Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
99 Cards in this Set
- Front
- Back
|
What are some histologic characteristics of chronic hepatitis?
|
hepatocellus apoptosis/necrosis, mononuclear or mixed inflammatory infiltrates, regeneration and (if severe) fibrosis and cirrhosis
|
|
|
What are some breed predispositions for chronic hepatitis?
|
cocker paniels (male>females)
Labs Bedlington terriers** Doberman pinschers (female>male) Dalmation Westies** standard poodles GSD Scotties Beagles Skye terriers **common |
|
|
What age animals does chonic hepatitis affect?
|
middle aged
|
|
|
Is chronic hepatits more common in dogs or cats?
|
dogs
|
|
|
True or false: One possible etiology of chronic hepatits is immune-mediated
|
true
|
|
|
What breed is predisposed to copper accumulation?
|
Westies
Dobermans Skye terriers English springer spaniel Bedlington |
|
|
Does secondary copper accumulation in dogs with hepatitis potentiate hepatitis?
|
Unsure
|
|
|
Does iron accumulation in dogs with chronic hepatitis cause additional inflammation?
|
Yes
|
|
|
Explain the cycle of fibrosis/cirrhosis
|
inflammatory cells and mediators cause Hepatocellular necrosis and creates dead speace
Liver responds by producing more hepatocytes and biliary duct epithelium Inflammatory cells release proteiases/free radicals and damage ECM and cell membranes Collagen-producing cells are recruited by transforming growth factor Alterations in ECM + collagen = disarray of hepatocytes and altered function Fibrows follows tracts of inflammation and necrosis (starts in portal region but will bridge to central vein) Briding fibrosis = permanent damage = cirrhosis |
|
|
True or false: hepatocellular fibrosis will lead to portal hypotension
|
False: leads to portal hypertension (impede ability of vessels to distend => increased resistance)
|
|
|
Are dogs with elevated portal pressures suscepible to ascites?
|
yes - and hepatic encephalopathy
|
|
|
What type of portal hypertensions are there? (causes)
|
pre-hepatic
intra-hepatic Post-hepatic |
|
|
What does right-sided heart failure lead to in terms of type of portal hypertension
|
Post-hepatic
|
|
|
Which two types of hepatic cuases of portal hypertension will lead to development of acquired collaterals?
|
Pre-hepatic
Intra-hepatic |
|
|
What must the portal pressures be in comparison to systemic pressures be in order for portal collaterals to become patent?
|
Portal pressures must be increased above systemic pressures
|
|
|
List some causes of intra-hepatic disorders of portal hypertension
|
cirrhosis
chronic hepatitis biliar fibrosis |
|
|
List some causes of pre-hepatic disorders of portal hypertension
|
portal vein obstruction (thrombus, invasive neoplasia, fibrosis/structure)
extraluminal neoplasia cyst abscess |
|
|
What are two kown toxins that can lead to hepatic encephalopathy if they are not metabolized by the liver?
|
ammonia and aromatic amino acids
|
|
|
What are some signs of hepatic encephalopathy
|
lethargy, aggression, head pressing, stupor, coma, seizures and death
|
|
|
In the dog, when will the circulation of toxin cross the BBB?
|
portosystemic shunting (acquired or congenital)
|
|
|
Do cats require PSS to get hepatic encephalopathy?
|
nope - hepatic encephalopathy can occur with fasting (arginine deficiency)
|
|
|
What is the most ammoniagenic protein?
|
Blood - GI bleeding can make encephalopathy worse
|
|
|
What acid base disturbance can exacerbate HE by increasing ammonia production and CNS uptake?
|
metabolic alkalosis
|
|
|
What element causes a shift extracellulary in exchange for sodium and hydrogen ions?
|
potassium
|
|
|
Whattype of diuretics are recommended in cases of HE?
|
potassium-sparing aldosterone receptor antagonizing diuretics
|
|
|
With an animal with ascites, do we want to removal all of the ascetic fluid?
|
No, it may exacerbate encephalopathy by activating RAAS
|
|
|
what are some clinical signs of chronic hepatitis?
|
weight loss, anorexia, vomiting, lethargy, PU/PD, weakness and ascites
|
|
|
What breeds of dog can develop cutaneous lesions as a result of chronic hepatitis?
|
Cockers and westies
|
|
|
What are some things you will find on PE of a dog with chronic hepatitis?
|
distended abdomen, poor BCS and icterus (rarely)
|
|
|
What will be on a CBC/chem of a dog with chronic hepatitis?
|
anemia of chronic disease
typically moderate to severe elevations in ALT and moderate elevations in ALP decreased BUN Decreased cholesterol Decreased albumin decreased clotting factors Decreased glucose |
|
|
In an animal with chronic hepatitis, what would be the PT and PTT of an animal with a guarded prognosis?
|
increased
|
|
|
Does chronic hepatitis cause hepatomegaly or microhepatica?
|
Microhepatica
|
|
|
How do you diagnose chronic hepatitis?
|
biopsy (typically surgical or laparoscopic due to size)
|
|
|
Are vacuolar changes common in animals with chronic hepatitis?
|
Yes - due to endogenous corticosteroids
|
|
|
What type of liver tissue is needed for quantification analysis of copper
|
fresh tissues
|
|
|
copper levels greater than ____ warrant treatment
Iron levels greater than _____ may cause inflammation |
2000 ppm
1200 ppm |
|
|
when treating chronic hepatitis, what is the first type of drug we try?
|
glucocorticoids for anti-inflammatory effects
|
|
|
When would you want to avoid glucocorticoids
|
infectious hepatitis
acute hepatitis (will lead to increased mortality) |
|
|
What specific glucocorticoid is provided for cats (dosage)?
|
prednisolone 1-2.2 mg/kg/day
tapered to 0.5-1 mg/kg EOD |
|
|
What liver enzyme should decrease with effective glucocorticoid therapy?
|
ALT
|
|
|
What glucocorticoid is given to dogs that cannot stand the side effects of pred?
|
budesonid
|
|
|
For dogs that fail to respond to glucocorticoids, what drug do we procede onto (dose)?
|
azathioprine 2.2 mg/kg/day for 1 week, followed by 1mg/kg/day EOD for maintenance
|
|
|
Should azothioprine be given to cats who cannot tolerate side effects of prednisolone?
|
NO
|
|
|
What do you need to make sure to monitor while giving azathioprine?
|
CBC and liver enzymes
|
|
|
True or false: you should wear gloves while giving azathioprine
|
True
|
|
|
what does UDA stand for
|
Ursodeoxycholic acid
|
|
|
true or false: UDA is more hydrophobic than other, more toxic bile acids
|
false - more hydrophilic
|
|
|
What is the dose used for UDA
|
15 mg/kg/day or divide
|
|
|
Under what condition is UDA contraindicated?
|
contraindicated in biliary obstruction
|
|
|
what medication is a microtubule assembly inhibitor and used to slow fibrosis in the liver?
|
colchicine**
|
|
|
What is the dose for colchicine
|
0.03mg/kg/day for dogs
|
|
|
What are some drugs thought to decrease fibrosis?
|
corticosteroids
vitamin E silymarin SAMe Azathioprine Penicillamine Zinc |
|
|
What are some antioxidants that we provide animals with chronic hepatitis?
|
Vitamin C
Vitamin E* SAMe* Silymarin( zine N-acetylcysteine UDA |
|
|
What is the dose for Vitamin E?
|
7 IU/kg or 50-400 IU/day
|
|
|
What treatment option is found in normal liver cells and acts as a precursor for cysteine?
|
SAMe
|
|
|
What is a precursor for SAMe?
|
methionine
|
|
|
What does cystein help to form - its helpful to reduce oxidative injury
|
glutathione
|
|
|
What is the dose for SAMe
|
20 mg/kg/day in dogs
|
|
|
what is N-acetylcystein converted to?
|
cysteine and glutathione
|
|
|
What are the ways to administer N-acetylcysteine?
|
orally
IV |
|
|
How do we dose N-acetylcysteine?
|
140mg/kg IV followed by 50-70 mg/kg IV for 7 treatments
Oral: 50-70 mg/kg TID - give once any vomiting has stopped |
|
|
What medication is extracted from fruit of milk thistle
|
Silymarin
|
|
|
What is silymarin's MOA
|
increase superoxide dismutase to act against oxidative damage
|
|
|
What is the dose of silymarin?
|
5mg/kg or 50-250 mg BID
|
|
|
What are the copper chelator medictions and how do they work?
|
D-penicilamine
2,2,2-tetramine They bind up free extracellular copper |
|
|
Which of the copper chelators is first choice?
|
D-penicillamine
|
|
|
What is the component that binds copper and equesters it in teh gut so it can't be absorbed? What drugs utilize this?
|
Metallathoinein
zinc gluconate or acetate |
|
|
When should you give D-penicillamine? Zinc?
|
D-penicillamine: at feeding
Zind: 1 hour before feeding |
|
|
True or false: it is alright to give chelators and zinc at the same time
|
False - chelators bind to zinc
|
|
|
Does zinc address copper that is already present in the liver?
|
No - only used to prevent further accumulation
|
|
|
What is the main treatment plan for HE?
|
reduced protein diet
|
|
|
what is prescribed for ascites in animals with chronic hepatitis?
|
dietary sodium restriction is limited
|
|
|
What type of medications should be used fo GI ulcers?
|
GI protectants (carafate)
H2 antagonists (famotidine, ranitidine) PPIs |
|
|
What type of prognosis do we see with chronic hepatitis?
|
variable - but dogs with clinical signs show progression and death in weeks to months
|
|
|
What breeds carry a poorer prognosis with chronic hepatitis?
|
Doberman, cockers, dalmations
|
|
|
Doberman Pinscher - what is the signalment of most affected dogs?
|
middle-aged females
|
|
|
What type of chronic hepatitis are dobbies prone to?
|
severe forms, cirrhosis and acute decompensation
|
|
|
Is hemorrhage common in dobies with chronic hepatitis?
|
yes
|
|
|
What is the prognosis of dobies that get chronic hepatitis?
|
poor - death often occurs within weeks of diagnosis of symptomatic dogs.
Early diagnosis/therapy has not greatly improved survival times |
|
|
Bedlington terriers area commonly affected breed - what is the supposed reason frot his?
|
autosomal-recessive defect in copper transport proteins (higher hepatcellular accumulation, apoptosis, and inflammation)
|
|
|
What are considered normal copper levels? when do they start to cause problems?
|
<500ppm
>2000 ppm |
|
|
How do we definitively diagnose copper accumulation?
|
biopsy
|
|
|
Bedlington have the genetic component to their chronic hepatitis. Explain the copper levels seen in Heterzygotes and homozygous recessive at 6 and 15 months
|
Heterozygotes:
6 months - higher levels, decrease at 15 months Homozygous recessive 6 months high, even higher at 15 months |
|
|
How do we treat copper accumulation?
|
low copper diets, chelators, and zinc supplementation
|
|
|
How long do we give chelators for?
|
until copper levels drop to <1000ppm
|
|
|
What do we use for maintenance of copper accumulations
|
low copper diet, and zinc supplementation
|
|
|
What breed is more commonly affected with increased hepatic copper levels than any other breed?
|
Westies
|
|
|
true or false: Like other breeds, westies continue to accumulate copper as they age
|
False - westies stop accumulating copper as they age - actually decreases!
|
|
|
What is the average life span of dalmations that are affected with chronic hepatitis?
|
80 days - super short!
|
|
|
How do cocker spaniels with chronic hepatitis typically present?
|
young males, with ascites
|
|
|
What is the life span of an affected cocker spaneil?
|
most die within a month of presentation
|
|
|
What drugs can cause acute or chronic hepatitis?
|
technically, any drug because the liver filters so much blood.
The following cause inflammation: Phenobarbital TMS Diethylcarbamazine osibendale Amiodarone |
|
|
Is lobular dissecting hepatitis common?
|
No - its rare
|
|
|
What is the typical signalment of an animal with lobular dissecting hepatitis?
|
young dogs
possibly elevated copper levels |
|
|
What is the Tx/Px of lobular dissecting hepatitis?
|
Anti-inflammatories, anti-fibrotics, diuretics for ascites, chelators
Prognosis is poor |
|
|
How is granulomatous hepatitis differentiated from chronic hepatitis?
|
preponderance of macrophages
|
|
|
What are some organisms that are associated with granulomatous hepatits?
|
Bacterial: Nocardia, Rhodoccocus, Borrelia, Bartonella, Histoplasma, cocciciodes, Hepatozoonosis, Mycobacterium
Neoplasic: lymphoma histiocytosis lymphangectasia |
|
|
True or false: Many causes of granulomatous hepatitis are idiopathic
|
True
|
|
|
Do we start treatment of granulomatous hepatitis with immunosuppressive drugs?
|
No - only used as a last resort (bacterial components possible)
|
