Liver: Clinical Essentials

Question 1

An elevated ALP could be indicative of what?

Answer 1

• reactive hepatopathy
• induced
• cholestasis

Question 2

Relevant to an elevated ALP, some questions you would be sure to ask the owner would be

Answer 2

• recent/current medications
• excessive panting
• drinking/urinating a lot

Question 3

if you suspect that your patient has a portosystemic shunt, what historical questions would you want to ask the owner?

Answer 3

• size compared to littermates
• excessive drinking?
• frequent urination?

Question 4

In addition to hypoglycemia, which chemistry panel parameter would you be most interested in evaluating as evidence for decreased liver function

Answer 4

cholesterol

Question 5

Is the Pre- and Post Prandial Bile Acids test specific to diagnosing a Portosystemic Shunt?

Answer 5

no

Question 6

your patient is severely icteric. would you recommend running a pre- and postprandial bile acids test?

Answer 6

no, will automatically be abnormal. pointless to run if patient is jaundiced

Question 7

what are the reasons ALP would be elevated?

Answer 7

cholestatic, reactive, induced
is a very empathetic organ! e. coli, dental disease, hyperthyroidism, cushing’s can all elevate

Question 8

what are the cholestatic enzymes?

Answer 8

ALP, GGT

Question 9

T/F: ALP can be induced in cats

Answer 9

FALSE. dogs

Question 10

T/F: liver enzymes are indicative of liver function

Answer 10

FALSE

Question 11

what parameters indicate liver FUNCTION?

Answer 11

glucose, BUN, albumin, cholesterol

Question 12

your patient is icteric. what parameter will be increased

Answer 12

bilirubin, will be hyperbilirubinemic

Question 13

what are causes of hyperbilirubinemia?

Answer 13

1. pre-hepatic: lysis of RBC: IMHA, low PCV/normal TP = low PCV but not bleeding out of vasculature so TP is normal
2. hepatic
3. post-hepatic: physical obstruction or a functional problem like pancreatitis. imaging! gall bladder mucocele, EHBO, pancreatitis

Question 14

if your patient’s bilirubin is >0.2 ?

Answer 14

hyperbilirubinemia (normal is 0-0.2
1.5 = icteric, jaundice, yellow

Question 15

will primary hepatopathy cause elevated ALT or ALP?

Answer 15

ALT

Question 16

causes of primary hepatopathy

Answer 16

inflammation, hepatitis, infection, necrosis, immune, neoplasia

Question 17

causes of cholestasis or secondary (reactive) hepatopathy

Answer 17

medications: steroids, phenobarb
inflammation/infection, pancreatitis, GI, systemic
endocrine: hyperadrenocorticism
hypoxia

Question 18

clinical signs of pancreatitis

Answer 18

non-specific
V+, anorexia, lethargy, D+, abd pain, dehydration, weight loss, jaundice

Question 19

how trustworthy is a snap fPL?

Answer 19

portion of results are in the “grey” zone- feel GOOD about a negative, but there is always a problematic zone

Question 20

what radiographic signs are consistent with pancreatitis?

Answer 20

1. soft tissue opacity
2. decreased serosal detail
3. wide pyloric duodenal angle
4. gas-filled duodenum
   corregated small intestines can be confused with a linear foreign body!