Liver pathology 2

Question	Answer
What colour top should you use for haematology? Biochemistry?	purple top red top
What are the three leakage enzymes? why are they called leakage enzymes? How long does it take them to appear?	ALT, AST, GLDH leak from cells when cells damaged seen in serum within hours of damage
What are the two induction enzymes? Why are they called induction enzymes? How long does it take them to appear?	ALP, GGT made by cells in response to cell damage days
What kind of enzyme is ALT What does an increase in ALT mean? when does increase occur?	Liver specific leakage enzyme Acute hepatocellular damage <12 hours after damage
How do you interpret ALT Mild increase Marked increase (400)	-may be underlying cause, not just primary liver dz- liver neoplasia, endocrine disease, pancreatitis, aenamia, dehydration -infection, toxin, trauma
What kind of enzyme is AST? what does an increase in AST mean?	non liver specific leakage enzyme Acute hepatocellular damage or muscle injury
To interpret what an increase in AST is due to, what do you need to know?	CK
What kind of enzyme is GLDH? What does an increase mean?	liver specfic leakage enzyme acute hepatocellular injury
What kind of enzyme is ALP? what may an increase in ALP indicate? when would you see an increase in ALP?	non specific induction enzyme Choleostasis, bone disease, young growing animal, chronic stress, steroids tx 1-2 days after damage
Why is ALP difficult to interpret?	Multiple different ALP isoforms- hepatic isoform Bone isoform Corticosteroids isoform routine blood testing does not distinguish between the different isotopes
What kind of enzyme is GGT? what does an increase indicate?	fairly liver specific induction enzyme of largies Choleostasis, corticosteroids, colostrum
What may cause an increase in GGT in largies (specific diseases)	facial eczema ragwart liver fluke colostrum intake
What do liver function tests evaluate?	The livers ability to perform normal functions measure serum levels of compounds that are normally removed or made by the liver
What level must serum bilirubin be at before you see jaundice?	50 micromols/L
What are the 5 causes of hyperbilirubinaemia?	fasting pre hepatic-haemolytic hepatic post hepatic- Choleostatic sepsis
When may fasting hyperbilirubinaemia occur? Who does it affect? How severe is it/do you see jaundice?	After a period of anorexia- decreased uptake of bilirubin by hepatocytes Horses mild- no jaundice
When may pre-hepatic hyperbilirubinaemia occur? How severe is it/do you see jaundice?	Animals with haemolytic anaemia -IMHA, lepto pomona, paracetemol marked- with jaundice
When may you see hepatic hyperbilirubinaemia? How severe is it/do you see jaundice?	Animals with significant liver disease- impaired bilirubin uptake Often mild with variable jaundice
What may cause post hepatic hyperbilirubinaemia? How severe is it/ do you see jaundice?	Animals with choleostasis- bile is regurgitate back into circulation marked with jaundice
What may cause septic hyperbilirubinaemia? what animal does it affect?	severe bacterial septicemia- increased inflam mediators reduce bilirubin transport into the liver, get decreased bilirubin excretion dogs
In which species is seeing hyperbilirubinaemia and bilirubinuira significant? what does it suggest?	cats significant hepatobiliary disease and cholestasis
Is seeing bilirubinuria significant in dogs? why?	No low renal threshold for bilirubin so can pass out easily
Describe entero-heptic re circulation of bile acids	Bile acids made in liver- excreted into intestine- re-absorbed into portal vein- re-circulated back to liver- removed from blood in liver- reused to make more bile
What may cause an increase in serum BA's	1. decreased BA clearance from portal blood- PPS, severe liver damage 2. Decreased BA excretion- cholestasis
Explain portosystemic shunt	Where the portal vein does not carry blood back to the liver and shunts the blood straight into the circulation
When and when not should BA levels be tested?	DO- liver disease suspected but routine biochemistry results equivocal Don't- you have ruled out non hepatobiliary causes and animal has jaundice- BA gives no additional info
How do you test Bile acids?	Need 2 samples -pre-prandial serum sample (after 12 hour fast) -post-prandial serum sample (2 hours after eating)
How do you interpret a BA test?	pre-prandial low and post prandial mildly increased = normal Pre prandial increased and post prandial markedly increased =abnormal
What does it mean if BAs are increased?	Damaged liver PSS Choleostasis
What are some compounds the liver usually makes	albumin urea cholesterol glucose coagulation factors
Do you see low albumin in acute or chronic liver disease? why?	chronic long 1/2 life
What CS might you expect to see 2ndary to hypoalbuminaemia?	oedema- mostly ascites
In what animal won't you see low albumin in chronic renal failure?	Horses
Why do you get decreased urea in liver failure?	Liver normally converts ammonia into urea, can't do this if there is significant loss of liver function
What are the two things may you see in terms of cholesterol and liver failure? why?	hypocholsteraemia-Decreased cholesterol synthesis by liver Normal cholesterol- because biliary excretion of cholesterol also decresed cholesterol appears normal or even increased
What may you see in terms of glucose and liver failure?	Hypoglycaemia- decreased liver synthesis by liver Normal or hyperglycaemia- decreased glucose uptake by liver post eating
What may you see in terms of clotting factors with liver failure?	reduced production of clotting factors -increased coagulation times- APTT, ACT, PT -2dry haemostasis effects- bleeding into joints, cavities, muscles
Besides bloods, what are some other methods to sample the liver?	Cytology Histology PM
Name some advantages and disadvantages ofdoing a FNA for cytology	-good for diffuse dz process -cheap, quick, patient conscious -less diagnostic than histology -individual cells- no architecture, can miss if a focal lesion
What are some advantages and disadvantages of doing a liver biopsy for histology	-good for focal or diffuse lesions more diagnostic then cytology- tissue architecture + cells -slower, expensive, GA needed
If taking a PM liver sample, how thick should the sample be and what is the ration of tissue: formulin	<1cm 1:10

Next up

Description

Resource summary

Similar

	Created by Hayley Pfeffer over 8 years ago