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what are the most common signs associated with feline hepatobiliary disease?
jaundice and hepatomegaly
what are the four most diseases associated with jaundice cat?
- hepatic lipidosis (#1)
- cholangitis/cholangiohepatitis (#2)
how does prolonged anorexia lead to hepatic lipidosis?
increased lipolysis -->hepatocyte triglyceride accumulation (fat builds in liver) -> intrahepatic cholestasis -> liver failure and fatal without tx
Is hepatic lipidosis more often primary or secondary?
what is the connection between obese cats and hepatic lipidosis?
obese not able to convert fat to energy during starvation/catabolic state
what are some causes of anorexia that leads to hepatic lipidosis?
- stressful event (diet change, change in environment)
- non-hepatic illness like IBD, cholangitis, pancreatitis
what is signalment of hepatic lipidosis patient?
- middle aged adult cat
- median 7yr; no gender/breed predilection
- obese (median BW = 10lb)
what are some major signs associated with HL?
- anorexia (>2wks)
- recent wt loss; muscle wasting, weakness
- depression, lethargy
- vomiting (38%)
- bleeding disorders (20%)
- jaundice (70%)
- hepatic encephalopathy
what are two common differentials for ventral flexon of the neck in a cat?
hypokalemia due renal failure or hepatic lipidosis
what are expected chemistry panel findings with HL?
- *elevated liver enzymes but normal GGT*
- hypoalbuminemia, decreased BUN
- low K, Mg, P
what would rads reveal with HL?
hepatomegaly (can alter gastric axis)
what diagnostic should be done before doing an FNA in suspected HL patient?
check coagulation times (APTT, OSPT)
can a cytology be diagnostic of HL?
- yes IF cytology findings coincide with expected history/clinical signs
- (vacuolated/foamy hepatocytes + anorexia/wt loss,etc)
what is hallmark of tx for HL? what are the best methods for accomplishing this?
- prolonged aggressive nutritional support
- -esophagostomy tube or PEG tube
How do you handle treatment for a HL patient that is vomiting?
trickly feeding or CRI of metaclopramide
what are two examples of hepatoprotectants that can aid in tx of HL?
- SAMe/Denosyl (S-adenosyl methionine)
- Vit E
What is prognosis for cat with HL?
good if primary form and treatment is LONG TERM - don't pull feeding tube too soon
Are cats more likely to get hepatic disease related to the cells or the bile system (so hepatocyte or hepatobiliary disease)? what is an exception to this rule?
- cats usually get hepatobiliary
- *exception is hepatic lipidosis
Does the cat more consistently have a major or minor duodenal papilla? what is its role?
- cats have major duodenal papilla - connects common bile duct and major pancreatic duct to duodenum
- (minor often absent in cats but is primary output for pancreatic secretion in dogs)
how does the hepatobiliary system get diseased in cats?
- ascending bacteria from duodenum up
- ascending digestive enzymes from subclinical pancreatitis
- *triaditis* - concurrent lesions in duodenum, pancreas, & biliary tract
With cholangitis/cholangiohepatitis, what is the major infiltrate associated with suppurative form? what about non suppurative?
- suppurative - neutrophils
- non - lymphoplasmacytic; immune mediated (can progress to suppurative)
what are some concurrent diseases that can be associated with either suppurative/non-suppurative cholangitis?
is immune mediated cholangitis associated w/acute or chronic form?
what are the components of triaditis?
- pancreatitis (often secondary)
with neutrophilic cholangitis, both acute and chronic can present w/icterus, vomiting, anorexia, and lethargy. Which is specifically associated with fever? what about diarrhea? abdominal pain?
- acute- fever; abdominal pain
- chronic- diarrhea
with neutrophilic cholangitis, is acute or chronic more likely to happen in middle aged cats?
- chronic- middle aged/older
- acute - younger at risk
what is end stage sign of chronic neutrophilic cholangitis?
ascites, coagulopathy, encephalopathy
what are expected liver enzyme levels with neutrophilic cholangitis?
- elevated ALT, AlkP, and *GGT*
- (elevated GGT helps you think its NOT hepatic lipidosis)
what is expected level of globulins and albumin with chronic cholangitis?
why is there often a vitamin K responsive coagulopathy associated w/chronic cholangitis?
- vit K not being absorbed from GI since poor bile flow (fat soluble)
- also poor liver function once chronic
is liver cytology enough to diagnose cholangitis? what about biopsies of intestine?
- *no*, although helpful with hepatic lipidosis, biopsy required for cholangitis
- intestinal biopsies *not* usu. helpful bc you won't know if the inflamm. is due to cholangitis or IBD or both
is ultrasound helpful in diagnosing cholangitis?
- yes, US can identify destructive biliary disease (and guide biopsy)
- bacterial culture also helpful
can you administer antibiotics for tx of cholangitis without biopsy to confirm diagnosis? when you decide to give Abs, what will you give and for how long?
- yes, ok to start Abs even w/o biopsy (cytology negative for HL/lymphoma)
- -clavamox, amoxicillin, metronidazole, cephalosporins for 6-8wks
is ursodiol indicated for treating cholangitis?
- yes, hepatoprotective (antiinflamm., immunomodulator, antifibrotic)
- Vit. E or SAMe also options
is it indicated to give steroids to chronic cholangitis patient?
can try steroids even w/o biopsy if 6-8wk Antibiotic trial didn't work
what vitamins should be supplemented when treating chronic cholangitis? what fluid therapy would you choose?
- vitamin K and B12 (if concurrent IBD, not absorbing cobalamine)
- fluids with KCl
can cholangitis be cured with these treatments?
- typically goal is to manage long term, not cure
- but occasionally cat will acute case can be cured w/Abs
is neoplasia in the cat's liver usually primary or secondary?
- secondary/metastatic more common
- (if primary, likely carcinoma)
what is an ultrasound finding that is consistent with neoplasia?
target lesions (esp. indicative of metastasis) - get biopsy/cytology
what is the significance of biliary cyst adenoma?
- benign (won't spread) but can get large enough to incr. liver values
- biopsy to diagnose; may req' surgical removal
What can cause intraluminal obstructive lesions?
- inspissated bile
- liver flukes
what can cause extraluminal obstructive lesions?
- neoplasia (pancreatic, duodenum, biliary)
what is the best diagnostic tool for diagnosing extrahepatic obstruction?
- (will show dilations of GB or bile duct; hepatomegaly)
what is treatment for extrahepatic obstruction?
combo of surgical and medical approach = stabilize with fluids then sx to relieve obstruction + cholecystojejunostomy/duodenostomy + biopsies
are cats who have PSS usual congenital or acquired? intra or extrahepatic? single or multiple shunts?
congenital single extrahepatic (same w/small breed dogs)
what type of stone is associated with PSS? what are some another findings associated w/PSS?
- ptyalism and hepatic encephalopathy (esp. after eating)
- copper colored irises in cats
will liver w/PSS be large or small? will kidneys be large or small?
- small liver (microhepatica seen on rads)
- large kidneys
how will PSS affect the patient undergoing anesthesia?
what will bilirubin value like be with PSS?
normal, so not jaundiced
what will bile acid values be like with PSS?
markedly elevated (often >100)
what are liver enzymes like with PSS?
normal to mildly increased
young + normal ALT + elevated bile acids = what diagnosis is most likely?
what is the problem w/giving diazepam to cats?
could cause fulminate liver failure
with acute liver toxicosis, what are liver enzymes like and is liver large/small/normal?
- markedly elevated ALT/AST
- normal sized, normal echogenicity