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C/S of acute hepatitis? 6
- Hepatic encephalopathy
Expected liver enzymes with acute hepatitis?
Elevations of hepatocellular & cholestatic enzymes
Dietary recommendations for acute hepatitis?
- Decrease protein (avoid aromatics)
- Increase carbohydrates
- Mineral oil/Lactulose/Neomycin to reduce ammonia formation
Is total parenteral nutrition a good option for acute hepatitis patient that is sick?
No, high in fat/protein
Use Dextrose CRI = partial nutrition
Ingestion of pyrrolizidine alkaloids => acute or chronic onset?
Chronic (month to year later) - delayed onset with progressive liver failure
what are 3 PA plants horses eat?
- Amsinckia intermedia
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
which liver enzymes are elevated first with PA toxicity?
GGT and ALP - cholestasis
Is fever more likely associated with theiler's disease/PA toxicity or chronic hepatitis?
chronic active hepatitis
what type of dermatitis is associated with chronic hepatitis?
coronary band exfoliative dermatitis
Expected lab findings with chronic hepatitis? 6
- Persistent GGT and ALP
- Mild SDH and AST
- Bile acids
- Bilirubin also increased
What are expected biopsy/histo findings w/ chronic hepatitis
- Periportal necrosis
- Mononuclear cells predominate
- (if lots of Neuts --> culture/sensitivity)
Tx for Chronic Hepatitis if histopath reveals...
- Lymphocytes- immune mediated- steroids
- Neutrophils - antimicrobials
Most common liver Dz's in the horse?
Cholelithiasis & Cholangiohepatitis
What are some extrahepatic causes of cholangiohepatitis? 3
- Abscess formation
- Inflammatory Dz near common bile duct
- Neoplasia (rare)
what is the classic triad of C/S's associated with cholangiohepatitis?
- Colic (one of the only liver diseases that causes colic signs)
Expected lab findings with cholangiohepatitis?
- All enzymes elevated (SDH, GGT, AST, ALP)
- Bili elevated (Direct)
3 classical C/S's associated with hyperlipemia/hyperlipidemia?
Serum color seen with...
- Hyperlipidemia: normal/straw
- Hyperlipemia: creamy/milky
- HyperTG: normal/straw
TG levels in horse with...
- hyperlipidemia: mild/mod (<500)
- hyperlipemic: moderate (>500) - only one w/evidence of fatty liver
- hyperTG: mod/severe (>500)
Which of the 3 syndromes is most similar to fatty liver in cows or HL in cats?
Which horses are "classically" affected
- Miniature horses
Which of the 3 syndromes is most commonly associated with horses in intensive care?
- (anything predisposing negative energy balance can lead to hyperTG)
How is fat stored in the liver?
What form are they in order to be transported out of liver?
Stores: Esterified TG's
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
Hyperlipemia is due to...?
NOT Liver Failure
- Excess peripheral lipolysis
- Goes to liver
- Liver functions effectively =
- Overproduction of VLDLs in circulation
What happens once liver's ability to process TG's into VLDL's is overwhelmed?
- Hepatic lipidosis ensues
- Fatty infiltrates lead to liver failure
How is insulin therapy helpful in treatment of hyperlipemic patient?
- Inhibits Hormone Sensitive Lipase =
- Reduced lipolysis =
- Less fat put into circulation from periphery
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