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SA Alimentary 3: Approach to liver disease: Part B - Coggle Diagram
SA Alimentary 3: Approach to liver disease: Part B
Describe how to investigate liver disease in dogs and cats
SIGNALMENT, HOSTORY AND PHYSICAL EXAM
SIGNALMENT AND HISTORY:
breed
toxicity
travel history ie infectious hepatitis
other clinical signs suggestive of secondary hepatitis
JASPER: CLINICAL CASE:
History
:
10 days lethargy
1 week V and inappetace and dark yellow urine
Examination
BCS 3/9
icterus
cranial adbominal discomfort
pyrexic
Problem list
jaundice
pyrexic
cranial abdominal discomfrot
vomiting
inappetance, lethary
reduced body condition
Haematology:
Low platelets
false thrombocytopenia (his platelet count is adequate)
high WBC
high neutrophils
low lymphocytes
low eosinophils
platelets appear
ACUTE INFLAMMATORY PATTERN
neutrophilia with toxic neutrophils (left shift)
**Serum biochemistry:
Hepatocellular hepatopathy
increase in ALP which is significant in cats
Hepatic jaundice
BLOODS:
interpret liver enzymes in light of clinical signs
liver enzymes can be low in liver sirrhosis despore poor liver function
can be high after an acute toxicity despite mormal liver function
DIAGNOSTIC IMAGING:
liver can appear normal when diseased on radiogrpahy and US
radiograph may reveal hepatomegaly
liver US findings may be non-specific or incidental findings
JASPERS ABDOMINLA US:
The gall bladder wall was
irregularly thickened and
contained a large volume
of echogenic sludge. The
biliary tract was
markedly and tortuously
dilated, no biliary
obstruction was
observed. The hepatic
parenchyma was mildly
heterogenous.
LIVER SAMPLING:
less common
must consider haemostsis
hepatic fine needle aspirate
hepatic biospy fpr histopathology
definitive diagnosis
can be performed laproscopically
Explain the management of acute and chronic liver disease in dogs and cats
GENERAL THERAPEUTIC MEDICAL PRINCIPLES IN LIVER DISEASE:
dietary mod
liver supportive diets
compluicaiyon management
hepatic ecephalopathy
portal hypertension
**hepatoprotective therapies
antioxidants
choleretics
specific
copper chelation
infectious
neoplastic
supportive
NUTRITIONAL MANAGEMENT:
Aim to
supplement antioxidants
restruct animal protein - reduce ammonia
restruct copper
Soy based hydrolysed diet
Hepatic prescroption diets
need to supplemt protein
copper restructed
antooxidants supplemented
Choleretics : UDCA:
Hydrophilic, 'beneficial' bile acid
• Synthetically derived
• Mechanism
• Alters bile composition
• Stimulates bile flow
• Modulates inflammatory response in liver
• Modifies apoptosis
• Indications
• Cholestatic disease (biliary disease)
• e.g. cholangitis, gall bladder mucocoele
• Not safe in rabbits
ANTIOXIDANTS:
Milk thistle extracts
SAMe
NAC (IV)
Antibiotic Therapy:
• Cholangitis/cholangiohepatitis
• Leptospirosis
• Amoxicillin-clavulanate / penicillins – IV / pending results
• Doxycycline – 2 weeks oral to clear carrier state
• Hepatic abscess
• Surgery + antibiotics (empiric e.g. amoxicillin-clavulanate, then guided by
culture/sensitivity)
• Toxoplasmosis (cats, uncommon)
• Clindamycin, others
• Protozoa – some antimicrobials have efficac
Anti-inflammatories / immunosuppressives:
Steroids:
antiinflamms vs immunosuppressives
eg chronic hepatotos
immunosuppression
lymphocytic cholangitis
starts with steroids
may need adjuncts
COMPLICATIONS
-• Hepatic encephalopathy
• Portal hypertension
• Coagulopathies
• Hypoglycaemia
Management considerations in acute liver
disease:
• Isolation or barrier nursing?
• Venepuncture risks - coagulopathy
• Patient monitoring
• Neurological signs/seizures?
• Management of hypoglycaemia
• Complex carbohydrates little and often
• Glucose infusion
Management of portal hypertension:
• Increased resistance to blood flow through the liver
• Consequences
• Secondary shunting
• Splanchnic bed oedema (e.g. GI wall) → impairs GI perfusion and health; GI
haemorrhage
• Ascites
• Therapy
• Treat cause of portal hypertension (if possible)
• Spironolactone +/- Na+ restriction
• Avoid GI toxic drug
Copper Storage Treatments:
Decoppering therapy 6-9 months
• Chelator: D-penicillamine (others less
commonly used)
• Dietary copper restriction
• AVOID red meat/offal/eggs, cereals
• Zinc supplementation / maintenance
• NOT with decoppering agents
• Hepatoprotective therapies
• E.g. SAMe
• Management of complications
Medical therapy for hepatic encephalopathy –
at home:
Dietary modidication:
protein modification to minimise encephalotpahy
vegetable based protein vs protein restrictions
Lactulose
diasacchardide - colonic bacterial fermentaion - SCFAs
ion traps ammonia in the colin
Antibiotics
CONGENITAL PORTOSYSTEMIC SHUNT:
Surgical
macroscopic vascular anatomy to prevent further shunting
requires period of pre-op medical stabilisation
better long term outcome
Medical
as a pre-curser to intended surgical management
as a long term option where surgery is declined or not possible
