Clin Med - SA Hepatobiliary 2

drraythe's version from 2016-03-14 21:49

Liver Continued

Question Answer
A Resting Ammonia Concentration test is usually done when & & indicates what?Usually done if there is suspect of hepatic encephalopathy & Indicates reduced hepatic mass or shunting
What additional measurement can you take on the Resting Ammonia Concentration test? What about a challenge test?You can additionally do a post-prandial measurement 6 hours post-meal. A challenge test is NOT RECOMMENDED bc if there is hepatic encephalopathy, the last thing they need is more ammonia & that's what you'd be doing w/ this test-feeding them ammonia
If you are going to do a resting ammonia concentration test, what are some cautions/limitations you must know?Use a green top! Has to be in ICE prior to receiving the sample in it. The machine has to be warmed up 30 min prior to even drawing blood. Blood goes into ice tube & then RUN the tube to the lab, bc the sample is very labile (you must be close to the lab)
What is normal Resting Ammonia Concentration for DOGS? CATS?DOGS: <100 mg/dL
CATS: <90 mg/dL cats
If you're going to do Abdominocentesis, don't...Poke the spleen
When is Abdominocentesis useful, when isn't it usefulGood for DX, rarely therapeutic.
It how much fluid should you consider removing if you are doing an abdominocentesis & why?DONT remove LARGE VOLUMES of fluid-that is still body fluid you are removing. If there is ascites they are probably hypoproteinemic.
If the animal is dyspneic from ascites, what can you do & what else should you consider?Can do a tap (abdominocentesis) just be careful not to cz hypovolemia → consider COLLOID fluids
What are some different types of fluids you can get from an abdominocentesis?Modified transudate, transudate, or rarely exudate if bile peritonitis, neoplastic, or FIP
**There is a table on slide 21. There will be 1 question from this tableLook it over in whole
What color is Pure transudate, what are examples of when this would be in the abdomen?Clear (less than 1500 cells per microliter ↓ protein, ↓ specific gravity) usually from Chronic hepatic failure, ↓ Alb
What color is Modified transudate, what are examples of when this would be in the abdomen?Serosanguinous or amber in color, usually occurs in:
Chronic hepatic failure
Intrahepatic portal hypoplasia
Neoplasia (<7000/μL nucleated cell count, ≥ 2.5 g/dL protein, SG 1.010-1.031)
What does septic exudate look like? When does this usually happen?Can look Cloudy, red, green, dark yellow
Usually happens in... Perforations, bile peritonitis (nuc cell count >7000/μL, protein ≥ 2.5 g/dL, SG 1.020-1.031)
What does non-septic exudate look like? When does this usually happen?Can be `Clear, red, dark yellow, green. Usually happens in...FIP, neoplasia, HAS, early bile peritonitis (nuc cell count >7000/μL, protein ≥ 2.5 g/dL, SG 1.017-1.031)
What does chylous fluid in the abdomen look like? When does this usually happen?Looks White to pink, opaque. Usually happens in....Neoplasia, lymphatic obstruction. (Nuc cell count is 1000-10,000/μL, proteins is 2.5-6.5 g/dL, SG is 1.030-1.032)
What does hemorrhagic fluid look like in the abdomen? When does this usually happen?Red, Neoplasia, HSA (hemangiosarcoma) (nuc cell count is variable, protein is ≥ 3 g/dL, SG is <1.013)
(Prolly not too important) Urine Bile Acids → what does this test look at? How can you remove the factor of urine conc & flow?You can get a good average of biles over time w/ a urine bile acid test. If you look at the UBA:Creatinine ratio, this Removes influence of urine concentration & flow.
Plasma Protein C Activity → what is PPC? What does this test tell you/ ID?PPC is an Anti-coagulant protein which is synth In THE LIVER. It Assesses hepato-portal circulation & can ID PSS (but not end-all-be-all), both congenital & acquired (Improved after Sx repair). May identify intra vs. extra hepatic shunts
What is MVD? How can you differentiate it from PSS?MVD (microvascular dysplasia) is basically a PSS but w/ tons of capillaries, not big vessels. Doing a Plasma Protein C Activity test can differentiate these
Single xtraheaptic congenital shunt in who?YORKIES
If the do is smaller than the litter mates, doesnt grow well, you suspect a shunt but can't find 1 on ultrasound. What is your Ddx? How do you confirm this Ddx?MVD (microvascular dysplasia) is basically a PSS but w/ tons of capillaries, not big vessels. Confirm w/ HISTOPATH bc so many TINY TINY vessels
If liver prob, which 1st-rad or ultrasound?Radiographs before ultrasound!!!!! Rad tells us about SIZE & POSITION. So almost ALWAYS rads before ultrasound
What is radiography good for w/ assessing the liver?Great for assessing SIZE! ( Lateral view). Use the GASTRIC AXIS to determine the size. (Can also tell you about the affect a mass is having on the liver)
Explain how to use gastric axis on a radiograph to determine liver sizeGastric axis (if you drew a line through the stomach length wise) should be approximately parallel to the ribs. If it supersedes this angle or is crossing over the ribs opposite, the liver is too big or small, respectively.
When is the 1 major time you'd do ultrasound before rads?Animals w/ ascites
What are 5 things the Abdominal Ultrasound is super good at evaluating? (liver & related stuff)Animals w/ ascites, looking at Hepatic parenchyma, Gall bladder & bile duct, Portal vein, Shunts—single or multiple (Doppler)
What should you know about lesions & abdominal ultrasound?Ultrasound can LOCATE lesions, but NOT IDENTIFY them (Must have cytology/Histopathology for that)
If you see a super torturous bile duct on ultrasound, what are you thinking?EBDO-extrahepatic bile duct obstruction
Abdominal ultrasound can be used to guide which 2 procedures? (Explain a little about them)(1) FNA-have them be sedated. Can dx Lymphoma, MST, Hepatic Lipidosis (cytology)
(2) Needle biopsy-MUCH bigger needle, so need Heavy sedation/anesthesia (Esp if you can slide a vessel). You will need a Coagulation profile prior & will need to Check later for bleeding just in case
What is a type of Contrast Radiography which you can use to help find shunts? What’s another option for this specific method?Can do Mesenteric portovenography, which is where you inject contrast into mesenteric vasculature-then it should go to the liver-help you find the bypass. You can also do this intraoperatively to make sure you've got it
FNA vs BIOPSY-what diagnostic things can you get from each?FNA = Cytology
BIOPSY = Histopath
Explain trucut biopsyHave a needle w/ a slot for the tissue specimen
Push needle into lesion
Sheath needle to cut specimen into the slot, withdraw needle, sheath & specimen
What can you do w/ an Exploratory Laparotomy/Laparoscopy? NEVER FORGET TO...You can Examine all abdominal organs, Examine gall bladder, Assess common bile duct patency, Culture bile & get wedge biopsies (More accurate Dx that FNA or needle biopsy). NEVER FORGET TO GET A BIOPSY IF YOU'RE GONNA GO IN THERE