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Exam 4
Dx of Hepatic Dz
36
Veterinary Medicine
Professional
04/02/2017

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Term
What is the pre-hepatic cause of ascites?
Definition
-protal v occlusion
Term
What is the hepatic cause of ascites?
Definition
-inc portal hypertension secondary to primary hepatic parenchymal dz
Term
What is the post-hepatic cause of ascites?
Definition
-post-hepatic venous congestion: RCHF, ovstruction in thoracic caudal vena cava
Term
What are the mechanisms leading to ascites w/ liver dz?
Definition
-inc hydrostatic P w/ venous congestion
-dec oncotic P
Term
Describe ascites w/ bile peritonitis.
Definition
-strong inflamm response
-fluid is dark orange/red, yellow, or green
-msot patients die
Term
What will we see on cytology of abdominocentesis of ascites due to bile peritonitis?
Definition
-might see bile pigment
-intracellular bacteria
Term
What causes hepatic encephalopathy?
Definition
-toxin exposure to CNS w/ liver failure
Term
What is the most important cause of hepatic encephalopathy?
Definition
-ammonia
Term
What will worsen the CS that occur due to hepatic encephalopathy?
Definition
-feeding large amt of protein
-GI bleeding
-azotemia
-dehydration
-constipation
-hypokalemia
Term
Briefly outline ammonia metabolism.
Definition
-liver detoxifies ammonia by urea cycle or its consumption in glutamine synthesis
-urea is excreted by kidneys
Term
At what levels is icterus detectable in the tissues? In the serum?
Definition
-jaundice at >2mg/d
-in serum at >1.5mg/dL
Term
What is the mechanism behind pre-hepatic hyperbilirubinemia?
Definition
-hemolysis
-amt of unconjugated bilirubin exceeds the capacity of liver to remove it
Term
What are the mechanisms behind hepatic hyperbilirubinemia?
Definition
-liver dysfunction
-intrahepatic cholestasis: bile backs up into systemic circulation
Term
What are the mechanisms behind post-hepatic hyperbilirubinemia?
Definition
-extrahepatic bile duct obstruction: bile backs up into systemic circulation
-ex extraluminal compression = pancreatitis
-ex intraluminal compression = cholelithiasis, inspirssated bile, & neoplasia
Term
How do we distinguish pre-hepatic, hepatic, & post-hepatic hyperbilirubinemia?
Definition
-pre-hepatic: severe anemia w/ normal protein
-hepatic or post-hepatic: no anemia
Term
Describe the significance of bilirubinuria in dogs.
Definition
-can be normal
-low renal threshold
Term
Describe the significance of bilirubiuria in cats.
Definition
-always something wrong
Term
HOw does cholestasis lead to choagulopathies?
Definition
-need bile acids to absorb fat to make fat-dependent vitamins like vit K
-thus no more vit K to activate factors 2,7,9,10
Term
Which liver enzymes indicate leakage?
Definition
-alanine transaminase (ALT)
-aspartate transaminase (AST)
Term
Which liver enzymes are inducible?
Definition
-alkaline phosphatase (ALP)
-gamma-glutamyltransferase (GGT)
Term
How do we know that inc AST is due to liver dz?
Definition
-ALT must be elevated as well
Term
What does ALP indicate?
Definition
-new synthesis and release in response to certain stimuli (bile caniculi, bone)
-inc w/ liver regen
Term
What are the major causes of inc ALP in dogs?
Definition
-cholestatic dz
-bone lysis/remodelying
-drugs: steroids, anticonvulsants
Term
What are the major causes of inc ALP in cats?
Definition
-cholestatic dz
Term
What drugs can inc canine GGT?
Definition
-glucocorticoids
Term
True or False: Liver enzymes are a measure of liver function.
Definition
-FALSE
Term
What are some examples of psudo liver function tests?
Definition
-albumin
-urea nitrogen
-glucose
-cholesterol
-bilirubin
Term
What is the true test of liver function?
Definition
-pre-prandial & post-prandial serum bile acids
Term
Do pre-prandial & post-prandial serum bile acids correlate w/ severity of liver dz, reversibility, or both?
Definition
-ONLY severity
Term
Why do we not need pre-prandial & post-prandial serum bile acids if the animal is icteric?
Definition
-bile acids inc before bilirubin so if the animal is icteric we know the bile acids are inc
Term
Where are bile acids made? What are they conjugated w/ in dogs? Cats? Where are they stored?
Definition
-synth from cholesterol in liver
-Both: conjugated w/ taurine
-Dogs only: conjugated w/ glycine
-stored in gallbladder
Term
What do inc bile acids suggest?
Definition
-shunting of portal blood around liver: PSS, MVD
-hepatocellular dysfunction
-cholestasis
Term
What is the ideal way to diagnose a shunt?
Definition
-CT portography
Term
How can we diagnose a shunt w/ nuclear scintigraphy?
Definition
-liver lights up first = no shunt
-heart lights up first = shunt
Term
In general, what is secondary reactive hepatophaty?
Definition
-liver freaks out due to another primary dz process
Term
When would we biopsy a case of secondary reactive hepatopathy?
Definition
-documented hepatic dysfunction
-no evidence of non-hepatic dz
-patient worsens
-persisitent elevation of liver enzymes over 3m period
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