Liver Disease Diagnosis Quiz

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Questions and Answers

What are the possible causes of liver dysfunction mentioned?

Septic cholangitis, hepatitis A, iron toxicity

Cholelithiasis, hepatotoxicity, neoplasia, viral infections (correct)

Cholelithiasis, cholestasis, immune-mediated diseases

Hepatotoxicity, septic cholangitis, viral infections

Which of the following is considered a toxic substance that could cause liver damage?

Epicarp toxins

Pyrrolizidine alkaloids (correct)

Benzodiazepines

Corticosteroids

Which virus is associated with equine liver health and liver enzyme levels?

Equine Hepacivirus (correct)

Equine Coronavirus

Equine Influenza Virus

Equine Rhinovirus

What is a challenge associated with diagnosing liver fluke infections?

Non-patent detection of eggs in feces Signup and view all the answers

What is the role of hepatic ultrasound in diagnosing liver disease?

It can help identify biopsy sites and assess risks. Signup and view all the answers

Which of the following is a known infectious disease that can affect the liver?

Fasciola hepatica Signup and view all the answers

Which type of assays have poor diagnostic value for liver fluke infections?

Copantigen assays Signup and view all the answers

What is the significance of elevated GGT and GLDH levels?

They suggest potential liver dysfunction. Signup and view all the answers

What is a common problem with serologic assays related to liver disease?

Variable reliability Signup and view all the answers

Which of the following statements about liver disease diagnosis is true?

Most horses with liver disease have unremarkable hepatic images. Signup and view all the answers

What is the first step in the biopsy procedure?

Sedate Signup and view all the answers

Which of the following findings can indicate specific aetiology in liver biopsies?

Pyrrolizidine alkaloids Signup and view all the answers

What is the main purpose of taking a liver biopsy?

To confirm liver disease is definitely present Signup and view all the answers

Which step in the biopsy procedure comes after inserting the biopsy instrument?

Operate biopsy instrument Signup and view all the answers

How do liver biopsy findings help guide therapy?

By indicating prognosis Signup and view all the answers

Which of the following accurately describes an obligation after obtaining a liver biopsy?

Place the biopsy into formalin/plain tubes Signup and view all the answers

What does the term 'haemosiderin accumulation' refer to in liver biopsies?

Iron overload in liver tissues Signup and view all the answers

What is a probable outcome if severe fibrosis is identified in a liver biopsy?

Irreversible damage to the liver Signup and view all the answers

What is a common clinical sign associated with hepatic insufficiency in horses?

Inappetance Signup and view all the answers

What diagnostic method is typically necessary to fully investigate a case of liver disease in horses?

Liver biopsy Signup and view all the answers

Which of the following is NOT a neurotoxic product associated with equine hepatic insufficiency?

Bilirubin Signup and view all the answers

What is the most likely prognosis if more than 70% of the functional liver mass is affected?

Poor prognosis Signup and view all the answers

Which of the following therapeutic options may be considered for a horse with liver disease?

Antimicrobials Signup and view all the answers

Which condition is NOT typically a common presentation in horses suffering from liver disease?

Euphoria Signup and view all the answers

What is indicated by persistent increases in liver enzymes in horses?

Subclinical liver disease Signup and view all the answers

In diagnosing equine liver disease, what could epidemiologic clues indicate?

Hepatotoxicity or infection Signup and view all the answers

Study Notes

Equine Liver Disease

Investigating equine liver disease is presented by Andy E Durham, Liphook Equine Hospital, UK.
Learning objectives include recognizing presentations, clinical signs, diagnostic approaches, prognostic indicators, and therapeutic options for treating horses with liver disease.

Key Points

Differentiating hepatic disease from hepatic insufficiency is important.
Subclinical liver disease frequently affects horses.
Elevated liver enzymes are common in horses.
Outbreaks of subclinical liver disease are prevalent.
Liver biopsy is often necessary to investigate liver disease fully.

Clinical Signs of Hepatic Insufficiency

Lethargy and lack of appetite
Weight loss
Colic
Photosensitivity
Encephalopathy
Diarrhea
Jaundice
Edema
Coagulopathy

Clinical Signs of Hepatic Encephalopathy

Depression
Circling
Aimless wandering
Head pressing
Blindness
Yawning
Coma
Bilateral laryngeal paralysis

Pathophysiology of Hepatic Encephalopathy

Neurotoxic substances from the gut cause issues.
Ammonia, glutamine, osmotic astrocyte/neuron swelling, and mercaptans/phenols contribute to this.
Neurotransmitters are impacted (e.g., reduced excitatory dopamine, increased inhibitory GABA).
Endogenous benzodiazepine-like substances increase in concentrations.
Other factors such as hypoxia, electrolyte imbalances, acid-base problems, and hypoglycemia play a role.

Clinical Signs - Hepatic Insufficiency

Assessing if over 70% of the functional liver mass is affected determines prognosis and suggests biopsy is more risky and adverse outcomes are likely.

Clinical Signs - Subclinical/Mild

If less than 70% of the functional liver mass is affected, the outlook for the horse is better and biopsy is generally deemed safe.

Clinical Scoring

Scoring system categorizes horses into normal or with varying degrees of hepatic issues (mild, moderate, severe).
Data (61 horses) from a 2003 study shows distributions for different categories (normal, mild, moderate, severe).

Survival Rates

Survival rates at six months differ according to the clinical score, with lower scores (0-1) associated with significantly higher survival than those with higher scores (2-3).

Clinical Signs - Implication

Clinically normal horses can have significant liver disease.
If signs of hepatic insufficiency are present, the prognosis is poor.

Serum Biochemistry

Liver damage releases enzymes (e.g., alkaline phosphatase, AST, GGT, GLDH).
Serum biochemistry tests on liver function including albumin, globulin, bile acids, bilirubin, and urea can provide more clues.
GGT, AST, GLDH, and AP are helpful for diagnostic purposes, but can be misleading at times.

Case Monitoring

Normalization of liver enzymes improves outcomes.
Persistent enzyme elevation (> 2-3 months) suggests persistent liver damage.
Assessing for treatment failure is important.

Epidemiological Clues

Potential causes of liver disease include hepatotoxicity, septic cholangitis, cholelithiasis, viral infection, parasitic infections, neoplasia, and immune-mediated conditions.

Possible Causes - Hepatopathy Outbreaks

Toxicity (e.g., pyrrolizidine alkaloids, iron, mycotoxins)
Infectious disease (e.g., Fasciola hepatica, viral hepatitis)
Viral infections (e.g., equine hepacivirus, equine parvovirus)

Infectious Hepatitis Outbreaks

Liver fluke (Fasciola hepatica) is a rare but significant concern, especially in areas with cattle or sheep.
Diagnosis is often challenging post-mortem.
Coproantigen analysis is unreliable and serology is variable.

Viral Hepatitis

Acute and chronic infections are observed in young horses, potentially linked to non-primate hepaciviruses.
Viruses such as equine hepacivirus and equine parvovirus have been identified as common causes.

Ultrasonography

Ultrasound is potentially helpful in identifying areas relevant for biopsy, minimizing risk.
Significant liver disease can still be present with unremarkable images.

Biopsy Procedure

Procedure includes sedation, ultrasound-guided site identification, biopsy depth/angle determination, clipping, scrubbing, local anesthesia, incision, instrument insertion and biopsy removal.
Biopsies are then placed in formalin or other preserving solutions and possibly antimicrobial agent, for effective analysis.

Purpose of Liver Biopsy

Confirms liver disease existence.
Helps determine the cause, guiding therapy.
Aids in prognosis determination.
Guides appropriate therapy.

Biopsy Findings

Several conditions are observed through biopsy, like pyrrolizidine alkaloids, hemosiderosis, septic cholangitis, and neoplasia are possible causes.
Most biopsies, however, do not indicate a specific cause.

Prognostic Biopsy Score

Scoring system categorizes biopsy findings based on severity of liver damage.
The scoring system can help predict the outcome or prognosis of diseases based on biopsy.

Prognostic Value of Biopsy

Biopsy score correlates with survival time, demonstrating a predictive value in determining prognosis.

Treatments

Empiric treatments for liver disease are not recommended.
Specific therapies are based on the precise findings of a liver biopsy, given there are varied pathological areas.
Antimicrobials, steroids, and other drugs may have detrimental impacts.

Specific Therapies

Based on finding of the biopsy.
Options include corticosteroids, immunosuppressants, anti-parasitic therapies, and supporting treatments.
Consider underlying factors.

Adverse Effects of Liver Biopsy

High risk of liver disease is associated with a poor prognosis anyway.
Focusing on early diagnosis is recommended to avoid serious outcomes and improve outcomes.

Overall Approach to Equine Liver Disease

Initial tentative diagnosis based on blood tests helps determine if herd mates have problems.
If there are concerns, consider common toxins, viral, parasitic causes, and if appropriate a liver biopsy to confirm, determine the cause and prognosis based on the findings.
Maintaining enzyme levels, along with considering other aspects, can aid in the treatment and prognosis of the disease.

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Description

Test your knowledge on the causes and diagnoses of liver diseases. This quiz includes questions on toxic substances, infectious diseases, and diagnostic tools like hepatic ultrasound. Challenge yourself with questions that explore the complexities of liver dysfunction.