Hepatobiliary 2

Question 1

Which blood test would be considered critical prior to performing liver FNA or liver biopsy in an animal who is suspected of having a hepatopathy?

Answer 1

Coagulation times- whether it is safe to stick a needle in and possibly cause a bleed

Question 2

Define chronic liver and biliary disease

Answer 2

Long-standing, chronic, recurrent or waxing-waning signs

Question 3

List the clinical signs of chronic liver and biliary disease

Answer 3

inappetence and weight loss
V+
D+
PU/PD
lethary

jaundice
ascites

Question 4

List 6 common differentials of chronic liver and biliary disease

Answer 4

Idiopathic chronic hepatitis
Copper-associated liver disease
True copper storage disease
Congenital vascular disease
Neoplasia
biliary tract disease

Question 5

What is a Portosystemic Shunt

Answer 5

Anomalous connection between the portal and systemic venous systems- bypasses the liver

Question 6

List the neuro clinical signs seen with portosystemic Shunt (PSS)-

Answer 6

lethargy
ataxia
obtundation
pacing
circing
blindness
seizures
come

Question 7

describe how to diagnose portosystemic Shunt (PSS)-

Answer 7

raised liver enzymes - but not always as liver is small
Raised fasting and post-prandial bile acids; increased ammonia
Ultrasound; portogram (radiograph/ fluoroscopy); contrast CT

Question 8

describe how to treat PSS

Answer 8

surgical ligation - generally offers greater survival times
Two types:
- complete attenuation- not tolerated well
- partial attenuation- second surgery 3-6 months later

Question 9

Why is metastatic disease common in the liver

Answer 9

excellent blood and lymphatic supply

Question 10

T/F primary liver tumours are relatively common in dogs

Answer 10

False- uncommon

Question 11

List the signs seen with primary liver neoplasia

Answer 11

often non-specific- lethargy, poor appetite
or
abdominal bleed if ruptured mass
palpable mass may be only sign

Question 12

describe how to treat liver neoplasia

Answer 12

surgery is often treatment of choice - assess for metastatic disease first
chemo only effective for lymphoma

Question 13

what happens to ALT in chronic hepatitis

Answer 13

moderate to severe increase - due to hepatic death

Question 14

what is the signalment of chronic hepatitis in dogs

Answer 14

middle-aged and older 8yrs but younger in springers and dobermans

Question 15

describe how to treat chronic hepatitis due to inflammation

Answer 15

corticosteroids
anti-oxidants: SAMe; silybin/silymaris; VitE

Question 16

Describe how to treat chronic hepatitis due to infection

Answer 16

antibiotics

Question 17

Describe how to treat chronic hepatitis due to slow biliary flow

Answer 17

Destolit (ursodeoxycholic acid)

Question 18

Describe how to treat chronci hepatitis due to ascites

Answer 18

diuretics
don’t tend to drain

Question 19

List 3 functions of steroids

Answer 19

anti-inflammatory
immune-modulating
anti-fibrotic - Reduce scarring of the liver- allows liver function to be maintained for longer

Question 20

what dose of prednisolone do you give to a chronic hepatitis case

Answer 20

immune suppressive dose
NOT just anti inflammatory

Question 21

what does Ursodeoxycholic Acid do

Answer 21

Hydrophilic bile acid that displaces more toxic hydrophobic bile acids
Draws water in to bile

Question 22

when should you not use Ursodeoxycholic Acid (UDA) in chronic hepatitis

Answer 22

if there is any blockage in biliary ducts (cholestasis)

Question 23

describe when we use antibiotics in chronic hepatitis

Answer 23

• don’t do unless have C and S
  if have to give ampicillin and metronidazole

Question 24

List 2 histopathology changes that indicate use of antibiotics in chronic hepatitis case

Answer 24

○ ascending cholangitis
significant neutrophilic component to any inflammation

Question 25

describe the dietary management of chronic hepatitis

Answer 25

High quality, highly digestible, palatable protein sources Complex carbohydrates preferred Only restrict fat if steatorrhoea develops

Question 26

define Cirrhosis

Answer 26

end stage Chronic hepatitis, when architecture is very distorted, fibrosis and portal hypertension are present.

Question 27

describe the prognosis of chronic hepatitis

Answer 27

very variable Stable disease- might do well for years with supportive care Springers- 6 months - steroids can increase this

Question 28

list 5 biliary diseases

Answer 28

Inflammation of the gallbladder (cholecystitis) Obstruction of the bile duct Gallbladder mucocele Gallstones (Choleliths) Rupture of the gallbladder or bile duct

Question 29

what causes Neutrophilic cholangitis

Answer 29

ascending infection or haematogenous spread

Question 30

describe how to diagnose Neutrophilic cholangitis

Answer 30

bile sample

Question 31

describe how to treat Neutrophilic cholangitis

Answer 31

antibiotic treatment based on culture results; treat for 8 weeks minimum supportive care

Question 32

list the clinical signs of Neutrophilic cholangitis

Answer 32

lethargy, pyrexia, vomiting, jaundice can be acute

Question 33

what do you tend to see on blood tests with Extrahepatic bile duct obstruction

Answer 33

Very high bilirubin Very high ALP and GGT Can increase ALT and AST

Question 34

what causes a Bile duct rupture

Answer 34

usually the same as EHBDO or possibly trauma- RTA

Question 35

describe how to treat bile duct rupture

Answer 35

manage underlying cause cholecystectomy - surgical repair

Question 36

List the 3 endocrine diseases that gall bladder mucocoele is associated with

Answer 36

Hypothyroidism Hyperadrenocorticism Hyperlipidaemia

Question 37

List 5 indications of cholecystectomy

Answer 37

Ruptured gallbladder Primary neoplasia of the gallbladder Cholecystitis that is unresponsive to medical management Gallbladder mucocoele Cholelithiasis