Icterus and hepatic encephalopathy in small animals Flashcards Preview

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Flashcards in Icterus and hepatic encephalopathy in small animals Deck (23)
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1
Q

icterus - define

A

hyperbilirubinaemia

2
Q

bilirubin in the liver

A

conjugated with glucuronic acid - water soluble for excretion in the urine

3
Q

pre-hepatic icterus - cause

A

Haemolysis

Conjugation + uptake of bilirubin into liver overwhelmed

4
Q

hepatic icterus - cause

A

Uptake, conjugation and excretion of bilirubin in hepatocytes overwhelmed

5
Q

post-hepatic icterus - cause

A

Cholestasis

Conjugation, excretion and uptake back into liver overwhelmed

6
Q

clinical signs linked with gastrointestinal tract

A
Vomiting
Diarrhoea
Acholic faeces
Melaena
Abdominal effusion = ascites (cirrhosis)
7
Q

clinical signs linked with neurological system

A
Personality change
Ptyalism (cats) (hypersalivation)
Head pressing
Disorientation
Seizures
stupor
8
Q

clinical signs linked with renal/urinary system

A

PU/PD
Pollakiuria, stranguria, dysuria
Bilirubinuria

9
Q

haematological signs

A

Pale mucous membranes - Anaemia from GI haemorrhage, anaemia of chronic disease, coagulation disorder, haemolysis

10
Q

DDx for pre-hepatic

A

Immune Haemolytic Anaemia
Babesia infection
Toxins: Onions, lead, copper

11
Q

DDx for hepatic - cat

A
Suppurative Cholangiohepatitis
Lymphocytic plasmacytic hepatitis
Hepatic Lipidosis
Feline Infectious Peritonitis
Toxins (acetaminophen, aspirin)
Neoplasia
12
Q

DDx for hepatic - dog

A

Acute liver disease (toxins)
Leptospirosis
Chronic hepatitis
Neoplasia

13
Q

DDx for post-hepatic

A

Pancreatitis
Neoplasia (Liver, duodenum, pancreas)
Cholelithiasis

14
Q

How would you differentiate between prehepatic and hepatic icterus?

A

Perform PCV/TS
If prehepatic: PCV low, TS normal
If hepatic: usually PCV normal, TS can be low if Albumin low

15
Q

How would you differentiate between hepatic and posthepatic icterus?

A

Ultrasound will identify obstruction of the gall bladder and masses or pancreatitis associated with it

16
Q

full hepatic disease workup

A
Haematology, chemistry profile, UA
Abdominal ultrasound
Liver function tests
Coagulation tests
Aspirate effusion, cytology
Liver fine needle aspirate
Fine needle aspirate and culture of bile
Liver biopsy: Histology, culture
17
Q

liver enzymes

A

ALT: most liver specific enzyme
AST: also present in muscle, intestines…
AP: Biliary duct cells, Isoenzymes: Cortisol-induced (only dogs!), bone, intestines, liver, placenta etc

18
Q

indications for liver failure on chemistry profile

A

Low albumin
Low cholesterol
Low glucose
Low BUN (blood urea nitrogen)

19
Q

measuring bile acid level

A

first measurement fasted
feed then take second measurement:
rate limiting step = re-uptake of bile acids from the blood into hepatocytes
elevated in liver failure/portosystemic shunt

20
Q

hepatic encephalopathy

A

Digestion of proteins: NH3 und aromatic AA go directly into the blood without passing through the liver first
Exposure of CNS to shunted gut-derived toxins

21
Q

hepatic encephalopathy - clinical signs

A
Neurologic signs
bizarre behaviour
head pressing
Seizures
intermittent blindness
Cats: Ptyalism
urate stone formation
22
Q

Most important diseases causing HE in small animals - cats

A

Acute liver failure (toxic)
Hepatic lipidosis
Neoplasia
Portosystemic shunts

23
Q

Most important diseases causing HE in small animals - dogs

A
Portosystemic shunts
Liver failure (acute): Toxic, infectious
Liver failure (chronic): cirrhosis