Veterinary Medicine: Hepatobiliary & Pancreatic Diseases

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Questions and Answers

What clinical signs are typically associated with hepatobilliary and pancreatic diseases?

Joint pain and swelling

Fever and chills

Specific respiratory symptoms

Non-specific gastrointestinal signs (correct)

Which of the following is NOT part of the diagnostic work-up for hepatobilliary and pancreatic diseases?

Conducting a neurological examination

Using imaging techniques

Administering antibiotics indiscriminately (correct)

Taking a thorough patient history

What aspect of hepatobilliary and pancreatic diseases must be understood for effective treatment?

Only the symptoms experienced by the patient

Principles of treatment and prognosis (correct)

Comparative analysis with unrelated diseases

Patient's age and gender only

Which type of abnormalities can occur in patients with hepatobilliary and pancreatic diseases?

Neurological and haemopoietic abnormalities (B) Signup and view all the answers

Which diagnostic modality is essential for investigating hepatobilliary and pancreatic diseases?

Endoscopic examination (A) Signup and view all the answers

What is the potential implication of values exceeding the control range for cobalamin and folate?

Bacterial overgrowth in the upper small intestine (D) Signup and view all the answers

Which imaging technique can differentiate between diffuse and focal hepatic disease?

Ultrasonography (B) Signup and view all the answers

What is the significance of hyperechoic findings in ultrasonography?

Suggests fibrosis, lipidosis, or steroid hepatopathy (B) Signup and view all the answers

Which dietary recommendation is suggested for managing liver disease?

Small amounts and often, balancing carbohydrates and good quality protein (C) Signup and view all the answers

What condition is indicated by values below the control range for cobalamin and folate?

Disease affecting the proximal small intestine (C) Signup and view all the answers

What is the primary purpose of fluid therapy in the treatment of liver disease?

Replace fluid losses and flush toxins (B) Signup and view all the answers

Which of the following options is contraindicated in some cases of liver disease treatment?

Anti-inflammatory/steroids (D) Signup and view all the answers

What type of liver change is associated with the term 'microhepatica'?

Reduced hepatic shadow (A) Signup and view all the answers

What is the most common primary hepatic disorder in cats in the UK?

Cholangitis (C) Signup and view all the answers

Which dog breeds are most commonly predisposed to portosystemic shunts?

Schnauzers and Maltese (D) Signup and view all the answers

What is a key feature that characterizes neutrophilic cholangitis?

Inflammatory disruption of hepatic parenchyma (A) Signup and view all the answers

What is triaditis syndrome in cats?

Concurrent cholangitis, pancreatitis, and inflammatory bowel disease (D) Signup and view all the answers

What factor influences the management of portosystemic shunts in dogs?

Contraindications for surgical intervention (A) Signup and view all the answers

Which of the following symptoms is NOT typically associated with liver disease?

Enhanced vision (A) Signup and view all the answers

What is an important factor to consider when interpreting liver function tests?

History of environmental exposure (A) Signup and view all the answers

Which of the following liver enzymes is NOT routinely studied for liver function?

Creatine kinase (CK) (D) Signup and view all the answers

Which of the following findings might indicate a liver issue during a physical examination?

Distended painful abdomen (B) Signup and view all the answers

In the context of liver disease, what does high ammonia levels indicate?

Potential liver dysfunction (C) Signup and view all the answers

What kind of abdominal symptom is typically associated with conditions affecting horses?

Colicy (A) Signup and view all the answers

Which specific test may NOT provide a definitive diagnosis for liver disease?

Liver biopsy (B) Signup and view all the answers

Which symptom in animals could suggest an issue with liver function?

Lethargy (B) Signup and view all the answers

What is a common clinical finding associated with feline hepatic lipidosis?

Anorexia (B) Signup and view all the answers

Which dietary management practice is beneficial for exocrine pancreatic insufficiency?

Enzyme replacement therapy (C) Signup and view all the answers

What is a key symptom when 85%-90% of the pancreas has atrophied?

Weight loss (D) Signup and view all the answers

What diagnostic tool is NOT used for diagnosing hepatic lipidosis?

Electrocardiogram (B) Signup and view all the answers

Which of the following supplements is commonly mentioned for treating liver issues?

S-adenosylmethionine (SAMe) (D) Signup and view all the answers

What can cause an increase in bile acid concentrations due to hepatocellular dysfunction?

Inability to produce or extract bile acids (C) Signup and view all the answers

Which condition is known to mask the ability to detect hepatic dysfunction when measuring bile acids?

Cholestasis (A) Signup and view all the answers

What is a potential reason for the onset of exocrine pancreatic insufficiency?

Pancreatic acinar atrophy (B) Signup and view all the answers

Why is measuring bile acids in cholestatic animals not useful?

Cholestasis obscures hepatic dysfunction detection (D) Signup and view all the answers

What laboratory test is likely to be performed for exocrine pancreatic insufficiency diagnosis?

Fecal fat test (D) Signup and view all the answers

Which of the following conditions is least likely to cause hepatic lipidosis?

Chronic pancreatitis (C) Signup and view all the answers

In horses, why is random bile acid concentration measured instead of standard measurements?

Horses lack a gall bladder (A) Signup and view all the answers

Which of the following can result in slightly increased bile acid concentration in horses?

Decreased feed intake over several days (D) Signup and view all the answers

What is the primary reason for increased bile acid concentrations in cases of abnormal portal blood flow?

Portal blood bypassing the liver (D) Signup and view all the answers

What is a notable characteristic of bile acid concentrations in young foals?

They can be higher than in adults (A) Signup and view all the answers

Which condition is NOT mentioned as a cause of increased bile acid concentrations?

Excessive water intake (B) Signup and view all the answers

Study Notes

Hepatobiliary and Pancreatic Diseases

This presentation covers hepatobiliary (liver, gall bladder, bile ducts) and pancreatic diseases in animals.
The speaker, Prof Kamalan Jeevaratnam, is an expert in veterinary medicine.

Lecture Outcomes

Students will understand the pathophysiology affecting the clinical presentation of these diseases.
Students will be able to determine the necessary history and clinical examination for diagnosis.
Students will gain knowledge of available diagnostic tools.
Students will learn about principles of treatment and disease prognosis.

Clinical Signs and Presentation

Clinical signs are often non-specific, typically gastrointestinal (GI) related, although neurological and haematopoietic abnormalities can also occur.
Common signs include vomiting, diarrhoea (often pasty and discoloured), loss of appetite, polyuria/polydipsia (increased drinking and urination), weight loss (especially chronic), distended abdomen (often with ventral oedema), painful abdomen, lethargy, and abnormal behaviour.
Specific signs might be noted in horses (e.g., photosensitization, colicy).

History and Physical Examination

Signalment (species, breed, age) varies depending on the condition.
History includes the time of onset, duration, previous diet, recent changes in behaviour, pesticide use, and exposure to the environment. Preventive healthcare history is also important.
Physical examination is focused on mucous membranes and the abdominal area.
Distended, painful abdomen can be a key sign along with other physical signs like palpable liver in smaller animals, lymph node enlargement (infection), bruising (clotting deficiency), yellowish discoloration, anaemia, and pyrexia.

Liver Function Tests

Many liver tests are not specific to the liver. Results must be interpreted considering the animal's history, clinical findings, and medications.
Several factors, like type, severity, and duration of the disease, are important factors to note when evaluating liver function in the patient.
Common tests include bilirubin, albumin, glucose, blood urea nitrogen, cholesterol, ammonia, alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP), gamma-glutamyltransferase (GGT), and sorbitol dehydrogenase (SDH).
Bile acid stimulation tests are also used.
Liver function tests often indicate potential issues rather than definitive diagnoses.

Liver Enzyme Details

ALT and AST are leakage enzymes, indicating hepatocellular injury and/or necrosis. ALT levels are usually higher than AST. Skeletal muscle is also a source of AST so elevations may not exclusively indicate liver damage.
ALP levels are associated with biliary disease or drug-induced conditions and bone disorders.
GGT levels are a useful indicator of biliary and hepatic disease, in particular impaired bile flow.
Plasma half-lives for the various enzymes vary depending on the type of animal

Bile Acid Stimulation Test

Bile acid levels are elevated with conditions like hepatocellular dysfunction or abnormal portal blood flow.
Cholestasis (impaired bile flow) also leads to elevated bile acid levels. Horses lack a gall bladder, making bile acid measurement less consistent. Decreased feed intake for a period of days or longer can also lead to slightly elevated concentrations.

Other Relevant Biomarkers

Trypsin-like immunoreactivity (TLI) is a marker of exocrine pancreatic insufficiency (EPI) if pancreatic exocrine secretory capacity is reduced below 10–15%
Pancreatic lipase immunoreactivity (PLI) can be helpful in diagnosing pancreatitis.
Cobalamin and folate are markers of metabolism in the distal and proximal intestinal absorption and are important in diagnosis.

Imaging

Radiology/X-rays are used for assessing liver size, opacity, and displacement of the stomach in relation to the costal arch
Ultrasounds distinguish between diffuse and focal hepatic diseases, identifying fibrosis, lipidosis, or possible neoplasia (cancer).

Treatment

General options include fluid therapy to replace fluid losses and flush toxins.
A diet with smaller, more frequent meals and a balance of carbohydrates and protein is generally recommended.
Anti-inflammatory medications (steroids) and/or antibiotics may be necessary, although they might be contraindicated in some cases.
Supplements, like Vitamin B, E, K, milk thistle, or zinc, might be beneficial.
Lactulose can be used to reduce ammonia in patients.
Other treatments include anti-emetics (to control vomiting) and anti-ulcers, depending on the animal's condition.

Hepatic Lipidosis

Common in cats, especially those under stress or with concurrent diseases.
Key features include anorexia, weight loss, and increased serum liver enzyme activities and associated metabolic pathways.
Diagnosis involves clinical history, physical examination, clinical pathology, radiography, ultrasound, and biopsy.

Exocrine Pancreatic Insufficiency

Insufficient digestive enzyme production causes inadequate nutrient digestion.
Characterized by gradual or rapid onset of symptoms, including weight loss, diarrhoea, increased fecal volume, steatorrhoea (fatty stools), coprophagy (eating feces), and poor coat condition.
Diagnoses rely on clinical history, physical signs, laboratory tests, including imaging.
Treatment includes enzyme replacement, dietary modification, vitamin supplementation, antibiotics, and glucocorticoid therapy.

Portosystemic Shunt

Congenital vascular anomalies bypass the liver.
Symptoms can vary, including hepatic encephalopathy and failure to thrive.
Often, diagnosis depends on clinical history and signs. Medical or surgical management are considered depending on individual circumstances.

Feline Inflammatory Liver Diseases

Cholangitis or cholangiohepatitis are common primary liver diseases in cats.
The disorders are classified by inflammatory cell types — in particular, neutrophilic or lymphocytic cholangitis and inflammatory disruption of hepatic parenchyma can signify extensions of primary cholangitis.
In some cases, other concurrent diseases, such as inflammatory bowel disease, can be present, leading to diagnosis needing to rule out concurrent issues as well.

Triaditis Syndrome

Suggests concurrent cholangitis, pancreatitis, and inflammatory bowel disease, a condition unique to cat's ductal anatomy.
Diagnoses need multiple biopsy samples, and testing should include analysis for each condition.
Treatment focuses on treating each condition individually.

Liver Disease Diagnostic Algorithms

Various algorithms exist to determine if a cat has pancreatitis, frequently involving serum fPL levels.

References

The presented material included references to various veterinary resources including BSAVA, Schaer and Gaschen, and eClinPath.

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Description

Explore the complexities of hepatobiliary and pancreatic diseases in animals through this informative presentation. Led by expert Prof Kamalan Jeevaratnam, the quiz will help students comprehend clinical signs, diagnostic tools, and treatment principles pertinent to these conditions.