SA Med, MT, VI

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SA Med, MT, VI
2013-03-09 16:11:09

SA Med, MT, VI
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  1. what common clinical signs in the cat with liver disease are not consistent in the dog?
    dog less likely to present jaundiced or with hepatomegaly
  2. Are dogs more likely to get hepatocyte disease or hepatobiliary? how does this compare the cat?
    • dog: hepatoCYTE
    • cat: hepatobiliary
  3. what are 3 conditions secondary to hepatic failure (more common in the dog)?
    • acquired PSS
    • portal hypertension
    • abdominal effusion
  4. what is the most common cause of chronic hepatitis? what is the most consistent lab finding?
    • idiopathic
    • elevated ALT (but pt often not sick)
  5. how is chronic hepatitis diagnosed? what are indicative findings of positive diagnosis?
    • biopsy/histopath
    • -inflammatory infiltrates; necrosis, fibrosis
    • -biliary hyperplasia, nodular regeneration
  6. what is goal of therapy for chronic hepatitis?
    reverse or control inflammatory process (but often never figure out the etiology)
  7. what dog breeds have a familial chronic hepatitis related to copper toxicity?
    • bedlington terriers
    • dobies
    • westies
    • chocolate labs
  8. With bedlington terriers, is presence of copper reason for disease or is diseased liver reason for copper accumulation?
    • Cu first then causes liver disease
    • (unable to metabolize Cu so causes hepatocellular dz)
  9. how is Cu related chronic hepatitis diagnosed and treated in bedlington terriers?
    • biopsy for quantitative analysis
    • chelation therapy (D penicillamine) to promote excretion
  10. With dobermans, is presence of copper reason for disease or is diseased liver reason for copper accumulation? usually males or females?
    • unknown in this breed; pathogenesis unclear
    • females 5-7 years old
  11. When westies have copper hepatitis, do you have to treat more or less aggressively with chelation drugs? why?
    less aggressively because in this breed, the Cu accumulation won't get worse over time
  12. what are some drugs associated with causing chronic hepatitis in the dog?
    • sulfa drugs
    • steroids
    • chemotherapeutics
    • anticonvulsants (phenobarbitol)
  13. Although infectious causes are rarely to blame for chronic hepatitis, what are 2 that could be considered in the dog?
    • leptospirosis (usu. acute)
    • CAV-1 (infectious canine hepatitis)
  14. With idiopathic chronic hepatitis, if you get test results back with elevated ALT but dog is not clinically ill, what other test would you want to run to help decide if you should treat or monitor?
    • *bile acids*
    • elevated ALT w/normal BA = can monitor
    • elevated ALT w/elevated BA = treat/pursue more diagnostics
  15. what supplement can decrease absorption of Cu while stimulating formation of metallothionen so Cu can bind to it?
  16. what is the MOST effective way to remove copper?
    chelation therapy w/D penacillamine or Trientine for months
  17. although not thoroughly studied in the dog, what is the goal when giving colchicine long term?
    anti fibrotic agent; inhibit collagen synthasis
  18. is it always necessary to include diet modification when managing these cases? what about antibiotics?
    • no
    • Abs not necessarily but can try for 6-8wks and see if improvement
  19. what are drug options for hepatoprotectants?
    • SAMe
    • Vit. E
    • Ursodiol
  20. when determining prognosis for chronic hepatitis patient, what are some negative indicators?
    • coagulopathy
    • hypOalbuminemia
    • hypOglycemia
    • cirrosis (<1mo survival)
  21. what are some important lab findings consistent w/ congenital PSS? large or small breeds usually?
    • elevated BA; microcytosis
    • small breeds (YORKIES; schnauzer, lhasa, shih tzu)
  22. what type of PSS do large breeds usually get?
    congenital intrahepatic shunt
  23. is PSS a surgical emergency?
    NO must stabilize first! (treat hepatic encephalopathy and seizures)
  24. what is microvascular hypoplasia? how is it treated?
    • clinically similar to PSS but microscopic vascular anomaly so appears *normal on US/scintigraphy/portogram*
    • -no surgical treatment (medically tx signs)
  25. with acute liver toxicity, is the animal ill? what is ALT value like? how does liver appear?
    acutely ill + elevated ALT + normal looking liver
  26. what are some drugs associated with acute liver toxicity?
    • acetaminophen
    • ketaconazole
    • lomustine
    • NSAIDs
    • (also environmental toxins like mushrooms =amanita)
  27. do dogs get primary or secondary biliary tract disease more often? what is the etiology?
    • *secondary *
    • -pancreatitis (common)
    • -sepsis from non-hepatic disease
    • (primary rare but common in cat)
  28. extrahepatic bile duct obstruction, bile peritonitis, and gall bladder mucocele are the more common biliary tract disorders in the dog. which of these require surgery?
    all of them
  29. how does patient present with biliary tract disorders?
    • icteric
    • acutely/chronically vomiting
    • anorexia/depression/wt loss
    • possibly abdominal pain
  30. with hepatobiliary disease what elevations are seen with MDB?
    • elevated GGT, ALP, bilirubin
    • (also ALT but less severe)
  31. what are two important rad findings with pancreatitis?
    • loss of serosal detail in cranial abdomen
    • duodenum shifted laterally
  32. what must you do if icteric animal without anemia presents?
    ultrasound to evaluate the liver!
  33. what is most common cause of extrahepatic bile duct obstruction in dogs?
    extraluminal inflammatory conditions
  34. Small breed older dogs are associated with GB mucoceles. how is gall bladder mucocele characterized on US?
    • sludge in GB w/STELLATE appearance ("kiwi sign")
    • GB thickening/distention
    • +/- biliary obstruction
  35. hepatic abscesses are relatively uncommon but what two diseases predispose them?
    • DM
    • Cushings
  36. what is treatment for hepatic abscesses?
    • sx remove if focal
    • Abs (broad spectrum) long term
    • guarded to fair prognosis
  37. what is a benign condition of older dogs that can be misconstrued as a more severe disease? what are liver enzyme and BA values?
    • nodular hyperplasia
    • elevated ALP w/normal BA
  38. what is purpose of cytology/biopsy of suspected nodular hyperplasia?
    • to rule out neoplasia/disease
    • *NOT to confirm hyperplasia*
  39. is it more common to have primary or metastatic neoplasia in the liver?
    mets (target lesions on US)
  40. how are skin lesions described w/hepatocutaneous syndrome? what is liver appearance?
    • "superficial necrolytic dermatitis"
    • "metabolic dermatosis"
    • honeycomb appearance to liver
  41. what is tx and prognosis for hepatocutaneous syndrome?
    • supplement amino acids/protein + Abs for 2ndary skin infections + Ursodiol/Vit E + omega FA
    • -grave prognosis