Liver Disease Diagnosis

What lab tests are indicated for liver disease?

• Haematology

• Biochem

• Urinalysis

• Coagulation

• Liver function tests

• Peritoneal fluid cytology

What are the two liver enzymes that are hepatocellular markers?

• ALT

• AST

What are the two liver enzymes that are cholestatic markers?

• ALP

• GGT

What tests can be used to assess liver function?

• Serum proteins (esp albumin)

• Glucose, urea cholesterol

• Bilirubin

• (Ammonia)

• Bile acids

Describe the general progression of changes in biochem markers throughout liver disease

• ALT + ALP first to increase

• Bile acids are usually next

  • most sensitive marker of liver function as change earliest

• Reduced albumin and increased bilirubin generally follow next

• Increased clotting times

• In end-stage you start seeing decreased glucose & urea

What diagnostic imaging can be used for liver disease?

• Survey radiographs

• Contrast radiographs

  • Portovenography

• US

What is portovenography?

• Technique to diagnose PSS

  • Mostly replaced by US now

• Inject contrast agent into intestinal vessels and then evaluate on radiograph to see where portal vein goes

What in the liver can be assessed on US?

• Size

• Heterogenous parenchymal disease

• Biliary obstruction

• Biliary calculi

• Masses

• Vasculature

  • PSS

  • Arteriovenous fistulas

What is the only way to definitively diagnose most liver conditions?

Liver biopsy

What are the indications for liver biopsy?

• Persistent increases in liver enzymes

• Altered liver size

• Monitoring progressive liver disease

• To evaluate response to treatment

What should you always do before performing a liver biopsy?

• Check clotting profile

What are the liver biopsy techniques?

• Percutaneous

  • Blind

  • US guided- Tru-cut

• Laparoscopy

• Coeliotomy

What are the contraindications for percutaneous biopsy technique?

• Lack of operator experience

• Small liver, unless ultrasound available

• Focal disease

• Extrahepatic cholestasis

• Bleeding disorder

• Severe anaemia

Uncommon disease seen in young dogs

• GSD, Rottweiler

Pathology

• Progressive fibrosis

• Minimal inflammatory reaction

• Central vein fibrosis & occlusion most common

What is the condition?

• Juvenile hepatic fibrosis

What is this showing?

What do they develop secondary to?

• Acquired shunts (usually multiple)

  • Shunts developing from redudnat vessels between portal vein and CVC

• 2° to juvenile fibrosis or cirrhosis

What are the different causes of canine chronic hepatitis?

• Idiopathic chronic hepatitis

• Lobular dissecting hepatitis

• Drug-induced chronic hepatitis

• Cu- associated hepatitis

All may lead to cirrhosis

What is this showing?

• Cirrhosis

  • End stage of many diseases

  • Shrunken liver from fibrosis

    • Micro or macro nodular regeneration

Condition which often have no clinical signs or signs like PSS

Affects small terrier breeds and causes an increase in bile acids

What is the condition?

Hepatic portal hypoplasia

What are the two presentations of feline cholangitis complex on histology?

• Suppurative cholangitis

• Lymphocytic cholangitis

What is this showing? What does it lead to?

Idiopathic hepatic lipidosis

Leads to:

• Biliary stasis

• Liver failure

• Anorexia

• Death

List the primary neoplasia of the liver

• Hepatocytes

  • Hepatocellular carcinoma

  • Hepatoma

• Biliary

  • Cholangiocarcinoma

• Connective tissue

  • Fibroma / sarcoma

  • Haemangioma / haemangiosarcoma