Diagnostics of liver and pancreas diseases

Liver function

Carbohydrate metabolism

Lipid metabolism

Protein metabolism

Storage of vitamin reserves: A, D, and B12, as well as iron.

Detoxification functions

heme transformation (bilirubin)

• Bile production

Immunologic functions

Clinical examination of the liver is conducted through

-Inspection of the liver area.

Palpation of the liver area.

Percussion of this area.

Ultrasonography of the organ.

Liver biopsy, often under ultrasound guidance.

Biochemical and functional tests that determine the organ's function.

X-ray of the abdominal cavity

Dog Liver

Along the posterior border of the lungs

7-9 ics on the left side

7-12 ics right side

Palpation of the live

dog liver LHS

7-9 ics left side

dog liver rhs

7-12 ics on the right side

Horse Liver loct

all located in the dome of the diaphragm

supression of horse liver

The entire liver lies in the dome of the diaphragm and is covered by the lungs, so there is no absolute suppression associated with this organ.

liver enlargment of horse- supression

suppression 10-17 ics right side and 8-10 ics left side

A suppressed bulge always indicates

enlargement of this organ

• - degeneration, abscesses, swelling and cancer. A significantly enlarged liver causes this suppression from 10 17 ics

If the liver is very enlarged, it may cause

bilateral bulging of the retrocostal area.

. A significantly enlarged liver causes this suppression from (horse)

10 17 ics

Cattle liver- supression

Liver suppression 10-12 ics right side (first line of lung percussion)

Enlargement of suppression due to

(ketosis, leukemia, fat cow syndrome, liver abscesses, parasites

Decreased suppression

high gestation, ruminal overload, ruminal bloating, atrophic cirrhosis

cattle liver- hepatic supression

occurs here on the right side from 10 - 12 ics, in the 1st lung percussion line.

what shifts the posterior limit of suppression by 2-3 cm

fasting or diarrhea

An increase in bilirubune occurs in

hemolytic, mechanical and parenchymal jaundice.

Albumins and total protein – decrease in

liver failure

Severe liver failure causes a decrease in

urea

Severe liver failure causes a increase in

ammonia

in severe liver faulire and decrease in urea and increase in ammonia results in

hepatic encephalopathy

Increased free bilirubin concentration

strong hemolysis of blood cells

Increased concentration of free and conjugated bilirubin

parenchymal and mechanical jaundice

The presence of bound bilirubin in the body is accompanied

by bilirubin in the urine, as well as a decrease in the level of stercobilinogen and urobilinogen

Total protein - lowering

• excessive loss of protein by the kidneys (e.g. in the course of glomerulonephritis, diabetic nephropathy, renal amyloidosis, etc.)

• excessive loss of protein through the digestive tract (e.g. inflammation of the digestive tract, digestive tract cancer, diverticulosis, etc.)

• excessive loss of protein through the skin (e.g. extensive burns, psoriasis, pemphigus)

• large hemorrhages

• sepsis

• extensive injuries

• advanced cancer diseases

• inhibition of protein synthesis in the liver (e.g. toxic liver injury, liver cirrhosis)

• protein absorption disorders in the intestine (e.g. malabsorption syndromes after removal of part of the intestine, severe diarrhea)

• protein deficiency in the diet

• overhydration

Total protein - increase

multiple myeloma

Waldenstrom's disease

heavy chain disease

other rare diseases of the lymphatic system

in chronic inflammation

in autoimmune diseases (e.g. systemic lupus erythematosus, rheumatoid arthritis and others)

in liver diseases (e.g. cirrhosis, chronic hepatitis)

Anincrease in total cholesterol occurs in:

• kidney failure

• nephrotic syndrome

• hypothyroidism

• bile stasis (cholestasis)

• Excess total cholesterol may also result from an inherited liver disease hyperlipoproteinemia, which involves too much cholesterol production

A drop in total cholesterol below the norm is caused by

• cirrhosis

• acute liver necrosis

• toxic liver damage

• infectious liver damage

• fasting

• sepsis

• anemia

• hyperthyroidism

An increase in aminotransferase is observed in the following liver diseases:

acute and chronic hepatitis, damage by drugs and toxins, autoimmune hepatitis, cirrhosis, hemochromatosis

An increase in aspartate aminontraspherase is also observed in non-hepatic diseases, such as:

hemolysis, i.e. breakdown of erythrocytes, muscle diseases, thyroid diseases, and intense physical exercise

In the diagnosis of liver diseases, the determination of aminotransferase is used primarily in the diagnosis and monitoring of the course of

acute viral hepatitis, chronic hepatitis of viral and autoimmune etiology, and metabolic diseases.

AspAT- Activity increase to 200 U/I

• Cirrhosis • Inflammation of the pancreas • Haemolysis

AspAT- Activity increase 200-400 U/I

• Skeletal muscle diseases (Se and vitamin E deficiency) • Chronic hepatitis • Surgical procedures • Parasites

AspAT- Activity increase 400-4000 U/I

• Myocardial infarction • Viral hepatitis • Toxic liver damage • cancer

AspAT levels

Horses 205-555 U/I

Cattle 58-100 U/I

Dogs 1-37 U/I

Cats 6-44 U/I

ALAT increase

hepatic cholestasis, i.e. blocking the secretion or flow of bile.

liver cirrhosis - parallel elevated AST values

heart attack - significantly higher AST values

inflammation of the pancreas

hemolysis

damage to skeletal muscles (such as crushing limbs, other injuries, myositis, less frequently muscular dystrophy (muscle wasting), intense, strenuous physical activity, strength training) may also lead to an increase in ALAT.

viral hepatitis

toxic liver damage

circulatory failure

hypoxia (oxygen deficiency in tissues)

increase of ALAT observed w use of drugs

during treatment with high doses of salicylates and long-term administration of fibrates and first-generation sulfonylureas

ALT- Activity increase to 200 U/I

• Liver cancer • Inflammation of the pancreas • Haemolysis

ALT- Activity increase 200-400 U/I

• Hepatic cholestasis • Cirrhosis

ALT- Activity increase 400-4000 U/L

• Viral hepatitis • Toxic liver damage • Circulatory failure

ALT

Horse 3-25 U/I

Cattle 25-74 U/I

Dog 3-50 U/I

Cat 20-107 U/I

where is large amt of ALP found in

hepatocytes, renal tubules and intestinal epithelial cells.

wjere is ALP excreted into

into the bile, therefore its concentration increases when the outflow of bile from the liver to the intestines is obstructed (in the case of obstruction of the bile ducts caused by stones or cancer)

why dose conc od ALP increase when outflow of bile from liver to intestines obstructed

This enzyme is excreted into the bile, therefore its concentration increases when the outflow of bile from the liver to the intestines is obstructed (in the case of obstruction of the bile ducts caused by stones or cancer).

increased alkaline phosphatase levels

rickets, osteomalacia- softening of bones due to loss of calcium and phosphorus

cancer, among others duodenum, liver and bile ducts.

vitamin D deficiency

calcium and phosphorus deficiency in the diet

kidney disease

intra- and extrahepatic cholestasis

secondary hyperparathyroidism associated with impaired vitamin D metabolism

long-term treatment with furosemide

A decrease in alkaline phosphatase (ALP) concentration means

means hypophosphataenia- lack of proper calcium deposition in bones and bone growth disorders- cretinism, ascorbic acid deficiency, achondroplasia

ALP levels

Horse 109-315 U/I Cattle 41-116 U/I Dog 20-155 U/I cat 23-107 U/

increase in GGT

• cholestasis (bile stasis), • damage to hepatocytes for various reasons, • diseases with infiltration of the liver parenchyma. • the use of certain medications

LDH (lactate dehydrogenase) found in

This enzyme is found in all cells of the body, including red blood cells.

Increased breakdown of blood cells (haemolytic anemia)

= increase in the release of both this enzyme and hemoglobin

= leads to the accumulation of bilirubin (so-called pre hepatic jaundice).

LDH increase also occurs with

• Pneumonia • Leukemia • Long-term stress • Skeletal muscle diseases

LDH levels

Koń 520-1480 U/I Bydło 2666-4293 U/I Pies 105-1683 U/I Kot 161-1051 U/I

exocrine function of pancreas

produce digestive enzymes.

• proteolytic enzymes (protein digestion): trypsin, chymotrypsin, carboxypeptidase A and B and elastase.

• lipolytic enzymes (fat digestion): lipase, phospholipase and esterase

• glycolytic enzyme (sugar digestion) α-amylase

• nucleolytic enzymes– ribonuclease and deoxyribonucleas

is pancreas palpable

nnoooooooooooooooo

(palpable only when significantly enlarged and hardened

Diagnostics of exocrine pancreatic insufficiency-

stool examination for the presence of food residues

Pancreatic diseases in cattle and horses

Rarely diagnosed

Infectious diseases of the pancreas

intermittent diabetes (tuberculosis, foot-and-mouth disease, BVD-MD, nephritis) - infectious and autoimmune mechanisms may damage pancreatic β-cells

chronic pancreaitis in horses

present with symptoms of polyuria and polydipsia, weight loss, hyperglycemia and glycosuria accompanied by hypoinsulinemia.

Metabolic syndrome in horses is diagnosed based on

presence of insulin resistance (IR), obesity, local fat deposition and previous or current laminitis

Metabolic syndrome most often occurs in wjat breeds

ponies, Morgan horses, Paso Finos and Norwegian Fjords

Metabolic syndrome rarely occurs in wjat breeds

purebred Arabian horses

quarter horses

saddlebreads

Tennessee walking horses

Thoroughbred horses and trotters.

The diagnosis of pancreatitis in a dog is based on

abdominal ultrasound and blood tests, which reveal an increased level of dog-specific pancreatic lipase (cPLI)

Predisposing factors to pancreaitis

• genetic predispositions,

• obesity,

• use of drugs and toxins,

• other diseases, e.g. hypothyroidism,

• poor nutrition, especially high-fat diets,

• little physical activity.

• Feeding your dog the so-called leftovers from home-cooked meals, as well as snacks such as chips or cookies.

• They contain large amounts of salt and sugar, which disturbs the proper functioning of the digestive system and stimulates the body to work excessively. As a result, an incorrect diet leads to the development of pancreatic diseases.

symptoms

non specfifc

• lack of appetite, • vomiting, • abdominal pain, • weakness and diarrhea

in whihc animals are the symptoms of pancreatis less pronounced

In cats, the symptoms are even less pronounced than in dogs.

For this reason, pancreatitis should always be on the list of differential diagnoses for gastrointestinal disorders.

Stool examination for the presence of food remains

detection of

fat

starch

striated muscles

Radiographic film test

Fat detection

- dilute feces with water, add Sudan III solution orange balls in the presence of fat

Detection of starch

stool smear, spot Lugol's iodine - dark blue starch grains - deficiency of carbohydrate-digesting enzymes

Detection of striated muscles

dilute feces in 10% vinegar clearly striated fibers - trypsin deficiency

Radiographic film test (so-called film test)

The stool is mixed with a 5% sodium bicarbonate solutio

a strip of previously developed X-ray film is placed in such a suspension

If the proteolytic activity of the stool enzymes is appropriate, the blackened X-ray film will become clear.

However, in the case of ZNT and low enzymatic activity, the film will not discolor.

Radiographic film test (so-called film test)- when will the film not discolour

, in the case of ZNT and low enzymatic (proteolytic) activity, the film will not discolor.

Pancreatic insufficiency (exocrine) symptoms:

• feeling of fullness in the abdomen,

• nausea,

• vomiting,

• abdominal pain or epigastric pain,

• repeated diarrhea (intestinal contents contain an increased amount of fats and undigested nutrients),

• steatorrhea and fat in the stool (the result of difficult fat digestion due to pancreatic lipase deficiency),

• indigestion,

• digestive disorders,

• disturbances in the absorption of nutrients, especially fats

Amylase and lipase activity testing

• Not very specific test (change in enzyme activity in kidney, intestinal and liver diseases)

• The dog's activity increased by 3-5 times, accompanied by symptoms - pancreatitis

• In cats, the test is not very diagnostic

amylase levels

Horse < 30U/I

Cattle 30-38 U/I

Dog 388-1800 U/I

Cat 433-1248 U/I

lipase levels

Horse 460-870 U/I Cattle 32-198 U/I Dog 268-1769 U/I Cat 157- 1715 U/I

Testing for trypsin-like immunoreactivity. TLI test

a species-specific test is used to qualitatively determine trypsinogen and trypsin in serum.

• TLI is an immunological test that determines the concentration of trypsinogen that entered the blood directly from the pancreas.

• Physiologically low concentration in animals

• Reduction even to 0 in cases of exocrine pancreatic insufficiency

• Increase on inflammation

Testing the specific activity of dog and feline pancreatic lipase (cPLI and fPLI test)

The test is very sensitive to the quantitative and qualitative determination of specific pancreatic lipase in plasma

• Quantitative assessment - specialized laboratories

• Qualitative assessment - SNAP tests (test based on the ELISA method)

• The result is marked as “positive” or “negative”, depending on the level of specific pancreatic lipase in the patient

Spleen role

important role in the body as a blood store and an important element shaping the body's immunity

spleen horse loct

e left side of the abdominal cavity, directly behind the percussion field of the lungs.

The posterior border of the spleen runs parallel to the costal arch, adjacent to the abdominal wall, and the upper border touches the left kidney. We can assess its posterior edge by rectal examination.

can spleen be asses during rectal exam

We can assess its posterior edge by rectal examination.

can spleen of cattle be examined

he spleen in cattle is not accessible for examination either by rectum or by percussion. If it is significantly enlarged (leukemia, cancer), it can be confirmed by tapping along the posterior border of the rumen.

can spleen be exmained in small animals

n small animals, the normal spleen is not available for clinical examination. If it is greatly enlarged, it may protrude beyond the costal arch, especially in the lower part of the abdomen

• To assess the spleen

imaging tests: ultrasound, X-ray