answer 5

elevated ALT 97%, hypoglycemia 78%, coagulopathy 91%

Question 6

which ultrasonographic technique may correlate with hepatic fibrosis?

Answer 6

shear wave velocity (dubious)

Question 7

What biochemical parameters are associated with decreased likelihood of survival in dogs with gallbladder mucocele?

Answer 7

ALP, phosphorous and creatinine

Question 8

what median survival times are reported for dogs with GB mucocele managed surgically , medically or medically then surgically? (JVIM paper) What mortality rates are reported for elective and non elective cholecystectomy? (JSAP paper)

Answer 8

Sx - 1802 d
Medical - 1340 d
Medical then sx - 203 d

Mortality rates - elective 6%, 21% non elective

Question 9

Activation of which system is implicated in portal hypertension in dogs?

Answer 9

RAAS (plasma renin activity higher in dogs with chronic hepatitis and PH than dogs with congenital EHPSS and normal dogs. Aldosterone higher in dogs with PH due to both CH and primary portal vein hypoplasia compared to cEHPSS and normal dogs)

Question 10

What percentage of cats experienced seizures after thing film attenuation of CEHPSS? In cats that died relating to their CEHPSS treatment, what percentage of deaths related to persistent seizures?

Answer 10

23.5% seizured (8/34 cases) 66.7% (4/6) deaths due to persistent seizures

Question 11

Deficiency of which anticoagulant may be implicated in thrombosis and ascites (in humans and a single case report in a Hungarian Viszla)?

Answer 11

Protein C

Question 12

which biochemical parameters should be monitored in dogs treated with ketoconazole?

Answer 12

liver enzyme activities (JAVMA paper- all dogs with ketoconazole hepatotoxicity had high serum liver values, 33% developed chronic hepatitis, tx duration ranged from 0.3 to 100 cumulative weeks)

Question 13

What is the incidence of high-degree (PCV drop >6%) but clinically silent bleeding after percutaneous liver biopsy in dogs?

Answer 13

42.50%

Question 14

which metabolite of lidocaine may aid in determining likelihood of PSS attenuation post-operatively?

Answer 14

monoethylglycylxylidide (MEGX) (MEGX measured 15 mins after lidocaine had 96.2% sensitivity and 85.3% specificity for shunt closure)

Question 15

What is ACHES?

Answer 15

aminoaciduric canine hypoaminoacidemic hepatopathy syndrome (ACHES)- collective term for dogs with hepatocutaneous-associated hepatopathy (HCH) with or without SND

Question 16

What are the pillars of treatment of ACHES?

Answer 16

> 2 IV amino acid infusions, home cooked diet and >3 nutritional supplements.

Question 17

Which urinary abnormality on dipstick are dogs with GBM more likely to have?

Answer 17

proteinuria

Question 18

which cardiac disease is associated with GB wall edema?

Answer 18

pericardial effusion

Question 19

Which amino acid ratio increases after successful ligation of PSS (but remains low and indicative of hepatic dysfunction)?

Answer 19

BCAA: AAA (branched chain AAs to aromatic AA ratio)

Question 20

Which haematologic change is associated with increased concentrations of hepatic lead in dogs with elevated hepatic copper?

Answer 20

microcytosis

Question 21

what breeds of dog are at risk of chronic hepatitis in the UK?

Answer 21

labrador, springer, cocker, WHWT

Question 22

what percentage of GBM dogs are hyper coagulable based on TEG? What percentage had increased protein C?

Answer 22

83% hypercoagulable on TEG. 87% increased protein C.

Question 23

what is the relationship between gall bladder wall thickness and albumin in dogs?

Answer 23

None (independent variables)

Question 24

Which biomarkers are indicative of ACHES?

Answer 24

reduced plasma 1-methyhistidine and cystathionine; increassed urine lysine and methionine.

Question 25

what factor is associated with survival in cats undergoing choledochal stenting with EHBDO?

Answer 25

absence of peritoneal effusion. Overall these cats did ok... improvement clinical signs in 75% cats, 78.3% surviving to discharge, cholelithiasis associated recurrence, MST 931d.

Question 26

which sedation drug may result in increased GB wall thickness in 24% dogs with 26.3% of these developing peritoneal effusion too?

Answer 26

dexmedetomidine (within 20-40 mins, duration sedation correlated with GB wall thickness)

Question 27

what percentage of dogs with pans after PSS ligation have resolution of neuro signs by discharge?

Answer 27

48%

Question 28

infection with which class of bacteria is associated with poorer survival in cats with cholangitis?

Answer 28

gram positive

Question 29

what factors are associated with better survival in cats with cholangitis?

Answer 29

surgically correctable problems and cholecystectomy

Question 30

dogs developing which biochemical abnormalities are more likely to die of MAPSS?

Answer 30

hypocholesterolaemia and hypoalbuminaemia

Question 31

what are the 6 different GB mucocele types?

Answer 31

I- organised echogenic debris occupying the lumen II- combination of organised echogenic debris with partial stellate strands adhered to GB wall III - stellate pattern IV- combination of stellate and kiwi pattern V- kiwi pattern with echogenic debris VI- kiwi pattern

Question 32

which types of GBM ultrasonographically more likely to be correlated with clinical signs?

Answer 32

types 5 and 6

Question 33

what management strategy is associated with better survival times and fewer clinical signs in dogs greater than or equal to 5 ydars with EHPSS?

Answer 33

surgical treatment

Question 34

After what time period of treatment with zonisamide is acute hepatopathy most likely to occur, and how likley is this?

Answer 34

13-16 days, (0.52% of cases)

Question 35

what proportion of digs with liver disease have gastroduodenal ulceration?

Answer 35

10%

Question 36

which serum biomarker is positively correlated with hepatic histologic necroinflammation and fibrosis?

Answer 36

CRP

Question 37

what percentage of dogs with biliary sludge develop GBM with follow up >12 months?

Answer 37

13%

Question 38

what are risk factors for progression of biliary sludge to GBM?

Answer 38

Being a sheltie or border terrier, increased BCS, non gravity dependent sludge

Question 39

what treatment pre-congenital EHPSS is sufficient in control of clinical signs?

Answer 39

diet and lactulose (diet alone and diet + metronidazole not sufficient and addition metro to diet and lactulose no difference)

Question 40

Which virus is associated with elevated concentrations of ALT and AST and lymphoplasmacytic hepatitis in cats?

Answer 40

domestic cat hepadnavirus

Question 41

Which histological change is a predictor of elevated hepatic copper in dogs?

Answer 41

necroinflammation (age negatively associated with hepatic Cu, breeds positively associated (Dobermans, Labradors, WHWT, CKCS, Corgi). Severity of inflammation and necroinflammation correlated with hepatic copper)

Question 42

what percentage of dogs with EHPSS that had ligation or thin-film banding had post attenuation seizures? What were risk factors for seizures?

Answer 42

6%, risk factors: age, WBC count, expression of hepatocyte growth activating factor and LysM and putative peptidoglycan-binding domain-containing protein 2 (LysMD2) (vs cats paper- 23.5% seizures)

Question 43

What effect does hyperlipidemia have on the gallbladder volume pre and post feeding?

Answer 43

significantly increases gallbladder volume (pre and post feeding)

Question 44

what is the upper limit for GB wall thickness in fasted dogs <40kg without hepatic dz ?

Answer 44

1.3mm

Question 45

which post-operative electrolyte abnormality associated with poorer survival after cholecystectomy?

Answer 45

hypernatraemia (dogs with GBM more likely to develop post-op hypernatraemia)

Question 46

which feature of feline cholelithiasis is negatively associated with survival?

Answer 46

biliary tract obstruction

Question 47

which hepatic hiistologic finding may correspond to poorer survival in dogs with GBM?

Answer 47

hepatic fibrosis

Question 48

what US changes are reported in dogs with granulomatous hepatitis? What MST reported?

Answer 48

hepatomegaly 54%, nodular parenchymal lesiosn 41%, hyperechoic parenchymal bands 41%. Histopath necroinflammatory scores were moderate to severe in 16/19 and fibrosis scores mild in 14/19. Tx varied- included abx, immunosuppressive drugs, hepatoprotectants. Overall MST 635 d (range 1-2472d)

Question 49

what signalment and biochemical features may help predict likelihood of biliary obstruction in cats?

Answer 49

older age, tbil >/= 66 umol//L (3.86 mg/dL)

Question 50

how do haematological findings alter between dogs with IHPSS vs EHPSS?

Answer 50

IHPSS more likely to have anaemia, microcytosis and hypochromia (also mmore likely to have GI signs)

Question 51

what percentage of dogs receiving azathioprine experience hepatotoxicitiy and at what time point? How about thrombocytopenia or neutropenia?

Answer 51

hepatotoxicity - 15%, median 14 days, CBC ahnges - 8% dogs, median 53 days

Question 52

what percentage of dogs and cats with portal vein hypoplasia without portal hypertension have concurrent macroscopic cPSS?

Answer 52

Dogs 58%, cats 87%

Question 53

what is HAVM?

Answer 53

hepatic arteriovenous malformation - rare congenital condition of dogs and cats - branch of hepatic artery communicates directly with portal v via multiple (dozens to hundreds of) aberrant shunting vessels - high pressure causes hepatofugal blood flow, portal vein arterialisation and portal hypertension which opens multiple acquired extra hepatic shunts to decompress this system- often causing ascites (75% cases). Px inferior to common PSS or PVH, but good outcomes can still be achieved Auscultation of turbulent blood flow (bruit) over the liver may be apparent

Question 54

in what dog breeds is cPSS likely hereditary?

Answer 54

Yorkshire terrier (+ maltese?) Left divisional IHPSS are likely heritable in Irish Wofhounds

Question 55

what breed are suspected to have inherited PVH?

Answer 55

Cairn Terriers (Yorkie overrepresented in a report)

Question 56

what percentage of large breed dogs with IHPSS have GI haemorrhage prior to shunt repair?

Answer 56

~30%

Question 57

what percentage of male dogs and male cats with PSS have cryptorchidism?

Answer 57

30% cats, 50% dogs

Question 58

what CBC changes are seen in PSS patients?

Answer 58

often have mild to moderate, microcytic, normochromic , non region anaemia - microcytic anaemia may be due to defective Fe-transport mechanism, decreased serum Fe conc, decreased TIBC and/or increased hepatic Fe stores in Kupffer cells (possible iron sequestration). Microcytosis reported with or without anaemia in 60-72% dogs and ~30% cats

Question 59

what breed of dog can have elevated bile acids without evidence of liver dysfunction?

Answer 59

Maltese

Question 60

what combination of tests have highest sensitivity/ NPV and specificity/ PPV respectively for PSS?

Answer 60

rectal ammonia tolerance test and fasting SBAs had highest sens (100% and 98% respectively) and NPV 100% and 96% respectively Combination of increased fasted SBAs and fasting ammonia had highest specificity (97%) and had PPV 97%

Question 61

levels of which cytokine are increased in dogs with cPSS?

Answer 61

IL6

Question 62

Which microRNA biomarkers are expressed in dogs with IHPSS and splenocaval/ gastrocaval EHPSS but not in dogs with splenophrenic or splenoazygous shunts?

Answer 62

Serum cfa-miR-34a (potent regulator of steatohepatitis) and miR-21 (involved in progression of hepatic damage leading to fibrosis)

Question 63

what is the sensitivity and specificity of US for detecting PSS?

Answer 63

Sens 74-95%, spec 67-100%, correct distinction EHPSS from IHPSS possible in 92% cases. Sensitivity higher for identifying IHPSS (95-100%) than EHPSS due to presence of liver parenchyma surrounding shunting vessel and typically larger diameter of intrahepatic shunting vessel and associated portal vein Doppler helpful - HAVMS classically have hepatofugal flow and venous-venous shunts have hepatopetal flow through the portal vein. Portal flow velocity increased or variable in 53% EHPSS and 92% IHPSS. Portal vein to aorta size ratio may be decreased in EHPSS

Question 64

how can plasma protein C levels help differentiate MVD/PVH from PSS?

Answer 64

protein c >70% in 88% dogs with MVD and low in dogs with PSS

Question 65

what type of choledochal cyst is most common in cats?

Answer 65

type I (fusiform extra hepatic dilatations of the EHBD )

Question 66

what type of choledochal cyst is CAroli disease?

Answer 66

type V - possible involvement of PKHD1 gene (polycystic kidney and hepatic disease gene 1)

Question 67

which breed of cat most commonly affected by polycystic liver dz? dogs?

Answer 67

Persian (+ PKD - 10% PKD have PLD) Dogs - PLD not reported in EBD despite them getting PKD