Liver

Question 1

Bioc values that decr with liver issues

Answer 1

• albumin
• urea
• glucose
• cholesterol

Question 2

bioc values that incr with liver issues

Answer 2

• bilirubin
• cholesterol
• ALP
• GGT

Question 3

When does ALT and ALP matter for dog vs cat?

Answer 3

• dog: if boht incr, or one is 2x upper normal

- 2 cat: if increased

Question 4

What might you see in UA with liver issue

Answer 4

• bilirubinuria (from less bilirubin processing by liver and thus accumulation?)
• ammonium biurate crystals

Question 5

Eg’s of primary liver dz’s

• hepatocellular
• bile duct
• vascular

Answer 5

• nodular hyperplasia (normal aging), chronic hepatitis, vacuolar hepatopathy, cirrhosis, toxin, neoplasia, infection
• gall bladder mucocele, inflammation, neoplasia, bac infection
• protosystemic shunt, neoplasia, telangiectasia, portal vein hypoplasia

Question 6

Secondary causes of liver issue

Answer 6

• pancreatitis (esp triaditis in cats)
• diabetes
• hyperadreno
• hypoxia
• trauma
• systeimc infection
• neoplasia
• amyloidosis

Question 7

Abn serum bile acid values can indicate issue with what?

Answer 7

• liver function
• cholestasis
• portal blood flow

Question 8

Dx options for liver

Answer 8

• xray: limited for size and opacity changes
• US: better info
• CT
• nuclear scintigraphy
• biopsy –> check hemostatsis before

Question 9

Chronic hepatitis

• what
• cause
• Bw
• histo

Answer 9

• inflammatory disease
• unknown: Cu? infection? oxidation?
• incr ALT/ALP/GGT
• single cell necrosis, mixed lymph and neutrophilic, periportal/bridging fibrosis

Question 10

Copper storage hepatopathy

• pathyphys
• breeds

Answer 10

• hepatocytes store Cu –> progressive accumulation –> necrosis of cells
• Bedlington terrier, lab, dalmation, westies

Question 11

General tx for liver

Answer 11

• anti-inflammatories: pred
• azathioprine (anti-metabolite to decr fibrosis and lymphocyte infiltration): –> not emperically as high side effects (BM supp, liver and pancrease issue)
• ursodiol: incr hydration of bile acid to decr cholestasis
• anti-oxidation: SAMe (incr glutathione), silymarin, vit E, zinc, Se
• D-penicillamine (Cu chelation)
• diet: high available carb, high protein quality, incr fiber
• if ascites: ACE inhibitor, spironolactone
• +/- albumin supp
• +/- vit K or plasma if coagulopathy

Question 12

Hepatic lipidosis

• presentation
• dx
• histo
• tx
• prognosis
• complications

Answer 12

• cat off food, yellow, acute
• elevated liver values with ALP > ALT, incr bilirubin, UA (bilirubinura)
• incr vacuolated hepatocytes
• nutrition**, fluid (avoid LRS), vit K, liver support (see liver tx card), anti-emetic (maropitant)
• good if no co-morb
• pancreatitis, infection

Question 13

Common liver dz’s in cats

Answer 13

• hepatic lipidosis
• cholangitis
• cholelith
• biliary cyst

Question 14

triaditis involves which 3 things?

Answer 14

• cholangiohepatitis
• inflamm bowel
• pancrease

Question 15

Neutrophilic cholangiohepatitis

• histo
• tx

Answer 15

• neutrophilic infiltrate, E. coli

- abx, liver support

Question 16

Lymphocytic cohlangiohepatitis

• who
• associated dz’s
• sign
• dx
• tx
• sequlae

Answer 16

• cats
• pancreatitis, inflamm bowel dz, bile duct obstr.
• decr appet., incr liver values, +/-jaundince, +/- high globulin
• def dx: biopsy
• tx: abx, predn., chlorambucil, liver support
• can progress to sclerosing cholangitis

Question 17

Gall blader mucocele

• pathogenesis
• signs
• BW
• dx
• tx
• prognosis

Answer 17

• abn fat met? some predisp factor –> mucoid sludge
• incidental to general illness, icterus, vomiting, abd pain
• incr neutrophil with left shift, incr liver enzymes, incr bili
• xray or US (sludge, stellate, kiwi)
• conservative tx if not full obstruction: ursodiol, low fat diet
• sx if worsens or full obst.
• low but better if can leave hosp, worse with co-morb

Question 18

Vacuolar hepatopathy

• cause
• breed
• dx
• signs
• tx

Answer 18

• lipidosis, steroid (forms glycogen)
• scottish terriers
• high ALP, vacoules on histo, US (holes)
• potentially hepatocutaneous sydrome erosions/crusts on paws, face, inginal area –> parakeratosis, basal cell hyperplasia
• shampoo, essential FA, Zn supp, high quality protein

Question 19

Portosystemic shunt

• 2 types
• signs
• dx
• tx

Answer 19

• intra vs extrahep
• young, supour, prominent kidneys, slow growth, coppor-coloured iris in cats
• microcystosis, ammonium biurate on UA, low liver prod values, xray (microhep), US (abn vessels), CT angiography
• sx

Question 20

Portal vein hypoplasia

• breed
• cause
• dx
• tx

Answer 20

• cairn terrier
• congenital –> abn intrahep vasculature –> microsopic shunting
• biopsy
• control hepatoencephalopathy

Question 21

Hepatic encephalopathy

• toxins
• signs
• tx

Answer 21

• ammonia
• depression, hypersalivate, head pressing, ataxia, blindness,, etc.
• enema, lactulose, abx, protein restriction

Question 22

Hepatic toxins

• what
• dx
• tx

Answer 22

• mushroom, aflatoxin, blue-green algae, xylitol, diazepam (cats), carprofen (labs)
• signs, high ALT/ALP/bili
• support liver, avoid hepatic encephalo, acetycysteine

Question 23

What breed more predisposed to polycystic disease in cats in biliary tract

Answer 23

Persian

Question 24

Biliary cystadenoma

• who
• how bad?

Answer 24

• older cats

- often incidental

Question 25

Neoplasia in liver --. changes what bioc value

Answer 25

incr ALP