Small Ani. Med 2- Canine Liver Dzs 2

wilsbach's version from 2016-02-28 16:10

Chronic Hepatitis/ Copper storage disease/ Non-specific reactive Hepatitis/ Galbladder and biliary duct

Question Answer
what is the typical age affected by chronic hepatitis?adult (average 7 y)
which gender gets chronic hepatitis more?female > male
CSs of chronic hepatitis?non-specific: lethargy, weight loss, anorexia, vomiting, polyuria, (icterus, anemia, ascites)
liver size with chronic hepatitis?variable (pretty sure acute would be large)
which enzyme is higher in chronic hepatitis?ALT > ALP
*Which breed has really high rates of chronic hepatitis? What are possible reasons they are prone?DOBERMANS!!! 75% female dogs-- you will see rapid clinical deterioration. Consider copper storage dz (copper stain), consider Autoimmune disease
Chronic Hepatitis Doberman-- what determines your therapy? possible therapy options?BX!! (bc could be copper storage/ autoimmune etc) UDCA, Prednisolone (OK IN CHRONIC HEPATITIS-- NEVER USE IN ACUTE, bc acute has super high GABA levels causing excessive ACTH stim--> high levels of steroids already), Penicillamine (chelating agent. It works by removing excess copper )
who is this breed who might get chronic hepatitis from copper storage dz?DOBIES
what kinda biopsying is this? When is it appropriate to bx like this? Menghini technique-- Blind biopsy in diffuse disease (done in one hour, can eat right after-- basically just a huge needle)
Copper stain ! ! ! which two stains can you use?H&E, rubeanic acid stain
how does tx differ between CHRONIC hepatitis and COPPER-associated chronic hepatitis (hence you will want to stain to know)Chronic hepatitis= PREDNISOLONE & UDCA !.... Copper-associated chronic hepatitis= PENICILLAMINE & DIET !
what does PENICILLAMINE do? (any side effects?)chelating agent. It works by removing (binds up) excess copper.. Penicillamine is effective in decreasing hepatic copper! SE: Expect vomiting (give with meal)
How high will copper be before you consider therapy, and what do you give to tx?considered storage dx if copper is >400mg/kg. Give Penicillamine (binding agent) and put them on a hepatic diet
TOC for chronic hepatitis? PREDNISOLONE ! (NEVER FOR ACUTE)
TOC for Copper-associated chronic hepatitis?PENICILLAMINE
aside from penicillamine, what other suppliment can you give to a copper storage dz dog?Zinc!
why does ZINC help with COPPER STORAGE DZ?Zn causes Metallothionein induction and MTs bind up excess metals and help prevent toxicity.
Therapy chronic hepatitis WITHOUT copper: 3 things you can give to help?(1) Immunosuppression: Prednisolone. (2) with Severe Cholestasis: Ursodeoxycholic acid. (3) supportive Therapy: Vit K, hepatic diet, Diuretics in Ascites (K+-sparing), Anabolics? SAMe(<---part of vitamin E antioxidant stuff)?
What is Non-specific reactive Hepatitis?non-specific response to a variety of extra-hepatic disease processes (often febrile), Or to residual lesion of previous hepatitis
*where do you histologically see the damage in Non-specific reactive hepatitis?ZONE 1 aka inflammatory infiltrate portal + parenchyma (so like, since it's non-sepcific and not a result of metabolism going on in zone 3, it will obv be in zone 1)
3 main things non-specific reactive hepatitis is reacting to?(1) Pancreatitis (2) Intestinal inflammation (3) parasites
Non-specific reactive Hepatitis-- how are the hepatocytes affected? what does histopath show?******NO hepatocellular necrosis*******, Max. moderate infiltrate of neutrophils in portal areas (inflammation=neutrophils, and also nonspecific= zone 1) also see Kupffer cell proliferation (more inflammatory response, these are macrophages too).
IN CHRONIC Non-specific reactive Hepatitis what will the histopath look like?mononuclear with plasma cells and lymphocytes and pigmented macrophages in portal areas (non-acute is neutrophils/kupffers)
What do you think this is? Inflammatory cell infiltrate= Non-specific reactive Hepatitis (remember zone 1)
what do you think this is? Zone 3 specific damage= HYPOXIA!! (remember zone 3 is last place to get blood so if low in O2 it will not get any)
what is Caroli disease ?Dilated biliary ducts (intra & extrahepatic) & cystic kidneys
what age tends to get caroli dz?young!
Galbladder mucocele happens to what breeds and what age?Cocker Spaniel (they also get acute hepatitis), Mini Schnauzer, collie. adult – old dogs
CSs of gallbladder mucocele?asymptomatic, Lethargy, Abdominal pain, Icterus, Hyperthermia, elevated liver enzymes & bilirubin, Bile peritonitis (ruptured)
dx GB mucocele?Ultrasound, ALP / GGT high
tx GB mucocele?sx
What are the CSs of Hepatocutaneous Syndrome?weight loss, Lethargy, PU/PD, Dermatitis: crusting footpads, external genital, Nose, Non-pruritic, painful
it aint Hepatocutaneous Syndrome unless you see?crusting fotpads/nose (think autoimmune crap)
what 3 dzs are associated with/ trigger hepatocutaneous syndrome?Chronic Hepatitis, Pankreatic Tumor, Glucagon-secreting tumor
age/gender most affected by hepatocutaneous syndrome?Old male dogs
how do you tx hepatocutaneous syndrome?underlying disease, amino acid substitution, high quality Protein Diet, Zinc