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CVSOH BVSc4 > Hepatology - medicine > Flashcards

Hepatology - medicine Flashcards

1
Q

What are the general clinical signs of liver disease?

A

vague, non-specific
Inappetence
Lethargy
Weight loss
Vomiting
PUPD

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2
Q

What specific signs of liver disease are there?

A

Icterus
Coagulopathy
Ascites
Hepatic encephalopathy

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3
Q

What is prehepatic jaundice?

A

Accelerated haemolysis
eg. IMHA

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4
Q

What is hepatic jaundice?

A

Liver cells arent working properly to clear bilirubin from the blood

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5
Q

What is post hepatic jaundice?

A

disease of biliary system eg. Inflammation or blockage

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6
Q

Why do ascites form during liver disease?

A

Liver is main site of albumin production
Controls oncotic pressure - if reduced then fluid leaks out of capillaries

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7
Q

What skin pathology can arise due to liver disease?

A

Hepatocutaneous syndrome - thickened cracked paw pads

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8
Q

What are the hepatocellular enzymes in small animals?

A

ALT
AST

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9
Q

What are the cholestatic enzymes?

A

ALP
GGT

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10
Q

What can cause elevated hepatic enzymes?

A

Primary disease - toxins, infections, immune mediated
Secondary disease - systemic inflammation, vacuolar hepatic change, hypoxaemia, endocrinopathies

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11
Q

What does the magnitude of the liver enzyme elevations tell us about the disease?

A

NOT prognostic
Often low with secondary hepatopathy
Can be anything with primary hepatopathy
May fluctuate

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12
Q

What are 3 tests that are evidence of hepatic dysfunction?

A

Elevated bile acids/ammonia - bile acid stimulation test
Hyperbilirubinaemia
Coagulation derangement - PT/APPT

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13
Q

What are two infectious inflammatory causes of hepatocellular disease?

A

Neutrophilic cholangitis (bacteria)
Leptospirosis

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14
Q

What are two sterile inflammatory causes of hepatocellular disease?

A

Chronic hepatitis
Lymphocytic cholangitis - immune mediated liver disease in cats

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14
Q

What drug can cause hepatocellular disease?

A

Phenobarbitone - antiepileptic drugs

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15
Q

What are some common causes of cholestatic disease?

A

Pancreatitis
Neutrophilic/lymphocytic cholangitis
Biliary rupture/obstruction
Gall bladder mucocoele
Lipidosis
Neoplasm compressing biliary tree

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16
Q

What can cause a small liver?

A

Portovascular disease
Chronic hepatopathy

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17
Q

What can cause a large liver?

A

Acute hepatic insult
Vacuolar change
Neoplastic or inflammatory disease

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18
Q

What does the gall bladder look like on ultrasound?

A

Cut kiwi

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19
Q

What minimally invasive diagnostics can you do for liver disease?

A

Abdominal effusion analysis
Specific infectious disease testing - lepto, FIP

20
Q

What should you do before hepatic sampling?

A

Check platelets, PT, aPTT first for clotting function
Know blood type for if haemorrhages
Give preventative vitamin K maybe

21
Q

When should you FNA in liver disease?

A

When you suspect:
Diffuse infiltrative hepatic disease
Diffuse metabolic disease
Focal hepatic pathology

22
Q

When should you biopsy liver disease?

A

When you suspect:
Inflammatory disease
Neoplastic disease

23
Q

What are the different techniques for biopsy/surgery for hepatic sampling?

A

Ultrasound guided percutaneous needle - tru-cut
Laparoscopy
Laparotomy - complete surgery

24
Q

What are the practicalities of tru-cut percutaneous needle biopsy?

A

Is a referral level procedure
Need a lack of ascites

25
Q

What are the complications of hepatic sampling?

A

Haemorrhage
Ascites
Clinical deterioration
May be unnecessary/non diagnostic

26
Q

What is the term for getting a sample of bile from the liver/gall bladder?

A

Cholecystocentesis

27
Q

When should you do a cholecystocentesis?

A

If suspect bacterial biliary infection - so can do bile cytology/culture
To rule this out in other cases eg. hepatic lipidosis

28
Q

What are the contraindications for cholecystocentesis?

A

Biliary obstruction
Gall bladder wall pathology/mucocoele

29
Q

When is surgery indicated for liver disease?

A

If there is abdominal free fluid
Hepatic mass lesion
Gall bladder compromise
Gall bladder mucocoele
Obstructive biliary disease

30
Q

How is liver disease in cats different?

A

Enzyme elevations variable
Short enzyme half lives
Often have non-specific signs
Usually have comorbidities

31
Q

What is an immune mediated liver disease in cats?

A

Lymphocytic cholangitis

32
Q

What treatment is preferable for a congenital portosystemic shunt?

A

Surgical correction - improves QOL long term
Stabilise medically first

33
Q

What is the medical therapy for hepatic encephalopathy? What is used to reduce ammonia levels?

A

Diet modification - less animal protein, more plant protein, feed cottage cheese
Lactulose - converts ammonia to ammonium ion so it is trapped in colon

34
Q

What is the general therapeutic treatment of liver disease?

A

Diet modification - restrict copper
Antioxidants
Anti-inflammatory/immunosuppressives
Choleretics - improve bile flow

35
Q

What are the main antioxidant drugs?

A

N-acetyl-cystine - IV
Milk thistle extracts/isolates - oral
S-Adenosyl-L-methionine (SAMe)
Vitamin E

36
Q

What is a choleretic drug?

A

Ursodeoxycholic acid (UDCA) - synthetically derived bile acid which reduces bile viscosity so increases bile flow

37
Q

What two liver diseases do you use antimicrobials in?

A

Neutrophilic cholangitis
Bacterial cholangiohepatitis

38
Q

What antimicrobials do you use for liver disease?

A

Ideally culture and sensitivity
Amoxicillin clavulanate if not

39
Q

What is portal hypertension?

A

Increased resistance to blood flow through the liver

40
Q

What are the consequences of portal hypertension?

A

Secondary shunting
GI wall oedema (splanchnic bed)
Ascites

41
Q

How do you treat portal hypertension?

A

Treat cause
Blood pressure reduction drugs:
Spironolactone - aldosterone antagonist which limits fluid accumulation
Sodium restriction

42
Q

What liver related disease are bedlingtons predisposed to?

A

Copper associated chronic hepatitis

43
Q

What is the decoppering therapy for dogs with copper associated chronic hepatitis?

A

Chelator - D-penicillamine
Dietary copper restriction
Zinc supplements - not alongside chelators though

44
Q

How long does de-coppering take?

A

6-9 months

45
Q

What is the most important management aspect of feline hepatic lipidosis?

A

Nutritional support - tube feeding to stop fat mobilistation

46
Q

What is the treatment for feline hepatic lipidosis?

A

Tube feeding - 40-60 kcal/kg/day
Antioxidants - SAMe, vit E
UDCA - choleretic
Supportive - fluids, antiemetic, opioids

47
Q

What liver condition can be caused by very bad dental disease?

A

Reactive hepatopathy

CVSOH BVSc4 (86 decks)

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