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103 Cards in this Set
- Front
- Back
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What is hepatic encephalopathy (hepatic coma)?
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Disturbances in cerebral and brainstem function associated with generalized liver disease
-Transient blindness, hear pressing, depression, stupor, coma, excessive nervousness, hysteria, character change including visciousness, paresis, ataxia, polyuria, polydypsia, anorexia, weight loss, ascites |
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How is ammonia delivered to hepatocytes?
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Portal vein
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What can exacerbate hepatic encephalopathy and why?
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High meat diets because damage to liver results in failure to metabolize ammonia to urea
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What causes the neurologic signs in animals with hepatic encephalopathy?
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-Ammonia by itself or in combination w/ glutamic acid (by-product of ammonia metabolism in the brain) results in status spongiosus of brain
-Altered amino acid metabolism results in decreased excitatory neurotransmitters and increased inhibitory neurotransmitters |
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What are 3 types of portal hypertension (increased pressure within the portal vein)?
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1) Prehepatic portal hypertension
2) Intrahepatic portal hypertensin 4) Posthepatic portal hypertension |
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What is the most common post-hepatic cause of portal hypertension? Not most common?
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-Passive congestion (heart failure) =most common
-Hepatic vein |
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What is intrahepatic portal hypertension?
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Increased resistance to blood flow within the sinusoids
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What are 3 causes of intrahepatic portal hypertension?
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1) Chronic hepatic disease
2) Increased collagen 3) Loss of normal lobular architecture |
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What is prehepatic portal hypertension?
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Blood flow through the portal vein is impaired
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What are 2 causes of prehepatic portal hypertension?
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1) Thrombosis
2) Invasion by neoplasms |
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What are the sequelae to right-sided heart failure?
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Passive congestion, increases the pressure in:
-Caudal vena cava -Hepatic vein -Tributaries of hepatic vein |
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What are the 3 gross lesions of acute passive congestion?
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1) Slight enlargement of the organ
2) Blood flows freely when the liver is incised 3) Lobular pattern of the liver more pronounced -Particularly on cut surface -Centrilobular areas are congested (dark red) |
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What are 3 gross lesions of chronic passive congestion?
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1) Sinusoids in these areas are dilated and congested (Red central area)
2) Accentuation of the lobular pattern of the liver 3) Especially evident on the cut surface of the liver-nutmeg liver |
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What will you see on histopathology of chronic passive congestion?
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Periportal hepatocytes undergo fatty degeneration because of hypoxia
-This area of the lobule appears yellow |
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What is a nutmeg liver?
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-Atrophy of centrilobular hepatic plates w/ fibrosis
-Portal fatty change -Associated w/ right sided heart failure |
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What are 4 classes of parasites that cause liver damage?
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1) Nematodes
2) Cestodes 3) Trematodes 4) Protozoa |
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How do nematodes (ascarids) cause liver damage?
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-Larval migration through liver is common
-Result is fibrosis/scars--> "milk spot" liver |
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How does a liver infested with nematodes appear on necropsy?
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Pale areas on capsule; "milk spots" of swine
-Can get mineralization from damage -Usually incidental finding |
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What causes caval syndrome?
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Heartworms in dogs
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What is caval syndrome?
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Where large numbers of adult worms are in the vena cava, right heart and pulmonary artery
-Liver is engorged with blood--> severe passive congestion--> partial blockage of the caudal vena cava |
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What host has the encysted forms of cestode parasites?
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Intermediate hosts
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What are 3 examples of larval cestodes?
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1) Taenia spp.
2) Cysticercus tenuicollis 3) Echinococcus granulosus (hydatid liver disease) |
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What are the 2 trematodes that affect the bile ducts?
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1) Fasciola hepatica
2) Fasciola gigantica |
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What trematode causes more extensive damage than just in the bile ducts (fasciola hepatica & gigantica)?
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Fascioloides magna: more extensive damage, especially in sheep
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What defines photosensitivity disorders?
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Defined by the action of sunlight on fluorescent pigments which accumulate in the skin, these pigments are related to heme or chlorophyll, each contains 4 pyrrole radicals
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What happens when fluorescent pigments are exposed to sunlight in an animal with a photosensitivity disease?
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Exposure to sunlight causes release of energy; damaging capillaries and venules in the skin--> edema, hyperemia, and epithelial damage
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What are 3 causes of photosensitivity disorders?
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1) Congenital or hereditary photosensitization
2) Hepatogenous photosensitization 3) Acquired (Exogenous) photosensitization =primary photosensitization=exogenous photosensitivity disease |
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What is the pathogenesis of congenital or hereditary photosensitization?
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Photosensitization due to retention of phylloerythrin from chlorophyll due to a defect in one of the steps of bilirubin metabolism
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What is Gilbert's syndrome?
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A type of congenital or hereditary photosensitization
-Southdown sheep-defective uptake of unconjugated bilirubin into hepatocytes |
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What is Dubin-Johnson syndrome?
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-Congenital photosensitization
-Corriedale sheep-decreased excretion of conjugated bile into canalicular system |
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What is protoporphyria?
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-Congenital photosensitization
-High protoporphyrin concentrations due to decrease in heme synthesis in liver and other tissues. -Ferrochetalase deficiency -Recessive trait in female Limousin Cattle |
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What is congenital erythropoietic porphyria?
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-Congenital photosensitization
-Inherited enzyme defects resulting in overproduction of type I porphyrins--> abnormal porphyrin formed in developing erythrocytes |
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What are the 2 clinical signs of an animal with congenital erythropoietic porphyria?
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1) Osteohemochromatosis= "pink tooth"-put black on turns green
2) Secretion of porphyrin in urine-turns red on exposure to light. -must differentiate from hemoglobinuria, myoglobinuria and hematuria |
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What is the pathogenesis of hepatogenous photosensitization?
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Liver damage ---> bile duct obstruction --> increase circulating phylloerythrin from ingested chlorophyll---> photosensitization when fluorescent phylloerythrin is excited by sunlight
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What is acquired (exogenous) photosensitization?
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Primary photosensitization= exogenous photosensitivity disease
-Ingestion of preformed photodynamic agents (buckwheat, St. John's wort, phenothiazine, antihelmentics, fermentative breakdown of alfalfa) |
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What are 2 types of diaphragmatic hernias?
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Congenital malformation
-Defect in diaphragm -Opening through diaphragm Trauma that ruptures the diaphragm -Herniation of the liver into the thoracic cavity |
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What happens when a dog gets a torsioned liver lobed?
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Will be painful for a while and then with time the pain goes away and the liver lobe degenerates
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Where does tension lipidosis occur?
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Adjacent to the insertion of a ligament (Serosal) attachment
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What is tension lipidosis?
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Ligament attachments impede blood supply to the subjacent hepatic parenchyma by exerting tension on the capsule--> hepatocytes accumulate fat within their cytoplasma (lipidosis) from hypoxia
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True or false. Tension lipidosis is causes severe liver dysfunction.
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False, no functional signifcance to the liver
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What is the disease caused by equine serum hepatitis?
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Theiler's disease
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What is Theiler's disease?
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Abrupt onset of blind staggers, icterus, death
-Clinical course of 1 to 2 days -Equine serum hepatitis |
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What do you find in an animal upon necropsy that died from Theiler's disease? What causes Theiler's disease?
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-Dishrag liver (liver has no form)
-Centrilobular hepatic necrosis with *inflammation -Etiology unknown! |
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What are the clinical signs of toxic hepatopathy of neonatal foals?
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-Normal at birth-die at 2 to 5 days
-Icterus, ataxia, head pressing, hepatic coma |
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What are the 5 lesions associated with toxic hepatopathy of neonatal foals?
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1) Livers 1/2 normal weight
2) Portal fibrosis 3) Bile duct proliferation 4) Massive hepatocellular necrosis & lobular collapse-periportal 5) Hepatic encephalopathy |
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When does toxic hepatopathy of neonatal foals start developing?
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Takes 10-14 days to get fibrosis and these foals die in 2-5 days, so must start in utero
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What is the etiology of toxic hepatopathy of neonatal foals?
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Prima Paste SL a Dietary inoculant
-Had to much iron |
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What kind of cellular response occurs with chronic progressive hepatitis in dogs?
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Largely composed of lymphocytes w/ varying numbers of neutrophils
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What are 6 lesions associated with chronic progressive hepatitis in the dog?
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1) Foci of hepatocellular necrosis centered on portal areas=piecemeal necrosis of limiting plate
2) Diffuse "bridging" fibrosis resulting in sublobules or pseudolobules 3) Bile duct proliferation 4) Disruption of limiting plates 5) Dilation of capsular lymphatics 6) Nodules of regeneration -See cirrhosis-end stage liver |
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What is the etiology of chronic progressive hepatitis in the dog?
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Unknown
-Viral in man |
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What is hepatosis dietetica? what animals are affected?
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AKA nutritional hepatic necrosis
-Syndrome of acute hepatic necrosis -Young, rapidly growing swine |
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What is the pathogenesis of hepatosis dietetica?
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-Deficiency of either Vitamin E or selenium
-Enzymes are antagonists of free radical formation -Maintenance of stability and integrity of cellular membranes -Deficiency leads to lipid peroxidation of cell membranes |
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What kind of liver lesions are seen with hepatosis dietetica?
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Randomly scattered lesions but entire lobules are affected
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Amyloidosis may result in a ______ liver-cattle, horses, dogs, cats.
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Ruptured liver
-Seen in most species |
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Where does amyloid accumulate in liver with amyloidosis?
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In the Space of Disse
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What is primary amyloidosis?
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-Caused by amyloid protein AL
-Ig light chains are synthesized by plasma cell neoplasms= endocrine cells |
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What is the most common type of amyloidosis?
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Secondary amyloidosis
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What type of amyloid accumulates with secondary amyloidosis?
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Serum protein synthesized by liver- serum amyloid-associated protein
-Precursor to amyloid associated fibrils |
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What is the pathogenesis of secondary amyloidosis?
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-Prolonged inflammation
-Chronic infection or tissue destruction |
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What is familial amyloidosis?
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-Family lines
-Uncommon in animals Shar-peis Abyssininan and siamese cats |
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How do livers appear with amyloidosis?
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Pale and waxy
-Hepatomegaly |
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What are the differentials for a pale and waxy liver?
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-Amyloidosis
-Steroid hepatopathy (dog) -Fatty liver -Storage diseases |
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True or false. Amyloidosis does not cause liver dysfunction.
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False, can cause hepatic dysfunction when severe
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What is telangectasia (Peliosis-hepatis)?
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Dilation of sinusoidal capillaries-not to be confused with hemangiosarocoma
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What animals do you see telangectasia in?
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Old cattle and aged cats
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What do they think that telangectasia arises from?
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Sawdust liver-liver has little yellow spots (necrosis)-looks like dropped in saw dust but looks like hepatosis dietetica so may be vitamin E or selenium deficiency..?
-Incidental finding |
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What are canine crystalloids?
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Intranuclear eosinophilic rectangular inclusions found in renal tubular cells and hepatocytes of dogs>4 yrs old
-Can look like viral inclusions -Incidental findings |
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What is chronic hepatitis?
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Continual inflammation due to persistence of stimulus
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What are 3 causes of chronic hepatitis?
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1) Certain bacteria & fungi are resistant to killing and incite chronic inflammation
2) Chronic biliary inflammation 3) Idiopathic |
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What are 4 responses of the liver to injury?
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1) Regeneration (if +10% affected)
2) Fibrosis (takes 10-14 days to develop) 3) Biliary hyperplasia (common in portal triads) 4) End-stage liver or cirrhosis (Scarred down liver) |
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What is cirrhosis?
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Diffuse fibrosis (Affects every lobule) characterized by conversion of normal liver architecture into structurally abnormal nodules. It is an "end-stage" liver not yielding clues to pathogenesis
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What is central (cardiac) cirrhosis?
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Cirrhosis that develops secondary to chronic passive congestion
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When does post necrotic scarring (cirrhosis) with nodular regeneration occur on the liver?
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Secondary to massive liver necrosis (>10%)
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What are 3 causes of icterus (jaundice)?
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1) Hemolytic disease. Overproduction of bilirubin
2) Hepatocellular disease. -Failure to metabolize bilirubin, decreased uptake, conjugation or excretion 3) Biliary obstruction. Reduced outflow -Intrahepatic -Extrahepatic |
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What are 6 disease manifestations of liver dysfunction?
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1) Edema & ascites
-Hypoproteinemia -Portal hypertension 2) Diarrhea-malabsorption (not getting bile into GI tract) 3) Photosensitization: phylloerythrin not excreted in bile; accumulates in skin 4) Bleeding abnormalities (factors V, VII, IX, X, fibrinogen) 5) Abdominal pain (stretching or blocking e.g gall stones) 6) Release of cytoplasmic enzymes (from hepatocytes) |
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What are the 5 systemic sequelae to liver injury?
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1) Hepatic encephalopathy
2) Hypoalbuminemia 3) Bleeding tendencies 4) Cutaneous manifestations 5) Icterus |
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What are 3 types of icterus (jaundice, hyperbilirubinemia)?
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1) Prehepatic-erythrolysis
2) Hepatic-hepatocyte injury 3) Posthepatic-bile flow obstruction |
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What are 5 gross lesions of icterus?
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1) Systemic yellow discoloration
2) Sclera 3) Intima of major arteries 4) Mucous membranes 5) Connective tissue planes |
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What are 4 types of growth disturbances of the liver?
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1) Nodular hyperplasia (hepatoma): spontaneously occurring lesions of no clinical significance in older dogs
2) Nodular regeneration 3) Hepatocellular carcinoma 4) Metastatic/multicentric neoplasms -Lymphoma -Hemangiosarcoma |
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When does nodular regeneration of the liver occur?
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A response to parenchymal loss & fibrosis
-Sudden loss of 10% of hepatocytes triggers marked proliferation of surviving hepatocytes from portal regions |
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What animals do not have a gall bladder?
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Horses, rats, many cervids, camelids, elephants
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What's the function of the gall bladder?
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Stores and concentrates bile
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What is bile composed of?
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Water, bile acids, bilirubin, cholesterol, inorganic ions
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What is the function of bile acids?
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Digest fats
Excretion of metabolites and drugs Buffer to neutralize acidic ingesta -Bile acids are recirculated |
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What are 3 congenital malformations that can happen to the gallbladder and bile ductules?
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1) Cysts (common)
2) Reduplicatin 3) Aberrant ducts |
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What are 5 acquired diseases of the gallbladder and bile ductules?
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1) Bile inspissation (Dried out bile that can form stones (choleoliths)
2) Cystic hyperplasia -Dogs, generally an incidental finding 3) Edema (non-specific change seen in many infectious diseases e.g. infectious canine hepatitis) 4) Neoplasms -Bile duct carcinoma, often umbilicated and multifocal 5) Cholecystitis, cholangitis, cholangiohepatitis |
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What do you call it when there's no gallbladder? 2 gallbladders?
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None=agenesis
2=bilobulation |
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Do congenital cysts of the liver usually cause clinical problems? What part of the liver is usually affected?
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-Usually an incidental finding
-Intrahepatic bile ducts -Hepatic capsule |
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What is congenital polycystic hepatic disease?
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Characterize by numerous epithelial-lined cysts in the liver & kidneys
-More common than congenital cysts |
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What is another differential for congenital cysts?
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Hydatid disease (echinococcus granulosus)
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What are the 2 types of cholestasis and what causes each one?
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-Intrahepatic: hepatocyte damage
-Extrahepatic: mechanical obstruction of bile flow |
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When do choleliths cause a problem?
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When get into the common bile duct
-Once they migrate & obstruct |
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What causes bile duct hyperplasia?
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Non specific response to variety of injuries
-Toxic -Obstructive |
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What is a differential for bile duct hyperplasia?
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Must distinguish from neoplasia
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What animals usually get obstructive disease from choleliths?
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Infrequent in domestic animals
-Ruminants |
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What are 6 causes of prolonged extrahepatic cholestasis?
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1) Dilation of bile ducts
2) Biliary hyperplasia 3) Hepatocellular injury 4) Retention of bile constituents 5) Inflammation & fibrosis 6) Extensive scarring of these areas -Biliary fibrosis |
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What is cholelithiasis?
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Concretions of normally soluble components of bile
-Gallstones |
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What are the gross lesions of cystic mucinous hyperplasia/mucocele of the gallbladder?
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-Mucosa is gray-white
-Diffusely thickened -Spongelike consistency (cysts within hyperplastic mucosa that contain lots of mucus) -Sessile or polypoid masses -Occasionally large cysts -Papillary projections |
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What are 2 gross lesions of biliary adenomas?
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1) Multinodular or papillary masses
2) Protrude from the mucosal surface -Rare neoplasm |
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What are 4 patterns of spread of biliary carcinomas?
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1) Direct extension (can invade the liver)
2) Metastasize to hepatic lymph nodes 3) Metastasize to distant sites (lung, etc.) 4) Multicentric origin |
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**What are 3 causes of acute cholecystitis?
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1) Viral infections
-Infectious canine hepatitis ---> edema & hemorrage in gallbladder 2) ***Salmonellosis -Fibrinous cholecystitis in calves 3) Other bacteria -Hematogenous -Ascending from intestine |
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What is the most common cause of acute cholecystitis? Why is it so important to diagnose right away?
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Salmonellosis in calves!!!!
Contagious and zoonotic disease |
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What are 2 parasitic diseases of the bile ductules and gallbladder?
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Eimeria stediae-rabbits
Aberrant ascarid migration |
