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Acute Liver Injury in Dogs :dog: - Coggle Diagram
Acute Liver Injury in Dogs :dog:
review
acute liver injury
acute hepatocellular damage
+/- necrosis
function retained
acute liver failure
extensive
compromised hepatic fxn
70% destruction needed to see slin/biochem changes
blood flow through portal triad passes through zones 1-3
zone 3
centrilobular
most susceptible to hypoxia
zone 1
periportal
most susceptioble to toxins
causes
toxins
drugs
intrinsic
types of drugs
acetaminophen
doses exceeding 100mg/kg are hepatotoxic
itraconazole and other triazole antifungals
ALT elevation
simpel dose reduction helps
discontinue if ALT continues to rise
phenobarbitol
increase serum liver enymes
ALP
ALT
transient GGT
+/- liver damage (~20%)
reversible if detected early
3-4mo blood chem monitoring req'd
dose-dependent
predictable
idiosyncratic
types of drugs
carprofen
hepatitis
labradors
CS within 1st month of treatment
isonazid
azathioprine
liver and bone marrow toxicity
hepatocellular and cholestatic effects (rare)
unexpected
production/accumulation of metabolites
immune response to drugs
dose independent
defined as a novel increase in ALT (>2-fold WRI)
infectious
leptospirosis
canine hepatitis
salmonellosis
liver flukes
for fun
neoplasia
ischemia
hepatic lipidosis
copper hepatopathy
CS
:eye:
general ADR
lethargy
anorexia
weakness
vomiting
diarrhea :poop:
icterus
PU/PD
:hand:
dehydration
+/- fever
abdominal pain
hepatomegaly
neurological signs
:microscope:
hypoglycemia
diagnosis
CBC/chem :red_circle:
:arrow_up:
leukocytosis
liver enzymes
ALT
within 24-48hrs
acute severe hepatocellular damage
can increase 100x
gradullay declines if inciting cause is removed
50% decrease within 60hr is a sign of recovery
AST parallels ALT
ALP
acute, severe necrosis
2-5x increase
+/- GGT
ammonia
PT and PTT
bilirubin
+/- hyperphosphatemia
lactate
:arrow_down:
thrombocytopenia
if septic
leukopenia
hypokalemia
possible hypophosphatemia
imaging :camera_with_flash:
FAST scan
rads
US
may be normal
hepatomegaly possible
not very accurate for differentiating causes
CT/MRI (sure...)
cytology :syringe:
good option if suspected...
hepatic lipidosis
neoplasia
risky if coagulopathy
don't do if
PTT is >1.5 WRI
plt count <80k
biopsy
rare
rule out lepto
SNAP
urine/serum PCR
need acute and convalescent titers
questions
vaccine status?
exposure to other animals?
med history?
hepatotoxin exposure?
new diet/treats?
treatment
N-acetlcysteine
resotres
glucathione
synthesis
cell detx
metabolic processes
reduces oxidative stress
SAM-E/Denamarin
assists in
hepatic regenration
cell membrane structure
cell detox
converts to glucothione
prevents depletion
normal liver product
in case of toxin ingestion, induce emesis if possible
correct hypoglycemia
seizure control
fluid/e- support
anti-emetics if needed
