Bryan - Sa Med - Hepatobiliary Disease - Fall 3Rd Year

Front 1

Which liver lobe is the largest?

Back 1

Left lobe (30-50% total mass)

Front 2

Put hepatic blood flow into the correct order:
Portal triad
Central vein
Sinusoids
Vena cava
portal vein

Back 2

Portal vein
Portal triad
sinusoids
central vein
vena cava

Front 3

Which (general) hepatic diseases do young animals get?

Back 3

Congenital portosystemic shunts
Lymphocytic cholangitis

Front 4

Which (general) hepatic diseases to older animals get?

Back 4

chronic hepatitis
Suppurative cholangitis

Front 5

Microcytic anemia is due to...
What other RBC abnormality may be noted with this condition?

Back 5

...Fe deficiency; also causes Target cells.

Front 6

Poikilocytosis can be due to...

Back 6

...hemangiosarcoma

Front 7

T or F:
Most changes in liver enzymes are extrahepatic.

Back 7

Tru

Front 8

What are the leakage enzymes?
Cholestasis enzymes?

Back 8

AST & ALT (leak)
ALP & GGT (stasis)

Front 9

What amount of drop in ALT is deemed to be a good prognostic indicator with liver disease?

Back 9

drop 50% in 48h

Front 10

In severe acute hepatocellular damage, what happens to the leakage enzymes?

Back 10

AST:ALT ratio increases (AST has a shorter half life)

Front 11

What are the biggest contributors to ALP in the dog?

Back 11

Liver ALP and corticosteroid-induced ALP

Front 12

What happens to the cholestatic enzymes in feline hepatic lipidosis?

Back 12

ALP is more markedly elevated than GGT

Front 13

What are hepatic causes of increased cholesterol? Decreased?

Back 13

Increased (cholestasis; back diffusion from biliary system)
Decreases (synthetic failure eg: cirrhosis or CPSS)

Front 14

Hypoglycemia due to hepatic disease indicates that there is _______% of liver mass remaining.

Back 14

<30%

Front 15

Which dog breed has high bile acids with normal biliary function?

Back 15

Maltese

Front 16

Why are bile acids conjugated? What are they conjugated to?

Back 16

COnjugation prevents absorption in places other than the ileum.
Taurine (cat and dog); Glycine (dog)

Front 17

What are sources of ammonia in the body? Which is the biggest source?

Back 17

Colon (biggest)
SI bacteria
Glutamine catabolism

Front 18

Which liver function tests measure hepatic synthesis?

Back 18

BUN, Glucose, Albumin, Cholesterol, Clotting factors, Protein C

Front 19

Which liver function tests measure hepatic uptake? Secretion?

Back 19

Bile Acids and BIlirubin for both

Front 20

Which liver function tests measure hepatic conjugation? Metabolism?

Back 20

Conjugation (Bilirubin)
Metabolism (NH3)

Front 21

Ammonium biurate crystals in the urine are consistent with what condition?

Back 21

CPSS in times of HE

Front 22

What is the signalment for canine chronic hepatitis?

Back 22

Middle aged dogs
Skye, Labs, Bedlington, Westies, Dalmations (all due to Cu issues)

Front 23

What are the causes of canine chronic hepatitis?

Back 23

Idiopathic (most common)
Toxin, drugs, infection, Fe, Cu, adenovirus

Front 24

How can cats develop HE without portosystemic circulation?

Back 24

Fasting cats get no arginine, an important component in the NH3 cycle, leading to hyperammonemia

Front 25

What are histologic characteristics of chronic hepatitis?

Back 25

Lymphoplasmacytic infiltrates and piecemeal necrosis leading to bridging necrosis

Front 26

Chronic hepatitis due to Cu storage must be treated when Cu is above....

Back 26

...>2000ppm

Front 27

T or F:
With corticosteroid therapy of chronic hepatitis with lymphoplasmacytic infiltrate, ALT often increases but ALP should decrease with effective therapy.

Back 27

False!
ALP often increases while ALT should decrease

Front 28

regenerative nodules + fibrosis =

Back 28

cirrhosis

Front 29

With hepatic encephalopathy, the branched chain:aromatic amino acid ratio is...
a) low
b) equal
c) high

Back 29

LOW (meaning more aromatic than branched and the aromatics are TOXIC)

Front 30

What are some factors that make HE worse?

Back 30

Protein catabolism
Dehydration (activates RAAS)
Hypokalemia
Constipation
Metabolic alkalosis
Portal hypertension

Front 31

What is hepatocutaneous syndrome? Which breeds are predisposed?

Back 31

Ulcerations on footpads and elbows; Cocker and Westies

Front 32

What are indications for using azathioprine in chronic hepatitis? Any contraindications?

Back 32

When glucocorticoids fail
NOT IN CATS

Front 33

What are indications for using ursodeoxycholic acid in chronic hepatitis? Any contraindications?

Back 33

in cholestasis;
NOT with bilary obstruction!

Front 34

What are some drugs thought to decrease hepatic fibrosis?

Back 34

Colchicine
COrticosteroids
Vit. E
Silymarin
SAMe
azathioprine
penicillamine
Zn

Front 35

What are antioxidants used in hepatic therapy? What is the MOA for each?

Back 35

SAMe (increases glutathione)
Silymarin (increases SOD)
N-acetylcysteine (increases glutathione)

Front 36

What are treatments for high Cu in the liver?

Back 36

Chelation (D-penicillamine or 2,2,2-tetramine);
Zn will sequester Cu and decrease further Cu absorption (just can't give with the chelators)

Front 37

Predict relative levels of bilirubin, ALT/AST and ALP/GGT in acute hepatitis.

Back 37

Usually increased bilirubin
High ALT/AST
Normal ALP/GGT (take 7d to increase)

Front 38

When are glucocorticoids indicated in acute hepatitis?

Back 38

NOT USED yo

Front 39

How is granulomatous hepatitis diagnosed?

Back 39

HISTOPATH, yo momma is fat like chedda cheez....

Front 40

What are the types of cholangitis affecting kitties?

Back 40

NEutrophilic
Lymphocytic
Fluke-associated in the SE US

Front 41

Predict the relative increases in ALT, bilirubin, GGT, bile acids, and ALP in a cat with suppurative cholangitis.

Back 41

ALT and bilirubin more increased than ALP and GGT; GGT>ALP
BA increased

Front 42

Which is more common, lymphocytic or neutrophilic cholangitis?

Back 42

lymphocytic

Front 43

What are the most common isolates from gallbladder FNA in neutrophilic cholangitis?

Back 43

E. coli
Bacteroides

Front 44

What is the common presentation for lymphocytic cholangitis?

Back 44

Young cats; persians overrepresented

Front 45

What feature can differentiate lymphocytic cholangitis from hepatic lymphoma?

Back 45

Ductopenia in lymphocytic cholangitis; also portal lipogranulomas

Front 46

T or F:
Lymphocytic and suppurative cholangitis are treated in essentially the same way.

Back 46

True (or maybe false...T/F questions blow)
Pretty much the same except NO ABX usually in lymphocytic.

Front 47

What are some liver enzyme values that can help to differentiate hepatic lipidosis from cholangitis?

Back 47

ALP>GGT in lipidosis
ALP<GGT in cholangitis

Front 48

What is the most important aspect to treating hepatic lipidosis?

Back 48

muthaflippin nutritional support BOYEEEEEEEEEEEEEEEE with high caloreeezzzzzz
Make sure you toss some Taurine in too

Front 49

If a suspected PSVA has high bilirubin, what is the likely answer and next steps?

Back 49

High bilirubin = probably not a shunt
Run bile acids to make sure!

Front 50

What is the approximate distribution of hepatic neoplasia in the dog (primary vs. hemolymphatic vs. metastatic)?

Back 50

46% mets
28% hemolymphatic
26% primary

Front 51

What is the approximate distribution of hepatic neoplasia in the cat (primary vs. hemolymphatic vs. metastatic)?

Back 51

60% Hemolymphatic
20% primary
20% metastatic

Front 52

Biliary mucocoele is seen in...
a) cats
b) dogs
c) both

Back 52

b) dogs

Front 53

Hepatic nodular hyperplasia is commonly seen in...

Back 53

...older dawgz