11/13 - Liver Infectious and Neoplastic Diseases

Liver

Patients with disease affecting what organ often present with: general malaise, GI signs, melena, icterus, bilirubinuria, hepatic encephalopathy, ascites, coagulopathy, or they can be asymptomatic?

Hepatocellular

What enzyme pattern will have ALT severely elevated and ALKP elevated to a lower degree? This is due to leakage of the enzymes.

Cholestatic

What enzyme pattern will have ALT mildly elevated and ALKP much more severely elevated? This is due to induction of the enzymes.

Function

Low glucose, low BUN, low albumin, low cholesterol, and high total bilirubin can all indicate that liver what is low? Bile acids, ammonia, and PT/PTT are more specific.

Hepatocellular

While endocrine conditions and pancreatitis can cause either liver enzyme pattern, shock, heat stroke, and SIRS will only occur in which pattern? Toxins will also cause this pattern.

Injury

Acute hepatic what will occur alongside severe acute hepatocellular necrosis, can cause acute hepatic failure, and will have normal-enlarged liver size?

Failure

Acute hepatic what will occur alongside AHI leading to failure of liver function, can also involve hepatic encephalopathy, icterus, and elevated PT, and is most commonly seen secondary to toxins, Leptospirosis, and feline hepatic lipidosis? Prognosis is 86% mortality.

Dose-dependent

Will acetaminophen, NSAIDs, TMS, azathioprine, CCNU/Lomustine, diazepam, and similar drugs cause dose-dependent or idiosyncratic liver toxicity?

Idiosyncratic

Will doxycycline, methimazole/azoles in general, phenobarbital, amiodarone, and similar drugs cause dose-dependent or idiosyncratic liver toxicity?

Ultrasound

What diagnostic technique is good for assessing the biliary system, and ruling out biliary obstructions, as well as assessing vasculature? It is not good at diagnosing or differentiating different types of liver disease. Many diseases will look normal on this imaging technique.

Leptospirosis

What bacterial infection of the liver will present with a cholestatic pattern, pulmonary hemorrhages, can be acute or chronic, and is most common in dogs? Diagnosis is with titers, point of care tests, and PCR.

Ascending

What type of infection (ascending or descending) of the liver will present with a cholestatic pattern, signs of infection, can affect dogs or cats, can involve sepsis, and can also have secondary infections to primary liver disease? Diagnosis is with AUS, FNA for culture, and blood cultures if there is Salmonella exposure.

Abscess

A focal what in the liver can present with a hepatocellular pattern, signs of illness, can involve sepsis, can affect dogs or cats, and is often secondary to neoplasia? Diagnosis is with AUS or FNA for culture.

1

What canine adenovirus is the cause of infectious canine hepatitis, and presents with respiratory, ocular, liver, and CNS disease? There will be a hepatocellular pattern, diagnosis is with PCR or ELISA, and treatment is only supportive. Recovery is possible, with no chronic hepatitis.

FIP

What feline viral disease (abbreviated) is easier to diagnose in the wet form than in the dry, and the dry form can mimic chronic liver disease? There will be pyogranulomatous inflammation and FNA or biopsy is required for diagnosis.

P. fastosum

What parasite (species) can infect cat livers, and present with either enzyme pattern? They live in the bile ducts and gallbladder, and can trigger chronic inflammatory disease. They can cause obstruction of the bile ducts and are diagnosed with fecal tests. Treatment is surgical or with praziquantel.

T. gondii

What protozoal parasite (species) presents with a hepatocellular pattern and is rarely seen causing hepatitis in cats? The liver signs are likely due to immunosuppression, but there will also be respiratory, ocular, CNS, and muscle signs. Diagnosis is with cytology or IgG/IgM titers. Treatment is with clindamycin.

Yes

Can vector-borne diseases like Cytauxzoon, Leishmania, Babesia, Bartonella, Borrelia, Ehrlichia, RMSF, and Anaplasma directly infect the liver?

Neoplasia

What type of hepatic disease will often present with asymptomatic presentation, or with often chronic signs of general malaise, GI signs, hemoabdomen, and enlarged liver? Enzyme pattern is variable. They can be diffuse, infiltrative, or nodular, but most are metastatic. On PE you may feel a cranial mass, and biliary ones will show signs of icterus. Chest radiographs are done for diagnosis, along with abdominal ultrasound and FNA or biopsy. Biopsy is most invasive but gives the most information. Definitive treatment is with surgery (solid epithelial ones) or chemotherapy (depending on response). Palliative care is also an option, with steroids/NSAIDs, and supportive care.

Dogs

Which animals are more likely to have liver carcinoma, adenoma, and histiocytic sarcoma? Sarcoma has a high metastatic rate, while carcinoma and adenoma will be solitary masses with low to no metastasis.

Cats

Which animals are more likely to have biliary cystadenoma (solitary, low metastasis), lymphoma, and mast cell tumors (diffuse or solitary)?