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The flashcards below were created by user
HLW
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How much of the liver is damaged before C/S?
>80%
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what are some of the classic c/s of liver Dz? 6
- Icterus
- Depression/neurologic disease
- Anorexia/wt loss
- Photosensitization
- Colic/diarrhea
- Hemorrhage (end stage)
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Liver enzymes suggestive of hepatocellular injury?
- SDH
- AST
- (ALT not reliable in large animals)
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Liver specific enzyme with short 1/2 life?
SDH (sorbitol dehydrogenase)
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Where else does AST come from?
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What enzymes are suggestive of cholestasis?
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What liver enzyme is elevated in healthy young horses due to bone isoform?
ALP
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what are liver functions indicators?
- *Albumin*
- *Glucose*
- *BUN*
- *Bilirubin*
- Bile acids
- Ammonia
- Coagulation tests
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If bilirubin is elevated due to inappetance, will elevation be due to conjugated/direct or unconjugated/indirect form?
Why?
Unconjugated/Indirect
Liganden, which conjugates bilirubin, has short 1/2 life in face of anorexia
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does direct or indirect bilirubin increase with cholestasis?
Why?
Direct
Its conjugated in liver but cholestasis impedes elimination
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Why is it unnecessary to fast a horse before bile acid?
- No gall bladder
- (steady release regardless)
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Is it helpful to do bile acids test if the horse is icteric?
Yes, in horses it is still indicated
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Where is US probe placed to visualize liver?
- L: 7-9th ICS
- R: 6-15th ICS
- Ventral to lung margins
- Within costrochondral jx
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where should liver biopsy be taken from (anatomical land marks)?
- R: 11-14 ICS
- Angle from point of hip down to elbow
- Aim cranio-ventral
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What is first step for treating hepatic encephalopathy?
- Sedation
- *detomidine* alpha 2 agonist
- (Self Trauma or injury to others)
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Why are benzodiazepines a poor choice for sedation in a horse with HE?
Elevated ammonia already upregulates GABA;
Benzo's have same MOA so can worsen the condition
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Although controversial what are some options for reducing ammonia formation in the gut? 3
- oral neomycin
- oral lactulose
- acetic acid/vinegar
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Benefits of dextrose CRI in a hypoglycemic horse with liver Dz?
- Decr. [Ammonia]
- Reduc catabolic gluconeogenesis (Work load on liver)
- Decr. protein catabolism
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Glucose should be maintained between 80-120. what is a non-invasive way to monitor?
U/A - renal threshold = 180
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Do appropriate liver diets have more aromatic or branch chain AA?
- avoid aromatics
- more Branch chain AA
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what are some good choices for feeding horse with liver disease?
- Supplements:
- Beet pulp
- Milo
- Sorghum
- (avoid alfalfa)
- *feed something, even if not ideal diet*
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When are ABx indicated for liver Dz? 4
- Biopsy = inflammatory infiltrates
- Positive culture/sensitivity
- Chronic active hepatitis
- Cholangiohepatitis
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What Abx concentrate in the liver and biliary tract? 5
- Penicllin/Gentamicin
- Enrofloxacin
- Chloramphenicol
- TMS
- +/- metronidazole
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Benefits of pentoxyfilline to horse with liver Dz?
What other drug may be helpful?
- Cheap
- Anti-fibrotic
- Anti-oxidant
- Anti-inflammatory
Flunixin meglumine
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Benefits of SAMe?
- Antioxidant
- Hepatoprotectant
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What is another drug option that acts as free radical scavenger and can potentially dissolve biliary stones/sludge?
DMSO - dimethyl sulfoxide
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Why is Actigall (ursodeoxycholic acid) not used in horses?
- Toxic effects in rabbits/Hind gut fermenters
- Used to Tx choleresis in SA Med
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Sx can be performed when biliary stones are located where?
When is Sx not an option?
- Distal bile duct
- No fibrosis
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What is the most common cause of acute hepatitis in the horse?
AKA
Idiopathic Acute Hepatitis Disease
- aka:
- Theiler's disease
- Serum sickness
- Post-vx hepatitis
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What part of the hepatocyte is most affected by acute hepatitis?
How long after giving biologics (vx, plasma, etc) can signs be seen?
Centrilobar necrosis (most O2 dependent part)
30-70 days post administration
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