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what are the most common signs associated with feline hepatobiliary disease?
jaundice and hepatomegaly
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what are the four most diseases associated with jaundice cat?
- hepatic lipidosis (#1)
- cholangitis/cholangiohepatitis (#2)
- FIP
- lymphoma
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how does prolonged anorexia lead to hepatic lipidosis?
increased lipolysis -->hepatocyte triglyceride accumulation (fat builds in liver) -> intrahepatic cholestasis -> liver failure and fatal without tx
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Is hepatic lipidosis more often primary or secondary?
primary (idiopathic)
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what is the connection between obese cats and hepatic lipidosis?
obese not able to convert fat to energy during starvation/catabolic state
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what are some causes of anorexia that leads to hepatic lipidosis?
- stressful event (diet change, change in environment)
- non-hepatic illness like IBD, cholangitis, pancreatitis
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what is signalment of hepatic lipidosis patient?
- middle aged adult cat
- median 7yr; no gender/breed predilection
- obese (median BW = 10lb)
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what are some major signs associated with HL?
- anorexia (>2wks)
- recent wt loss; muscle wasting, weakness
- depression, lethargy
- vomiting (38%)
- bleeding disorders (20%)
- jaundice (70%)
- hepatic encephalopathy
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what are two common differentials for ventral flexon of the neck in a cat?
hypokalemia due renal failure or hepatic lipidosis
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what are expected chemistry panel findings with HL?
- *elevated liver enzymes but normal GGT*
- hypoalbuminemia, decreased BUN
- low K, Mg, P
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what would rads reveal with HL?
hepatomegaly (can alter gastric axis)
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what diagnostic should be done before doing an FNA in suspected HL patient?
check coagulation times (APTT, OSPT)
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can a cytology be diagnostic of HL?
- yes IF cytology findings coincide with expected history/clinical signs
- (vacuolated/foamy hepatocytes + anorexia/wt loss,etc)
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what is hallmark of tx for HL? what are the best methods for accomplishing this?
- prolonged aggressive nutritional support
- -esophagostomy tube or PEG tube
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How do you handle treatment for a HL patient that is vomiting?
trickly feeding or CRI of metaclopramide
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what are two examples of hepatoprotectants that can aid in tx of HL?
- SAMe/Denosyl (S-adenosyl methionine)
- Vit E
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What is prognosis for cat with HL?
good if primary form and treatment is LONG TERM - don't pull feeding tube too soon
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Are cats more likely to get hepatic disease related to the cells or the bile system (so hepatocyte or hepatobiliary disease)? what is an exception to this rule?
- cats usually get hepatobiliary
- *exception is hepatic lipidosis
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Does the cat more consistently have a major or minor duodenal papilla? what is its role?
- cats have major duodenal papilla - connects common bile duct and major pancreatic duct to duodenum
- (minor often absent in cats but is primary output for pancreatic secretion in dogs)
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how does the hepatobiliary system get diseased in cats?
- ascending bacteria from duodenum up
- ascending digestive enzymes from subclinical pancreatitis
- *triaditis* - concurrent lesions in duodenum, pancreas, & biliary tract
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With cholangitis/cholangiohepatitis, what is the major infiltrate associated with suppurative form? what about non suppurative?
- suppurative - neutrophils
- non - lymphoplasmacytic; immune mediated (can progress to suppurative)
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what are some concurrent diseases that can be associated with either suppurative/non-suppurative cholangitis?
IBD, pancreatitis
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is immune mediated cholangitis associated w/acute or chronic form?
chronic
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what are the components of triaditis?
- cholangitis
- pancreatitis (often secondary)
- IBD
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with neutrophilic cholangitis, both acute and chronic can present w/icterus, vomiting, anorexia, and lethargy. Which is specifically associated with fever? what about diarrhea? abdominal pain?
- acute- fever; abdominal pain
- chronic- diarrhea
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with neutrophilic cholangitis, is acute or chronic more likely to happen in middle aged cats?
- chronic- middle aged/older
- acute - younger at risk
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what is end stage sign of chronic neutrophilic cholangitis?
ascites, coagulopathy, encephalopathy
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what are expected liver enzyme levels with neutrophilic cholangitis?
- elevated ALT, AlkP, and *GGT*
- (elevated GGT helps you think its NOT hepatic lipidosis)
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what is expected level of globulins and albumin with chronic cholangitis?
- hypOalbuminemia
- hypERglobulinemia
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why is there often a vitamin K responsive coagulopathy associated w/chronic cholangitis?
- vit K not being absorbed from GI since poor bile flow (fat soluble)
- also poor liver function once chronic
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is liver cytology enough to diagnose cholangitis? what about biopsies of intestine?
- *no*, although helpful with hepatic lipidosis, biopsy required for cholangitis
- intestinal biopsies *not* usu. helpful bc you won't know if the inflamm. is due to cholangitis or IBD or both
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is ultrasound helpful in diagnosing cholangitis?
- yes, US can identify destructive biliary disease (and guide biopsy)
- bacterial culture also helpful
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can you administer antibiotics for tx of cholangitis without biopsy to confirm diagnosis? when you decide to give Abs, what will you give and for how long?
- yes, ok to start Abs even w/o biopsy (cytology negative for HL/lymphoma)
- -clavamox, amoxicillin, metronidazole, cephalosporins for 6-8wks
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is ursodiol indicated for treating cholangitis?
- yes, hepatoprotective (antiinflamm., immunomodulator, antifibrotic)
- Vit. E or SAMe also options
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is it indicated to give steroids to chronic cholangitis patient?
can try steroids even w/o biopsy if 6-8wk Antibiotic trial didn't work
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what vitamins should be supplemented when treating chronic cholangitis? what fluid therapy would you choose?
- vitamin K and B12 (if concurrent IBD, not absorbing cobalamine)
- fluids with KCl
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can cholangitis be cured with these treatments?
- typically goal is to manage long term, not cure
- but occasionally cat will acute case can be cured w/Abs
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is neoplasia in the cat's liver usually primary or secondary?
- secondary/metastatic more common
- (if primary, likely carcinoma)
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what is an ultrasound finding that is consistent with neoplasia?
target lesions (esp. indicative of metastasis) - get biopsy/cytology
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what is the significance of biliary cyst adenoma?
- benign (won't spread) but can get large enough to incr. liver values
- biopsy to diagnose; may req' surgical removal
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What can cause intraluminal obstructive lesions?
- inspissated bile
- stones
- liver flukes
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what can cause extraluminal obstructive lesions?
- stricture
- neoplasia (pancreatic, duodenum, biliary)
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what is the best diagnostic tool for diagnosing extrahepatic obstruction?
- ultrasound
- (will show dilations of GB or bile duct; hepatomegaly)
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what is treatment for extrahepatic obstruction?
combo of surgical and medical approach = stabilize with fluids then sx to relieve obstruction + cholecystojejunostomy/duodenostomy + biopsies
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are cats who have PSS usual congenital or acquired? intra or extrahepatic? single or multiple shunts?
congenital single extrahepatic (same w/small breed dogs)
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what type of stone is associated with PSS? what are some another findings associated w/PSS?
- urates
- ptyalism and hepatic encephalopathy (esp. after eating)
- copper colored irises in cats
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will liver w/PSS be large or small? will kidneys be large or small?
- small liver (microhepatica seen on rads)
- large kidneys
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how will PSS affect the patient undergoing anesthesia?
prolonged recovery
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what will bilirubin value like be with PSS?
normal, so not jaundiced
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what will bile acid values be like with PSS?
markedly elevated (often >100)
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what are liver enzymes like with PSS?
normal to mildly increased
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young + normal ALT + elevated bile acids = what diagnosis is most likely?
PSS
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what is the problem w/giving diazepam to cats?
could cause fulminate liver failure
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with acute liver toxicosis, what are liver enzymes like and is liver large/small/normal?
- markedly elevated ALT/AST
- normal sized, normal echogenicity
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