Term
| What is the pre-hepatic cause of ascites? |
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Definition
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Term
| What is the hepatic cause of ascites? |
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Definition
| -inc portal hypertension secondary to primary hepatic parenchymal dz |
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Term
| What is the post-hepatic cause of ascites? |
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Definition
| -post-hepatic venous congestion: RCHF, ovstruction in thoracic caudal vena cava |
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Term
| What are the mechanisms leading to ascites w/ liver dz? |
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Definition
-inc hydrostatic P w/ venous congestion
-dec oncotic P |
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Term
| Describe ascites w/ bile peritonitis. |
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Definition
-strong inflamm response
-fluid is dark orange/red, yellow, or green
-msot patients die |
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Term
| What will we see on cytology of abdominocentesis of ascites due to bile peritonitis? |
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Definition
-might see bile pigment
-intracellular bacteria |
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Term
| What causes hepatic encephalopathy? |
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Definition
| -toxin exposure to CNS w/ liver failure |
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Term
| What is the most important cause of hepatic encephalopathy? |
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Definition
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Term
| What will worsen the CS that occur due to hepatic encephalopathy? |
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Definition
-feeding large amt of protein
-GI bleeding
-azotemia
-dehydration
-constipation
-hypokalemia |
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Term
| Briefly outline ammonia metabolism. |
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Definition
-liver detoxifies ammonia by urea cycle or its consumption in glutamine synthesis
-urea is excreted by kidneys |
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Term
| At what levels is icterus detectable in the tissues? In the serum? |
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Definition
-jaundice at >2mg/d
-in serum at >1.5mg/dL |
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Term
| What is the mechanism behind pre-hepatic hyperbilirubinemia? |
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Definition
-hemolysis
-amt of unconjugated bilirubin exceeds the capacity of liver to remove it |
|
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Term
| What are the mechanisms behind hepatic hyperbilirubinemia? |
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Definition
-liver dysfunction
-intrahepatic cholestasis: bile backs up into systemic circulation |
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Term
| What are the mechanisms behind post-hepatic hyperbilirubinemia? |
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Definition
-extrahepatic bile duct obstruction: bile backs up into systemic circulation
-ex extraluminal compression = pancreatitis
-ex intraluminal compression = cholelithiasis, inspirssated bile, & neoplasia |
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Term
| How do we distinguish pre-hepatic, hepatic, & post-hepatic hyperbilirubinemia? |
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Definition
-pre-hepatic: severe anemia w/ normal protein
-hepatic or post-hepatic: no anemia |
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Term
| Describe the significance of bilirubinuria in dogs. |
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Definition
-can be normal
-low renal threshold |
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Term
| Describe the significance of bilirubiuria in cats. |
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Definition
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Term
| HOw does cholestasis lead to choagulopathies? |
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Definition
-need bile acids to absorb fat to make fat-dependent vitamins like vit K
-thus no more vit K to activate factors 2,7,9,10 |
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Term
| Which liver enzymes indicate leakage? |
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Definition
-alanine transaminase (ALT)
-aspartate transaminase (AST) |
|
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Term
| Which liver enzymes are inducible? |
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Definition
-alkaline phosphatase (ALP)
-gamma-glutamyltransferase (GGT) |
|
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Term
| How do we know that inc AST is due to liver dz? |
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Definition
| -ALT must be elevated as well |
|
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Term
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Definition
-new synthesis and release in response to certain stimuli (bile caniculi, bone)
-inc w/ liver regen |
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Term
| What are the major causes of inc ALP in dogs? |
|
Definition
-cholestatic dz
-bone lysis/remodelying
-drugs: steroids, anticonvulsants |
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Term
| What are the major causes of inc ALP in cats? |
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Definition
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Term
| What drugs can inc canine GGT? |
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Definition
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Term
| True or False: Liver enzymes are a measure of liver function. |
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Definition
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Term
| What are some examples of psudo liver function tests? |
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Definition
-albumin
-urea nitrogen
-glucose
-cholesterol
-bilirubin |
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Term
| What is the true test of liver function? |
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Definition
| -pre-prandial & post-prandial serum bile acids |
|
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Term
| Do pre-prandial & post-prandial serum bile acids correlate w/ severity of liver dz, reversibility, or both? |
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Definition
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Term
| Why do we not need pre-prandial & post-prandial serum bile acids if the animal is icteric? |
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Definition
| -bile acids inc before bilirubin so if the animal is icteric we know the bile acids are inc |
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Term
| Where are bile acids made? What are they conjugated w/ in dogs? Cats? Where are they stored? |
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Definition
-synth from cholesterol in liver
-Both: conjugated w/ taurine
-Dogs only: conjugated w/ glycine
-stored in gallbladder |
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Term
| What do inc bile acids suggest? |
|
Definition
-shunting of portal blood around liver: PSS, MVD
-hepatocellular dysfunction
-cholestasis |
|
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Term
| What is the ideal way to diagnose a shunt? |
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Definition
|
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Term
| How can we diagnose a shunt w/ nuclear scintigraphy? |
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Definition
-liver lights up first = no shunt
-heart lights up first = shunt |
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Term
| In general, what is secondary reactive hepatophaty? |
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Definition
| -liver freaks out due to another primary dz process |
|
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Term
| When would we biopsy a case of secondary reactive hepatopathy? |
|
Definition
-documented hepatic dysfunction
-no evidence of non-hepatic dz
-patient worsens
-persisitent elevation of liver enzymes over 3m period |
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