EqMed Q2, Liver Dz II

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  1. C/S of acute hepatitis? 6
    • Depression
    • Inappetance
    • Pica
    • Jaundice
    • Photodermatitis
    • Hepatic encephalopathy
  2. Expected liver enzymes with acute hepatitis?
    Def Dx?
    Elevations of hepatocellular & cholestatic enzymes

  3. Dietary recommendations for acute hepatitis?
    • Decrease protein (avoid aromatics)
    • Increase carbohydrates
    • Mineral oil/Lactulose/Neomycin to reduce ammonia formation
  4. Is total parenteral nutrition a good option for acute hepatitis patient that is sick?

    Other Options?
    No, high in fat/protein

    Use Dextrose CRI = partial nutrition
  5. Ingestion of pyrrolizidine alkaloids => acute or chronic onset?
    Chronic (month to year later) - delayed onset with progressive liver failure
  6. what are 3 PA plants horses eat?
    • Senecio
    • Crotalaria
    • Amsinckia intermedia
  7. Pathogneumonic characteristics of liver histopath after PA toxicity?

    Which region is mostly affected?
    • *Megalocytes* (cross linked DNA= improper cell division)
    • Bile duct hyperplasia
    • Periportal fibrosis

    • *Portal Triads* (VS centrilobular w/ acute hepatitis)
    • highly fatal
  8. which liver enzymes are elevated first with PA toxicity?
    GGT and ALP - cholestasis
  9. Is fever more likely associated with theiler's disease/PA toxicity or chronic hepatitis?
    chronic active hepatitis
  10. what type of dermatitis is associated with chronic hepatitis?
    coronary band exfoliative dermatitis
  11. Expected lab findings with chronic hepatitis? 6
    • Persistent¬†GGT and ALP
    • Mild SDH and AST
    • Bile acids
    • Bilirubin also increased
  12. What are expected biopsy/histo findings w/ chronic hepatitis
    • Periportal necrosis
    • Mononuclear cells predominate
    • (if lots of Neuts --> culture/sensitivity)
  13. Tx for Chronic Hepatitis if histopath reveals...
    ++ Lymphocytes?
    ++ Neutrophils?
    • Lymphocytes- immune mediated- steroids
    • Neutrophils - antimicrobials
  14. Most common liver Dz's in the horse?
    Cholelithiasis & Cholangiohepatitis
  15. What are some extrahepatic causes of cholangiohepatitis? 3
    • Abscess formation
    • Inflammatory Dz near common bile duct
    • Neoplasia (rare)
  16. what is the classic triad of C/S's associated with cholangiohepatitis?
    • Colic (one of the only liver diseases that causes colic signs)
    • Fever
    • Icterus
  17. Expected lab findings with cholangiohepatitis?
    • All enzymes elevated (SDH, GGT, AST, ALP)
    • Bili elevated (Direct)
  18. 3 classical C/S's associated with hyperlipemia/hyperlipidemia?
    • Lethargy
    • Anorexia
    • Depression
  19. Serum color seen with...
    • Hyperlipidemia: normal/straw
    • Hyperlipemia: creamy/milky
    • HyperTG: normal/straw
  20. TG levels in horse with...
    • hyperlipidemia: mild/mod (<500)
    • hyperlipemic: moderate (>500) - only one w/evidence of fatty liver
    • hyperTG: mod/severe (>500)
  21. Which of the 3 syndromes is most similar to fatty liver in cows or HL in cats?

    Which horses are "classically" affected

    • Miniature horses
    • Donkeys
    • Ponies
  22. Which of the 3 syndromes is most commonly associated with horses in intensive care?
    • HyperTG
    • (anything predisposing negative energy balance can lead to hyperTG)
  23. How is fat stored in the liver?

    What form are they in order to be transported out of liver?
    Stores: Esterified TG's

    Transport: VLDL's
  24. What happens to fat that is brought to the liver?
    • 1: Oxidized - into TCA cycle to make ATP
    • 2: Esterified into TG for storage
    • 3: Gluconeogenesis
    • 4: Made into ketone bodies
  25. Hyperlipemia is due to...?
    NOT Liver Failure

    • Excess peripheral lipolysis
    • Goes to liver
    • Liver functions effectively =
    • Overproduction of VLDLs in circulation
  26. What happens once liver's ability to process TG's into VLDL's is overwhelmed?
    • Hepatic lipidosis ensues
    • and
    • Fatty infiltrates lead to liver failure
  27. How is insulin therapy helpful in treatment of hyperlipemic patient?
    • Inhibits Hormone Sensitive Lipase =
    • Reduced lipolysis =
    • Less fat put into circulation from periphery
  28. Poor indications for liver Dz P? 6
    • Hypoalbuminemia (<2.5) - Endstage b/c Alb has long 1/2 life
    • Incr. Glob
    • Prolonged PT
    • Chronic, severe elevation of GGT
    • Bridging fibrosis
    • Severe acidosis and diarrhea
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EqMed Q2, Liver Dz II
2013-04-11 22:14:46
EqMed Q2 Liver Dz II

EqMed Q2, Liver Dz II
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