Term
| What is the most common etiology behind chronic hepatitis? Others? |
|
Definition
-idipathic
-others: infections (adenovirus, lepto), drugs |
|
|
Term
| How is chronic hepatitis a self-perpetuating process? |
|
Definition
| -oxidaative damage stimulates imune system which causes mroe oxidative damage |
|
|
Term
| If we see neutrophils on histopath of chronic hepatitis, where should we focus treatment? |
|
Definition
|
|
Term
| If we see lymphocytic/plasmacytic inflamm on histopath of chronic hepatitis, where should we focus treatment? |
|
Definition
|
|
Term
| What two diagnostics do we always add to chronic hepatitis cases? |
|
Definition
-culture
-copper quantification |
|
|
Term
| Which dog breed is predisposed to familial copper excess? |
|
Definition
|
|
Term
| What is the significance of copper excess in regards to liver dz? |
|
Definition
| -Cu is hepatotoxic, thus causing progressive liver injury |
|
|
Term
| What kind of transmission does familial copper excess in bdlington terriers have? Explain it. |
|
Definition
-autosomal recessive
-failure of biliary excretion of copper |
|
|
Term
| How does copper excess present in young Bedlington terriers? |
|
Definition
-acute necrosis
-most die w/in 2-3d
-brought on by stress |
|
|
Term
| How does copper excess present in older Bedlinton terriers? |
|
Definition
-chronic/insidious
-progressive dz = cirrhosis |
|
|
Term
| HOw do we diagnose primary copper dz in Bedlington terriers? |
|
Definition
-biopsy before breeding
-genetic testing: less reliable |
|
|
Term
| Describe copper excess in Dobies. |
|
Definition
-females 1-3y
-cirrhosis w/ intraheptaic cholestasis
-Cu accumulation may be primary or secondary |
|
|
Term
| What is the prognosis of chronic hepatitis? |
|
Definition
-if caught early w/ minimal signs: fair
-if ascites, ulcers, anorexia, or chem changes: poor to grave |
|
|
Term
| How do we reduce copper levels in chronic hepatitis patients? |
|
Definition
-takes months to years
-special diets
-D-penicillamine: chelates free Cu and promote excretion from liver
-Zinc: maintains lower Cu |
|
|
Term
| HOw do we manage diet of liver dz patients? |
|
Definition
-restricted bad proteins
-liver diet: dec Cu, inc Vit E, inc Zinc |
|
|
Term
| We use abx based on culture results when treating liver dz patients. Which ones are we most likely to use? |
|
Definition
-gram-negative
-anaerobes
-ANYTHING BUT BAYTRIL |
|
|
Term
| Why would we add glucocorticoids to treat liver dz? What are the disadvantages? |
|
Definition
-if inflammation on liver biopsy suggesting immune-mediated component
-disadvantages: Na retention (Ascites), worsen hepatic encephalopathy, GI bleeding |
|
|
Term
| Why do we add Vitamin E to chronic liver dz tx? How do we do it? |
|
Definition
-reduces oxidative damage
-via D-alpha-tocopherol (water-soluble) |
|
|
Term
|
Definition
-it is a precursor to glutathione
-used for drug detoxification & anti-oxidation |
|
|
Term
| What is the advantage of giving usodeoxycholic acid to liver dz patients? |
|
Definition
-water-soluble bile acid
-dec cholestasis: inc viscosity
-immune-modulating |
|
|
Term
| What is the advantage of giving N-acetylcysteine to liver dz patients? |
|
Definition
-replenish intracellular cysteine and thus glutathione levels
-antidote for acetaminophen toxicity |
|
|
Term
| If fluids are needed, describe their use in liver dz cases. |
|
Definition
-avoid lactated ringer's b/c cannot metabolize lactate into bicarb
-be cautious w/ Na |
|
|
Term
| How do we treat ascites due to liver dz? |
|
Definition
|
|
Term
| How do we treat hepatoencephalopathy w/ liver dz patients? |
|
Definition
-high-quality protein diet
-lactulose: shifts ammonia to ammonium
-GI abx for urease-pdc bacteria: Ampicillin > Neomycin > metronidazole |
|
|
Term
| What are the complications seen w/ liver dz? |
|
Definition
| -Portal hypertension: ascites, ulcers, sodium retention |
|
|
Term
| Which congenital portovascular anomalies have normal portal pressre? |
|
Definition
-congenital portosystemic shunts
-microvascular dysplasia |
|
|
Term
| Which congenital portovascular anomalies have high portal pressure? |
|
Definition
-less common
-multiple, acquried extrahepatic PVAs
-ascites, microhepatica |
|
|
Term
| What is the typical signalment of congenital PVAs? |
|
Definition
|
|
Term
| What are the CS of congenital PVAs? |
|
Definition
-neuro signs
-intermittent GI signs
-PU/PD
-anesthetic intolerance
-urolithiasis |
|
|
Term
| Which small dogs get congenital PVAs? Which kind do they get? |
|
Definition
-Yorkies, Mini Schnauzers, Shih-tzus, Lhasa Apsos
-single, extrahepatic shunts |
|
|
Term
| Which large dogs get congential PVAs? Which kind do they get? |
|
Definition
-retrievers, irish setters, irish wolfhounds
-single, intraheptic shunt |
|
|
Term
| What do we see on CBC w/ congenital PVAs? |
|
Definition
|
|
Term
| What do we see on chem w/ congenital PVAs? |
|
Definition
-can be totally normal
-+ low pseudofunction parameters
-/+ liver enzyme elevations
-not icteric |
|
|
Term
| What do we see on UA w/ congenital PVAs? |
|
Definition
| -/+ ammonium biurate crystals |
|
|
Term
| How do we diagnose congenital PVAs? |
|
Definition
-elevated BAs > 100
-U/S
-CT portography: gold standard
-scintigraphy
-contrast portal venogram |
|
|
Term
| How do we treat congenita PVAs? |
|
Definition
-shunt attenuation via sx: ameroid ring, cellophane banding
-coil placenment |
|
|
Term
| Which animals are affected by microvascular dysplasia? |
|
Definition
|
|
Term
| How do we diagnose microvascular dysplasia? How do we treat it? |
|
Definition
-Dx: histopath, rule out PSS
-Tx: medical |
|
|
Term
| What are some etiologies behind acute hepatopathy? |
|
Definition
-Drugs: abx (ketoconazole, TMS), NSAIDs, anesthetics, Diazepam
-infectious: lepto, toxo, adenovirus
-Plants: mushroom, cycad palm, blue-green algae |
|
|
Term
| What do we see on clinpath w/ acute hepatopathy? |
|
Definition
-ALT/AST inc
-elevated bilirubin
-hepatoencephalopathy: cerebral edema |
|
|
Term
| How do we treat acute hepatopathy? |
|
Definition
-remove inciting cause
-antidote if available
-supportive care: fluids, plasma, antioxidants, etc |
|
|
Term
|
Definition
| -inflammatory dz involving the bile ducts |
|
|
Term
|
Definition
| -inflammatory dz invlving the gallbladder |
|
|
Term
| How do we respond to cystic hyperplasia & epi polyps? |
|
Definition
-common lesions in older dogs
-medical management & monitro w/ sx if an obstruction develops |
|
|
Term
| What is destructive cholangitis? |
|
Definition
| -idiosyncratic rxn in dogs to drugs containing sulfonamides |
|
|
Term
| What are the three primary extrahepatic bile duct obstructions? |
|
Definition
-choleliths: uncommon
-stricutre of common bile duct
-extraluminal compression: common |
|
|
Term
| How do we diagnose gallbladder mucoceles? How do we treat them? |
|
Definition
-stellate appearance on U/S
-tx: cholecystectomy, abx if bacteria present |
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