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Smallies 7 - Liver Flashcards

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1
Q

What is required in the dietary treatment for Copper Storage Disease?

A

Feed a low copper diet with increased dietary zinc
Avoid tap water in soft water areas with Cu pipes
Avoid high Cu treats e.g. shellfish, liver, kidney, cereals, chocolate

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2
Q

What is included in the general supportive care for Copper Storage Disease?

A

As for chronic hepatitis
Antioxidants such as SAM-e and Vitamin E
Ursodeoxycholic acid

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3
Q

What is the use of copper chelating agents in the treatment for Copper Storage Disease?

A

Bind free extracellular Cu which is then excreted by kidneys e.g. d-Penicillamine
Use to ‘de-copper’ the liver when biopsy proven or true copper storage breed

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4
Q

What is the use of zinc salts in the treatment for Copper Storage Disease?

A

Reduce absorption of Cu from the GIT
Use to prevent Cu accumulation
Don’t use with copper chelating agents

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5
Q

When is medical management important for congenital portosystemic shunts?

A

When stabilising a patient for surgical management
When surgery is not possible
When surgery has not been fully successful

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6
Q

List examples of canine primary hepatic neoplasia

A 
Hepatocellular carcinoma	
Hepatocellular adenoma 
Haemangiosarcoma (primary/secondary)
Biliary carcinoma
Biliary adenoma
Lymphoma 
Neuroendocrine tumours
Leiomyosarcoma
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7
Q

What are clinical signs of hepatic neoplasia in dogs?

A

Often non-specific clinical signs e.g. lethargy, poor appetite
Signs may be associated with a complication e.g. abdominal bleed?
Palpable mass may be only sign
Signs as for chronic chronic hepatitis

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8
Q

What is the treatment for hepatic neoplasia in dogs?

A

Surgery is treatment of choice but assess for metastatic disease before major interventions by doing thoracic radiographs R and L lateral +/- DV
Chemotherapy only effective for lymphoma (but all chemotherapy drugs are metabolised by the liver so may see more adverse effects – control doses carefully)

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9
Q

What are possible causes of neutrophilic cholangitis in dogs?

A

Ascending infection or haematogenous spread

Streps, E coli, Klebsiella, Proteus

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10
Q

What are clinical signs of neutrophilic cholangitis in dogs?

A

Clinical signs are variable but can include lethargy, pyrexia, vomiting and icterus

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11
Q

What is seen on clinical pathology with neutrophilic cholangitis in dogs?

A

Variable liver enzyme elevations, increased bilirubin

Neutrophilia with/without left shift

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12
Q

What is required to make a diagnosis of neutrophilic cholangitis in dogs?

A

Diagnosis requires bile centesis +/- liver biopsy

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13
Q

What is the treatment for neutrophilic cholangitis in dogs?

A

Antibiotic treatment based on culture results

Treat for 8 weeks minimum

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14
Q

What are possible causes of extrahepatic bile duct obstruction in dogs?

A 
Pancreatitis or pancreatic tumour
Bile duct tumour
Duodenal FB or mass 
GB mucocoele
Cholelithiasis
Local trauma, inflammation
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15
Q

What are clinical signs of extrahepatic bile duct obstruction in dogs?

A

Signs very often due to underlying reason for obstruction
Very variable, non-specific in early stages
Depends on whether partial or complete obstruction
Pointing to post-hepatic jaundice

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16
Q

What is needed for the diagnosis of extrahepatic bile duct obstruction in dogs?

A

Clinical pathology - ALP, bilirubin usually very high

Ultrasound to determine if cause can be seen

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17
Q

What are the causes of bile duct rupture from canine biliary tract disease?

A 
Usually same causes as extra hepatic bile duct obstruction 
Pancreatitis or pancreatic tumour
Bile duct tumour
Duodenal FB or mass 
GB mucocoele
Cholelithiasis
Local trauma, inflammation
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18
Q

What are the consequences if bile duct rupture?

A

Bile peritonitis leading to abdominal effusion

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19
Q

What are the clinical signs of bile duct rupture?

A

Profound jaundice common

Abdominal pain +/- distention

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20
Q

What is the treatment of bile duct rupture?

A

Surgery to manage underlying cause

Cholecystectomy - histopathology and culture of gall bladder wall

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21
Q

Why should hypertonic saline be avoided in dehydrated patients?

A

It will cause cellular dehydration and intensify the hypovolaemia by intensifying diuresis before plasma volume expansion has been achieved

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22
Q

Why would you perform a liver biopsy?

A 
Part of routine screen 
Mass
Generalised hepatopathy
Hepatitis
Jaundice
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23
Q

What are portosystemic shunts?

A

Portosystemic shunts are an anomalous connection between the portal and systemic venous systems.

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24
Q

What is the ductus venosus?

A

Normal bypass of the liver in utero, this then becomes a ligament once born)

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25
What are examples of abnormal liver bypasses?
Persistent (patent) ductus venosus Intrahepatic e.g. persistent ductus venosus. Normally it should close and become a ligamentum within the first 24-48hrs Extrahepatic
26
What is more common in large and small breeds of dog - intra or extrahepatic shunts?
In general, large breed dogs more commonly get intrahepatic shunts and small breed dogs more commonly get extrahepatic shunts
27
What is portal vein hypoplasia - microvascular dysplasia?
Communication between portal and systemic circulation at a microvascular level. Get abnormal shunting of portal blood at a microscopic level within the liver itself
28
What breeds are predisposed to portal vein hypoplasia - microvascular dysplasia?
Cairn and Yorkshire Terriers
29
What are common clinical signs of PSS?
Most commonly neurologic (hepatic encephalopathy) - Lethargy, ataxia, obtundation, pacing, circling, blindness, seizures, coma
30
What are GIT signs of PSS?
Vague | Vomiting, diarrhoea, anorexia, pica, melaena, haematemesis
31
What are urinary signs of PSS?
Haematuria, stranguria, pollakiuria, urethral obstruction (from crystals of ammonium biurate)
32
How are PSS medically managed?
With lactulose
33
Why is lactulose used in the treatment of PSS?
Lactulose helps to bind ammonia so prevent it being absorbed into the bloodstream. It also causes the patient to go to the toilet more regularly which helps to remove the bacterial load.
34
What is the surgical treatment of PSS?
Surgical ligation Ameroid ring Cellophae banding Percutaneous transvenous coil embolism
35
How does surgical ligation treat PSS?
If you completely occlude the vessel you may cause portal hypertension, it is common to partially close the vessel which will allow full closure over the next few weeks
36
What suture material should you use for ligation of PSS?
Polyprolene (non-reactive) | Silk (reactive)
37
What are the two types of surgical ligation of PSS?
Complete attenuation | Partial attenuation
38
What is an ameroid ring and how can it treat a PSS?
Ring of casein surrounded by stainless steel Hygroscopic substance that swells after absorbing fluid Incites a fibrous tissue reaction
39
What is cellphane banding and how can it treat a PSS?
Clear non-medical grade cellophane put around the shunt Fibrous tissue reaction leading to gradual occlusion – foreign body reaction around the vessel and within the vessel wall
40
When are percutaneous transvenous coil embolisms used to treat PSS?
USed for intrahepatic shunts
41
What is a percutaneous transvenous coil embolisation and how does it treat a PSS?
Caval stent placed via jugular vein Insert embolisation coils inserted through a large vascular catheter Self extends which stays in place forever
42
What are PSS surgical complications?
Hypoglycaemia | Portal hypertension Seizures
43
How can post PSS op seizures be treated?
Propofol infusion - CRI for several days
44
List causes of extra hepatic biliary tract obstruction
``` Pancreatitis Gallbladder mucocoele Cholelithiasis Inspissated bile Neoplasia Parasites Duodenal foreign body Malformations Fibrosis Stricture formation ```
45
What is the most common cause of extra hepatic biliary tract obstruction?
Pancreatitis
46
How can pancreatitis cause extra hepatic biliary tract obstruction?
Drainage of pancreatic enzymes usually through major duodenal papilla, common bile duct enters at same site - obstruction/inflammation of that site can mean pancreatitis, which may also be causing obstruction of the common bile duct at this site
47
What are indications of cholecystectomy?
``` Ruptured gallbladder Primary neoplasia of the gallbladder Cholecystitis that is unresponsive to medical management Gallbladder mucocoele Cholelithiasis ```
48
What is gall bladder mucocoele associated with?
Stasis of the gall bladder material
49
Why do you get gall bladder mucocoele with stasis of the gall bladder?
The bile has remained static in the gall bladder, so the water is drawn out leaving a sludgy material behind
50
What breeds are most likely to get gall bladder mucocoele?
Seen more in Terrier breeds especially the Border Terrier
51
How do you diagnose gall bladder mucocoele?
Will detect an enlarged gall bladder on imaging
52
What is the treatment for gall bladder mucocoele?
Cholecystectomy is the treatment of choice
53
What are the indications for a permenant biliary bypass?
Any underlying disease that has led to permanent and complete obstruction of the bile duct, major duodenal papilla or proximal duodenum Where resection of the proximal duodenum including the bile duct is required
54
What are common causes for a permanent biliary bypass?
Cholelithiasis Neoplasia of bile duct, pancreas or duodenum Pancreatitis (rarely)
55
What is a Cholecystoduodenostomy?
permanent opening into duodenum
56
What is a cholecystojejunostomy?
permanent opening into the jejunum
57
What is a choledochoenterostomy?
connection of bile duct into small bowel
58
What are the indications for a temporary biliary bypass?
Pancreatitis | Decompress EHBDO to stabilise patients before definitive surgery
59
When is pancreatic surgery indicated?
``` As part of a routine organ biopsy screen for: o Mass o Pancreatitis o Jaundice o Cholangiohepatitis ```
60
What does a primary islet cell tumour produce?
Insulin
61
What are the signs of a primary islet cell tumour?
hypoglycaemia lethary exercise intolerance

GI2 (27 decks)

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