SA Liver

Question 1

What enzymes of the liver are considered hepatocellular?

Answer 1

AST, ALT, LDS, GLDS, SDH

Question 2

Which hepatocellular enzymes are liver specific?

Answer 2

ALT (mainly), SDH, GLDH

Question 3

Which hepatocellular enzymes are NOT liver specific and where are they found?

Answer 3

ALT, AST, LDG - also found in muscle

Question 4

Which enzymes of the liver are considered cholestatic?

Answer 4

ALP and GGT

Question 5

Name the different isoforms of ALP.

Answer 5

Liver, bone (osteosarcs), Corticosteroid (stress induced), intestinal (lost in the intestine)

Question 6

What substances can be measured in order to test liver function?

Answer 6

Bilirubin, bile acids, cholesterol, albumen, clotting factors

Question 7

What is a cause of prehepatic jaundice?

Answer 7

Haemolysis - IMHA, lepto, NI etc, Haemorrhage, enzymeatic

Question 8

What is a cause of hepatic jaundice?

Answer 8

Hepatic dysfunction - hepatitis, neoplasia. Intrahepatic cholestasis

Question 9

What is a cause of post-hepatic jaundice?

Answer 9

Extra-hepatic obstruction - gall bladder

Question 10

Why may jaundice persist after resolution of clinical disease?

Answer 10

Persistent delta-bilirubin which is strongly bound to albumen

Question 11

What is a reactive hepatopathy?

Answer 11

Elevations in liver enzymes caused by extrahepatic disease

Question 12

What would be the best marker hepatic cellular damage

Answer 12

Enzymes - ALT, AST, SDG, GLDH

Question 13

What would be the best markers of cholestasis?

Answer 13

Bilirubin, cholestatic enzymes, ALP?

Question 14

What would be the best markers of hepatic cellular function?

Answer 14

NH3/ urea, cholesterol, bile acids, albumen, coagulation proteins, metabolites, immunoglobulins

Question 15

What would be the best markers of portal circulation?

Answer 15

Glucose, bile acids, BUN/ NH3, immunoglobulins

Question 16

What can glucose tell you about liver function?

Answer 16

Hypo - decreased liver stores

Hyper - reduced portal circulation

Question 17

Describe a bile acid stimulation test.

Answer 17

Test BA, give a fatty meal, measure post-prandial bile acids (should be removed from the blood in normal dogs and hence low! >25mmol/L is abnormal)

Question 18

What haematological abnormalities are seen with liver disease?

Answer 18

Microcytosis, ovalocytes, acanthocytes

Question 19

What urine abnormalities are seen with liver disease?

Answer 19

Isosthenuria, bilirubin, ammonium biurate crystals

Question 20

What characteristic jaundice colour of the mucus membranes would be suggestive of HEPATIC disease (rather than haemolytic jaundice)?

Answer 20

Yellow-pink

Question 21

Describe the pathophysiology of hepatic encephalopathy

Answer 21

Reduce urea formation (PSS/ hepatic dysfunction), increased blood ammonia (CNS dysfunction)

Question 22

What clinical signs are associated with hepatic encephalopathy?

Answer 22

Anorexia, VD, PUPD, dull, blind, head pressing, ataxia

Question 23

What can worsen clinical signs in dogs with hepatic encepahlopathy?

Answer 23

Proteinaceous meal, GI bleeding, dehydration. acid-base imbalance

Question 24

What infectious and non-infectious agents cause hepatitis?

Answer 24

Infectious - lepto, CAV, FIP, CHV, toxo

Non-infectious - toxic, iatrogenic

Question 25

What disease processes can cause reactive hepatopathy?

Answer 25

IBD, PLE, septicaemia, pancreatitis, dental disease, HAC, addisons

Question 26

What radiographic characteristic is useful for liver assessment?

Answer 26

Gastric axis - able to assess changes in liver size

Question 27

What dietary management should be used for PSS?

Answer 27

Low protein - minimise NH3 production

Question 28

What dietary management should be used for chronic hepatitis?

Answer 28

Low Cu, high Zn, high quality protein, anti-oxidants - protein will encourage regeneration

Question 29

What dietary management should be used for hepatic encephalopathy?

Answer 29

Protein restriction/ modification - minimise NH3 production

Question 30

What dietary management should be used for chronic active inflammation?

Answer 30

Mineral balance - fat soluble vitamins, taurine

Question 31

What empirical therapies may be used for hepatic encephalopathies?

Answer 31

Ampicillin/ metronidazole

Question 32

When might steroids be indicated in liver disease?

Answer 32

Chronic active inflammation, hepatic fibrosis

Question 33

What breeds are associated with copper associated hepatopathies?

Answer 33

Labs, bedlington terriers, WHWT, dalmatian, dobermann

Question 34

Name two copper chelators.

Answer 34

D-penicillamine, trientine

Question 35

What is the MOA of UDCA (BEARS)?

Answer 35

Alters bile composition (hydrophilic), stimulates bile flow, modulates inflammation/ immune response

Question 36

What is the MOA of SAMe (Denamarin)?

Answer 36

Antioxidant - glutanates - think cats and paracetamol

Question 37

What is the MOA of milk thistle?

Answer 37

Free-radical scavenger, inhibits inflammation, inhibits lipid peroxidase, inhibits collagen deposition, increased glutathionine

Question 38

What is the toxic dose of paracetamol for a cat?

Answer 38

>65mg/kg (1 tablet)

Question 39

Why can cats not process paracetamol?

Answer 39

Cannot glucoronidate - hence methaemoglobinaemia occurs - haemolytic anaemia, facial oedema and hepatocellular damage

Question 40

What treatment should be used for cats with paracetamol toxicity?

Answer 40

Emesis if soon enough? NAC, SAMe, Vitamin C, supportive - fluids

Question 41

What clinical signs are associated with feline liver disease

Answer 41

Anorexia, wt loss, jaundice, PUPD, hepatoencepahlopathy, hypersalivation, uveitis