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Y4 SA - Internal medicine > Liver disease – Diagnosis > Flashcards

Liver disease – Diagnosis Flashcards

1
Q

List the steps used in diagnosing liver disease

A

History & clinical signs
Physical examination
Laboratory evaluation
Diagnostic imaging
Liver biopsy

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2
Q

What signs may present on physical examination which would indicate liver disease?

A
  • Icterus: present in serum before visible to the eye. Can have severe disease without icterus
  • Ascites
  • Hepatomegaly / microhepatica: can feel the liver just behind the costal arch when its enlarged
  • Pain e.g. abdominal pain
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3
Q

Which laboratory tests can be done in suspected liver disease cases?

A

Haematology
Serum biochemistry
Urinalysis
Coagulation - Before liver biopsy
Liver function tests
Peritoneal fluid cytology - Ascites investigation

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4
Q

Which liver enzymes are hepatocellular markers?

A

ALT
AST

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5
Q

What are hepatocellular markers?

A

An insult that effects the liver cell can lead to the release of enzymes into the bloodstream. The damage doesn’t have to be fatal damage to the cell.
Number of enzymes reflects how many cells are affected.
In cirrhosis there aren’t many normal liver cells left so ALT and AST may not be that markedly increased

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6
Q

Which liver enzymes are cholestatic markers?

A

ALP
GGT

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7
Q

What are cholestatic markers?

A

Present within the biliary system.
Any insult that leads to cholestasis or bile stasis, can lead to increases in these markers

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8
Q

Which substances can be used to assess the function of the liver?

A
  • Serum proteins (albumin)
  • Glucose, urea, cholesterol
  • Bilirubin
  • Bile acids
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9
Q

Why can glucose, urea and cholesterol levels be used to assess the function of the liver?

A

All produced by the liver so if it is not functioning the levels of these will change

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10
Q

The levels of which markers in serum biochemistry tests will change in early liver disease?

A

ALT, ALP
Bile acids

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11
Q

The levels of which markers in serum biochemistry tests will change in end-stage liver disease

A

Increased clotting factors
Decreased glucose

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12
Q

At what stage of liver disease do clinical signs begin?

A

In chronic hepatitis there is a ‘window of no clinical signs’
Once cirrhosis begins, clinical signs develop through to end stage liver disease

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13
Q

Which test should you run when youre looking for possible liver disease and the patient is not yet jaundice?

A

Bile acid test

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14
Q

How can urinalysis complement haematology and biochemistry

A

Urine bilirubin is a more sensitive marker than serum
Evidence of protein

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15
Q

What are the 4 major reasons of decreased albumin?

A
  • Blood loss: pale mm
  • Through the GIT: protein losing enteropathy
  • Protein losing nephropathy: albumin loss through the glomeruli (if there isn’t protein in the urine then this can be ruled out)
  • Albumin isn’t being lost through the liver
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16
Q

Describe how radiographs are used for diagnosing liver disease

A

Normal – axis of the stomach should be parallel to the ribs
If the liver is enlarged, it will push the axis caudally
Can tell you if there’s an abnormal shape of the liver

17
Q

What is portovenography?

A

Inject contrast into a BV adjacent to the intestines which goes to the portal vein - contrast radiographs

18
Q

Which liver abnormalities can be detected on ultrasound?

A

Liver size
Heterogeneous parenchymal disease
Biliary obstruction
Biliary calculi
Masses
Vasculature - Portosystemic shunts, Arteriovenous fistulas

19
Q

List the indications for a liver biopsy

A
  1. Persistent increases in liver enzymes
  2. Altered liver size
  3. Monitoring progressive liver disease
  4. To evaluate response to treatment
20
Q

What must always be done before a liver biopsy?

A

Check clotting profile

21
Q

What are the 3 liver biopsy techniques?

A
  1. Percutaneous
    - ‘Blind’
    - Ultrasound guided “Tru-cut” technique
  2. Laparoscopy
  3. Coeliotomy
22
Q

List the contraindications for a percutaneous liver biopsy

A

Lack of operator experience
Small liver, unless ultrasound available
Focal disease
Extrahepatic cholestasis
Bleeding disorder
Severe anaemia

23
Q

Describe the pathology of juvenile hepatic fibrosis

A
  • Uncommon disease seen in young dogs (GSD, Rottweiler)
    Progressive fibrosis
    Minimal inflammatory reaction
    Central vein fibrosis & occlusion most common
24
Q

Secondary acquired shunts occur following?

A

Hepatic fibrosis

25
Q

Describe the features of acquired hepatic shunts

A

Usually multiple
Develop secondary to liver disease
- Juvenile fibrosis
- Cirrhosis
Shunts develop from redundant vessels
- Between portal vein and CVC
- Portal hypertension often leads to ascites

26
Q

Name the 4 types of canine chronic hepatitis

A

Idiopathic chronic hepatitis
Lobular dissecting hepatitis
Drug-induced chronic hepatitis
Copper-associated hepatitis

27
Q

Chronic canine hepatitis all may lead to…?

A

Cirrhosis - fibrous tissue deposition

28
Q

Dogs with chronic hepatitis will have shorter survival if which 3 conditions develop?

A
  • Hypoalbuminaemia
  • Severity of necrosis and fibrosis in the biopsy
  • Bridging fibrosis
29
Q

What is cirrhosis

A

End-stage of many diseases - chronic hepatitis, drug toxicity
Shrunken liver from fibrosis
Micro- or macro- nodular regeneration

30
Q

Microvascular dysplasia is another term for?

A

Hepatic portal hypoplasia

31
Q

Describe the features of hepatic portal hyperplasia

A

Microscopic intra-hepatic shunting
Often have no clinical signs or like PSS
Small terrier breeds
Increased Bile acids

32
Q

What are the two types of feline cholangitis complex?

A

Suppurative cholangitis - neutrophils
Lymphocytic cholangitis – lymphocytes and plasma cells

33
Q

What is idiopathic hepatic lipidosis?

A

Massive hepatic fat accumulation

34
Q

What are the 4 consequences of idiopathic hepatic lipidosis?

A

Biliary stasis
Liver failure
Anorexia
Death

35
Q

Name the 3 types of hepatic neoplasia

A

Primary tumours
Infiltrative
Metastatic

36
Q

Name some examples of primary hepatic tumours

A

Hepatocellular carcinoma
Hepatoma
Cholangiocarcinoma
Fibroma / sarcoma
Haemangioma / haemangiosarcoma

Y4 SA - Internal medicine (7 decks)

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