vet clinics liver

Question 1

name the blood markers for Hepatocellular Injury and their half life

what is their specificity and sensibility like?

Answer 1

GLDH: 12-24h

SDH <12h

AST 7 days

all very sensitive

highest specificity: SDH BUT very unstable in samples!!

Question 2

markers of Biliary Injury/Cholestasis, their half life and their sensitivity/specificity

Answer 2

GGT: 3d

sens ++++, spec: +++

AP: 3d

sens: +++/ spef: +

Question 3

GGT in training horses

Answer 3

small number of racehorses may have moderate increases in GGT (50–140 IU/L)

GGT activity is correlated to cumulative training load and racing frequency and considered a maladaptation to training

Question 4

bile acids and colic

Answer 4

Bile acid concentrations can be increased in some horses with intestinal disorders, such as

colic, enteritis, and equine dysautonomia.

Moderate to markedly increased bile acid concentrations in horses with colic are associated with a guarded prognosis.

Question 5

when do liver function tests become abnormal?

Answer 5

only after 70% or more of hepatic function is lost.

Question 6

bile acids are a good predictor of liver disease?

Answer 6

Bile acid concentrations above 20 μmol/L are a good predictor of liver failure

Question 7

What is a mild increase in bile acids and what mght this indicate?

Answer 7

Milder increases (up to 20 μmol/L) may occur in a few horses without hepatic disease that are anorexic for 2 or more days

Question 8

Can bile acid concentrations predict outcome of liver disease?

Answer 8

yes, in chronic liver disease: persistently increased bile acid concentrations greater than 20 μmol/L have a guarded to poor prognosis.

Bile acid concentrations s_hould not be used as a predictor of prognosis in horses with acute liver disease._

Question 9

Albumin concentration in liver failure

Answer 9

Albumin concentrations rarely are low in horses with

acute (6%) or

chronic (18%) liver failure,

and hypoalbuminemia is neither a sensitive nor specific test for liver failure in the horse.

Question 10

Why is Vit K important?

Answer 10

vitamin K (bile avids needed for absorption)

aids in synthesis of activated coagulation factors II, VII, IX, and X, along with the inhibitors proteins C and S

Question 11

are liver biopsies safe in chronic hepatic failure?

Answer 11

Clotting times often are increased in horses with liver failure due to insufficient hepatic synthesis of clotting factors II, V, VII, IX, X, XI, and XII.

Regardless, clinical bleeding is uncommon and liver biopsies can be performed safely in most cases

Question 12

lactic dehydrogenase is present in

Answer 12

in almost all living cells

very unspecific

Question 13

Cause of theiler’s disease? consequences?

Answer 13

suspected to be parvovirus

occurring several weeks after administration of a biological substance of equine origin

fulminant hepatic necrosis, often fatal

Question 14

For both equine pegiviruses, it was recently demonstrated that they are

Answer 14

not hepatotropic and not associated with hepatitis, but instead cause persistent infection of bone marrow

Question 15

prevalence of EqPV H

Answer 15

clinically healthy horse populations in the USA, China, Germany, and Austria have demonstrated

DNA prevalence between 7.1% and 17%

and seroprevalence between 15% and 34.7%

higher in farms with reported theiler’s disease

Question 16

EqPV-H:

experimental infection of horses

Answer 16

resulted in subclinical hepatitis, demonstrated by increased liver enzymes, without clinical signs in most cases

onset of hepatitis: 5-8 weeks after infection

viral DNA remained detectable in different organs for at least 15 weeks after infection

(in natural cases up to 20 months!!!)

Question 17

Can EqPV H be transmitted from horses to donkeys?

Answer 17

Unlike EqHV – for which detection of antibodies and nucleic acid in samples from donkeys confirmed cross-species transmission [46] – there is currently no evidence of EqPV-H transmission to other species of equines

Question 18

Liver biopsies as prognostic indicator for liver disease

Answer 18

Durham:

Histo Grading system: 0-14

scores 2 - 6: 12 times less likely to survive to 6 months than horses with biopsy scores of 0

scores 7 - 14: 46 times less likely to survive

Question 19

Best prognostic indicator for liver disease outcome?

Answer 19

Based on the available evidence,

histological evaluation of hepatic biopsies provides better prognostic information than does the results of blood tests.

Of the routinely performed blood tests, SBA concentration provides the best prognostic information.

Question 20

what happens with increased serum iron levels ?

Answer 20

The majority of iron in mammals (approximately 80%) is

• bound to heme in erythrocytes, and the
• remaining variable portion mainly to transferrin in blood or
• ferritin or haemosiderin intracellularly (Kohgo et al. 2008).

if transferrin in plasma is saturated -> liver tends to take up unbound iron more than erythrocytes-> hepatic accumulation = haemosiderinosis

Question 21

how to treat iron intoxication

is liver damage reversible?

Answer 21

2 case reports with poneys

• phlebotomy (8% of blood volume)
• deferoxamine:
  
  • inhibits cell iron uptake by binding to intraand extra-cellular unbound iron which is then excreted in bile or urine
  • reduction of hepatic stellate cell activation and fibrogenesis
  • attenuation of lipid peroxidation
• damage reversible if acute hepatopathy, not with chronic

Question 22

Stability of SDH in blood samples

Answer 22

stable in heparinized plasma stored under all temperature conditions for 4 h

at 4 ◦C for 24 h,

but changes in enzyme activity may only be considered clinically relevant if they exceed 25% of previously measured activity.

Question 23

amyloidosis definition

Answer 23

extracellular deposition of protein fibrils resistant to proteolysis

Question 24

What is AL amyloidosis?

Answer 24

protein deposition derived from the N-terminal region of monoclonal immunoglobulin light chains

associated with

• localised accumulations within the upper respiratory tract and combined nasal and conjunctival infiltration
• as well as systemic accumulation with the development of visceral masses
• associated with multiple myeloma (Kim et al. 2005), and finally in the cutaneous form,
• associated with histiolymphocytic lymphoma

Question 25

What is AA amyloidosis?

Answer 25

derived from the circulating acute phase reactant serum amyloid A (SAA) by proteolytic cleavage

associated with

nasal amyloidosis

splenic amyloidosis

hepatic am

Question 26

treatment and outcome of hepatic amyloidosis

Answer 26

1 case report

treatment with dexamethasone

dead after 7 months

hepatic rupture??

Question 27

Does a positive PCR eqPV H mean active infection?

Is there a risk factor?

Answer 27

Apparently yes, but

EqPV-H antibodies and DNA are frequently detected in Austrian horses, without associated hepatitis in horses with active infection.

The risk of active EqPV-H infection increases with increasing age. (16- to 31-year-old horses)

Question 28

causes of hepatitis in horses

Answer 28

Toxic: eg, pyrrolizidine alkaloids, Panicum grasses, aflatoxins

Metabolic: hepatic lipidosis

Bacterial: ascending cholangiohepatitis, Tyzzer disease in foals (Clostridium piliforme)

Idiopathic: Chronic active hepatitis, (Theiler disease)

Neoplastic: lymphoma, hepatocellular carcinoma

Viral: nonprimate hepacivirus (NPHV), equine parvovirus-hepatitis (EqPV-H)

Question 29

Nonprimate hepacivirus

Answer 29

• Virus prevalence: 2% to 7% (based on serum PCR). Seroprevalence: w40%.
• Transmission: iatrogenic through biologic products, vertical, otherwise unknown.
• Disease association in experimental models: subclinical hepatitis with mild elevations in liver enzymes.
• Disease association in clinical cases: 1 report of suspected NPHV–associated hepatitis.
• Clinical implications: likely a relevant cause of mild liver disease. Capacity to cause clinical hepatitis, liver failure, or chronic diseases, such as cirrhosis, chronic active hepatitis, and neoplasia, is unknown.

Question 30

Theiler disease–associated virus

Answer 30

not clinically relevant

Question 31

pegivirus in horses

Answer 31

not clinically relevant

Question 32

how long does it take for theiler’s to occur?

Answer 32

90% of cases occurring 40–70 days after the antiserum inoculation

also kann ÜBER 2 MONATE NACHHER sein

90% mortality