Liver

Question 1

Which liver disease is most likely to develop DIC with decreased platelets?

Answer 1

Acute liver disease

Question 2

What liver enzymes may be increased with hepatocellular damage?

Answer 2

ALT and AST

Question 3

What liver enzymes may be increased with cholestasis?

Answer 3

ALP and GGT

Question 4

Which liver enzyme has a shorter half life and is more affected by muscle damage…AST or ALT?

Answer 4

ALT

Question 5

Which species is it more concerning that ALP is elevated? Why?

Answer 5

Cats because there is no inducible reasons for why a cat would have an elevated ALP level, unlike in dogs.

Question 6

If AST is higher than the ALT, what does this indicated?

Answer 6

Muscle damage

Question 7

In the cat, what does an elevated GGT indicate?

Answer 7

Pancreatitis and biliary disease

Question 8

Increased ALT and GGT ( with GGT being more elevated) in a cat may indicate which diseases?

Answer 8

Cholestatis or choleohepatitis

Question 9

What liver function tests are based off of substances synthesize in the liver?

Answer 9

1. BUN
2. Glucose
3. Albumin
4. Cholesterol
5. Clotting factors
6. Anticoagulants

Question 10

What are some reasons other than liver failure why a patient may have a decreased BUN?

Answer 10

Diets

Medullary washout

Question 11

What substances are taken up into the liver that and secreted by the liver that measured to determine liver function?

Answer 11

1. Bile acids

2. Bilirubin

Question 12

What substances are conjugated in the liver that can be measured to help us determine liver function?

Answer 12

Bilirubin

Question 13

What is metabolized by the liver that can be measured to help us determine liver function?

Answer 13

Ammonia

Question 14

Why would cholesterol increase in liver disease?

Answer 14

A bile flow issue leading to cholestatic disease

Question 15

Why would cholesterol decrease in liver disease?

Answer 15

It is synthesized in the liver, so if the liver is damaged, it won’t be made.

Question 16

Why would albumin decrease in liver disease?

Answer 16

It is synthesized in the liver

Question 17

Which liver enzyme tests will have decreased values early in liver disease? Late?

Answer 17

Early:
BUN, cholesterol and albumin
Late:
Glucose

Question 18

Which two situations would we be most likely to see elevated ALP and GGT levels?

Answer 18

Glucocorticoid use or

Vaculour hepatopathy

Question 19

What liver enzyme would you expect to see elevated in a cat with hepatic lipidosis?

Answer 19

1. ALP will be the highest
2. ALT
3. GGT

Question 20

Which liver enzymes tests will not be on routine blood chemistry and must be ordered separately?

Answer 20

Bile acids

Ammonia

Question 21

Why would platelet count increase in liver disease?

Answer 21

The patient is suffering from a hepatocellular carcinoma and is most likely a dog

Question 22

Which organs does GGT enzyme come from other than the liver?

Answer 22

Pancreas
Kidney
Intestines

Question 23

Which diseases are associated with vacuolar hepatopathy?

Answer 23

1. Cushings
2. Diabetes
3. Hypothyroidism
4. Idiopathic (scottie)

Question 24

Which liver diseases are associated with a patient coming into the clinic sick?

Answer 24

1. Acute Hepatopathy (Hepatitis or hepatotoxicity)
2. Chronic hepatitis
3. Lymphoma
4. PSVA
5. Vaculoar hepatopathy
6. Hepatic lipidosis

Question 25

Which liver diseases are associated with a patient coming into the clinic normal?

Answer 25

1. Chronic hepatitis 2. Lymphoma 3. Biliary mucocele 4. Vacuolar hepatopathy 5. PSVA 6. Cholangitis-L/P 7. Reactive hepatopathy

Question 26

What P/E findings are common with liver disease?

Answer 26

1. Icterus 2. Hepatomegaly 3. Ascites 4. Hepatic encephalopathy

Question 27

Why would an animal with liver disease potentially have ascites?

Answer 27

Portal hypertension due to chronic hepatitis that is end stage and likely has fibrosis causing hypertension.

Question 28

What are you likely to see on cbc with liver disease?

Answer 28

Anemia that can be from chronic disease, regenerative due to hemorrhage from the portal hypertension, or iron deficiency microcystic anemia from the liver not producing iron

Question 29

What liver diseases commonly have iron deficiency anemia on CBC?

Answer 29

Shunts | Hepatic lipidosis in cats

Question 30

When does hypoglycemia occur with liver disease patients?

Answer 30

When there is less than 30% functional liver mass left

Question 31

Describe hepatocutaneous dogs..

Answer 31

These dogs have a rare condition where they are hyperglycemic due to increased glucagon production which decreases insulin. They don't metabolize amino acid correctly. these dogs have concurrent diabetes mellitus with a swiss cheese liver. usually a fatal disease.

Question 32

Why would we ever see elevated globulins with liver disease?

Answer 32

Increased: cats with cholangitis in a chronic immune situation and rarely decreased because globulins are secreted from other parts of body than the liver

Question 33

What other differentials besides liver disease will there be hypocholesterolemia and hypoalbuminemia? How would you tell these differentials apart from liver disease?

Answer 33

1. GI Disease in dogs 2. Histiocytic sarcoma in dogs Is there panhypoproteinemia? If so, probably GI disease

Question 34

Describe how bilirubin is made?

Answer 34

Hemoglobin and myoglobin breakdown into unconjugated where it travels to the liver and conjugated into bile then goes to the GI and becomes deconjugated and leaves via the feces or is reabsorbed from kidneys/liver.

Question 35

Is hypoglycemia due to liver disease more common in dogs or cats and why?

Answer 35

Dog, because cats have a stress response which keeps glucose high