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A - Medicine Liver > Liver diseases of the dog > Flashcards

Liver diseases of the dog Flashcards

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1
Q

In dogs what does chronic parenchymal disease typically progress to?

A

Fibrosis and cirrhosis

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2
Q

Is primary biliary disease rare or common in dogs?

A

Rare

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3
Q

What is a common sequele to chronic liver disease in dogs?

A

Portal hypertension

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4
Q

Is chronic or acute hepatitis more common in dogs?

A

Chronic

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5
Q

Why is chronic hepatitis often not diagnosed until late stage?

A

Because it rarely causes icterus
Ends up manifesting as hepatic insufficiency in the end
Frequently associated with portal hypertension

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6
Q

What 3 defining features characterise chronic hepatitis in dogs histologically?

A

Hepatocellular apoptosis or necrosis
Variable mononuclear or mixed inflammatory cell infiltrate
Regeneration and fibrosis

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7
Q

Name some dog breeds that are predisposed to chronic hepatitis?

A 
Spaniels
Terriers
Dalmatian
Doberman
Great Dane
Labrador
Saomyed
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8
Q

What age group of dogs is overrepresented in chronic hepatitis?

A

Young to middle aged

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9
Q

What is the most common cause of chronic hepatitis in dogs?

A

Usually idiopathic

- maybe unidentified infectious agent, toxin, immune mediated

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10
Q

Although uncommon in dogs with chronic hepatitis, what 3 specific processes may contribute to icterus?

A

Hepatocyte swelling
Fibrosis
Portal hypertension

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11
Q

In dogs with chronic hepatitis what is the main reason for the resulting portal hypertension?

A

Inflammation and fibrosis which obstructs and disrupts the sinusoids

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12
Q

As a result of portal hypertension, what 3 other things does this then predispose the dog to?

A

Ascites
Chronic - acquired intrahepatic portosystemic shunts (PSS)
Splanchnic congestion

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13
Q

If splanchnic congestion as a result of portal hypertension isn’t relieved by acquired PSS, what can then happen?

A

Gastric mucosal hypoperfusion and hypoxia

Results in GI bleeding

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14
Q

What are the 9 clinical signs to look for in a dog with chronic hepatitis?

A 
Vomiting and diarrhoea
Anorexia
Polyuria/polydipsia
Weight loss 
Ascites
Icterus sometimes
Hepatic encephalopathy in end-stage
Coagulopathy
GI bleeding
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15
Q

How do you definitively diagnose chronic hepatitis in dogs?

A

Liver biopsy

Although remember to do a coagulation test first!

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16
Q

In a dog with chronic hepatitis what is the most commonly elevated enzyme?

A

ALT
Although other enzymes may be elevated
But if cirrhotic may produce overall minimal enzymes

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17
Q

In late stage chronic hepatitis in dogs, when the functional mass is being destroyed what 4 functional indicators become abnormal? (Not enzymes)

A 
Low urea
Low albumin
Possibly -
Increased bilirubin
Increased SBA's
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18
Q

What are the 3 goals of treatment for a dog with chronic hepatitis?

A

Find and address underlying cause
Slow disease progression
Support liver function

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19
Q

In a dog with chronic hepatitis what should you do to its protein intake?

A

Give it a high quality highly digestible protein
Reduces hepatic work and ammonia production
Don’t restrict dietary protein

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20
Q

What drug has an antifibrotic effect?

A

Colchicine

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21
Q

What drug class should you give to a dog with confirmed chronic hepatitis for anti-inflammatory and anti-fibrotic properties?

A

Glucocorticoids

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22
Q

What are the 5 contraindications for administration of glucocorticoids in a dog with chronic hepatitis?

A 
Portal hypertension
Non-inflammatory fibrosis
Infection
Hepatic encephaolopathy 
GI ulceration
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23
Q

What breed gets true copper storage disease and why?

A

Bedlington terriers
Genetic defect in copper storage and transport
Accumulates in perivenous hepatocytes

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24
Q

What causes secondary copper storage disease?

A

Any chronic hepatitis with cholestasis

Usually mild and accumulates in peribiliary area

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25
Apart from true copper storage and secondary copper storage disease, what is the 3rd type of copper storage disease?
Copper toxicosis | Fed a high copper diet
26
How do you definitively diagnose a copper storage disease?
Biopsy with copper staining and/or genetic testing of Bedlington Terriers
27
What can the clinical pathology and imaging of idiopathic chronic hepatitis also look like?
Copper storage disease
28
What are 4 key management points for copper storage disease?
Intensive support for acute hepatic crisis Copper chelation Feed low copper, high zinc diet Liver support and medication similar to chronic hepatitis
29
What are 2 infectious cause that rarely, but may cause canine chronic hepatitis?
Atypical leptospirosis | Sporadically Borartonella
30
What are the 5 infectious causes of canine acute hepatitis?
``` Canine adenovirus 1 Canine herpesvirus Leptospira interrogans Endotoxaemia Yersinia ```
31
What are the 2 toxic causes of canine acute hepatitis?
Aflatoxins and blue-green algae Drugs -Paracetamol, phenobarbitone, carprofen, sulfonamides, lomustine
32
Other than infectious and toxic causes of canine acute hepatitis, what are 3 other causes?
Heat stroke Copper storage disease Mercury poisoning
33
What are the 9 clinical signs you should look for in a dog with acute hepatitis?
``` Anorexia Vomiting Polydipsia Hepatic encephalopathy Icterus Coagulopathy Pyrexia Pain DIC ```
34
What are 4 characteristic clinical pathological findings for canine acute hepatitis?
Increase in liver enzymes Hyperbilirubinaemia Hypoglycaemia Coagulopathy
35
What 3 things are usually used to diagnose a dog with acute hepatitis?
History Clinical signs Clinical pathology findings -Usually can't biopsy because it is severe and acute disease
36
What is the most common congenital portovascular anomaly in dogs?
Congenital portosystemic shunt
37
What is the portal pressure like in a dog with a congenital portosystemic shunt?
It has low portal pressure unless there are additional anomalies
38
What are the 7 main clinical signs of a dog with a congenital portosystemic shunt?
Poor growth and body condition Neurological signs PU/PD Ammonium biurate crystalluria and LUT signs Renomegaly Other congenital defects like cryptorchidism Anaesthetic intolerance
39
Post prandially, a dog with a congenital portosystemic shunt will have a high what?
High serum bile acids
40
What is the treatment of choice for a dog with congenital portosystemic shunt?
Surgical ligation of anomalous vessel - referral
41
How does a dog with a portovascular disorder with portal hypertension usually present?
Has typical signs of a portosystemic shunt But also ascites Can only systematically treat but do NOT give glucocorticoids
42
What 3 things do a dog with cholangitis and cholecystitis typically present with?
``` Acute onset of- Anorexia Vomiting Icterus +/- Pyrexia ```
43
Diagnostically what should you do to a dog with suspected cholangitis/cholecystitis?
Clinical pathology and ultrasound that supports a post-hepatic icterus Obtain liver and/or gall bladder histopathology sample and bile cultureq
44
How will the gallbladder appear on ultrasound in a dog with a gall bladder mucocoele?
Stellate appearance
45
What are the two treatment options for a dog with a gall bladder mucocoele?
Surgical - cholecystectomy +/- biliary diversion | Medical management - low fat diet, antioxidant and choleretic
46
What is the most common cause of extrahepatic bile duct obstruction in the dog?
Acute-on-chronic pancreatitis
47
What are the 6 causes of extrahepatic bile duct obstruction in the dog?
``` Acute-on-chronic pancreatitis Neoplasia Inflammation and stricture Cholelithiasis Diaphragmatic hernia Intestinal foreign body at level of bile papilla ```
48
What will you see on ultrasound of a dog with extrahepatic bile duct obstruction?
Dilated tortuous bile ducts | Gall bladder distension
49
What do you need to be aware of in a dog when diagnosing it with a suspected extrahepatic bile duct obstruction via ultrasound?
That gall bladder distension alone can occur if the dog has been fasting
50
What does chronic, complete obstruction of the common bile duct in dogs result in? (3 things)
Acholic faeces Vitamin-K responsive coagulopathy Lack of urobilinogen in faeces
51
What can incomplete obstruction of the common bile duct in dogs also present as?
Other types of biliary disorders -unspecific
52
What are the 2 most common causes of bile peritonitis in the dog?
Trauma | Pathological rupture of a diseased gall bladder
53
What are the 6 signs of bile peritonitis in the dog?
``` Initially non-specific signs Acute abdomen (pain) Icterus Pyrexia Vomiting Anorexia Abdominal effusion ```
54
What is the effusion from a bile peritonitis usually contain?
Bile pigment Initially non-septic inflammation Later cell necrosis and increased intestinal permeability causes septic peritonitis
55
What is the treatment of bile peritonitis in the dog?
Surgical with aggressive supportive treatment
56
What should you do about nodular hyperplasia in the dog?
Nothing. It is a benign condition of older dogs with no clinical signs
57
What 2 diseases can nodular hyperplasia be misdiagnosed as?
Cirrhosis | Neoplasia
58
What clinical pathology signs will you see in a dog with nodular hyperplasia?
Moderate to high elevation of ALP | But no evidence of liver dysfunction
59
How do you definitively diagnose canine nodular hyperplasia?
Wedge biopsy | With a FNA you can't differentiate from hepatocellular adenoma or carcinoma
60
What hepatic neoplasia type is more common in dogs, Primary or metastatic?
Metastatic
61
Are malignant or benign hepatic neoplasia more common in dogs?
Malignant
62
Why can diagnosing canine hepatic neoplasia be difficult?
Because clinical signs are non-specific On imaging it can be diffuse or nodular Clinical pathology results can be normal or reflect hepatocellular damage and cholestasis
63
What type of canine hepatic neoplasia carries the best prognosis usually?
A massive hepatocellular carcinoma | Has a low metastatic rate and usually surgical resection of affected lobe gives a low recurrence rate
64
Why do many primary canine hepatic neoplasias carry a poor prognosis?
Poor response to chemotherapy Can't do radiation Metastasise earlier and difficult to surgically resect all of the affected area
65
What does the prognosis of a secondary canine hepatic tumour depend on?
What the primary tumour is | E.g. if lymphoma generally responds well to chemo
66
What do canine hepatic abscesses usually result from?
Embolism from an infected site | Generally pretty rare
67
What 2 things predispose a dog to contracting a hepatic abscess?
Endocrine disorder | Immunosuppression
68
Are gram negative or positive organisms more common in a canine hepatic abscess?
Gram negative
69
What 7 things will a dog with a hepatic abscess present with clinically?
``` Anorexia Lethargy Vomiting Fever Dehydration Abdominal pain Predisposing factors ```
70
What 5 things contribute to a diagnosis of a canine hepatic abscess?
Neutrophilic leukocytosis with left shift High serum ALT and ALP Imaging may reveal mass and emphysema FNA mass to differentiate from other lesions Ideally MC&S from deep in lesion
71
What are the 5 steps for treating a dog with a hepatic abscess?
Surgical removal of affected tissue Antibiotics based on the MC&S Supportive care for sepsis Address underlying problem
72
What changes contribute to the pathophysiology of canine dermatological conditions associated with liver disease?
``` Probably multifactorial Low circulating amino acid concentration +/- zinc deficiency +/- fatty acid deficencies decreased plasma amino acid concentrations ```
73
In dogs with dermatological conditions associated with liver disease, what and where are the typical skin lesions?
``` Erythema Crusting Hyperkeratosis Affects - Footpads Nose Periorbital Perianal Genital areas Limb pressure points Painful ```
74
How do you diagnose a dog with a dermatological condition that is associated with liver disease?
A skin biopsy There are nonspecific clinical pathological changes consistent with liver problems On ultrasound the liver appears like 'swiss cheese'
75
What is the management and prognosis of a dog with a dermatological condition that is associated with liver disease?
Usually live under 6 months Poor prognosis unless underlying cause is found and treated Treat symptomatically and supportively Amino acid and protein supplementation Antibiotics for secondary skin infections Do NOT give glucocorticoids - predispose to diabetes mellitus
76
Are primary or secondary hepatic changes more common in dogs?
Secondary
77
In a canine secondary hepatopathy, what are the liver enzymes and liver function typically like?
Liver enzymes mild to moderately elevated | No compromise to liver function
78
Why do you need to do a complete work up of a dog you suspect with a secondary hepatopathy?
Exclude primary liver disease | Determine the underlying extra-hepatic disorder
79
What 2 secondary hepatic disorders of dogs is most common if hepatic vaculolation exists?
Endocrine disease | Certain drugs
80
What 2 secondary hepatic disorders are most commin if hepatic congestion and oedema exists?
Right sided congestive heart failure | Other causes of post-hepatic venous congestion

A - Medicine Liver (3 decks)

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