2. Liver Diseases
High regenerative capacity; damage must be severe for signs to appear
Drug/Toxin induced Liver Disease
Acute liver failure requires >70% of liver to be affected
Susceptible to toxin ingestion (portal circulation)
Some drugs have a Hx of liver toxicity
Acetaminophen
Phenobarbital
The liver filters the blood coming from the digestive tract, before passing it to the rest of the body. The liver also detoxifies chemicals and metabolizes drugs
Could be caused by medications animal has taken. It is important to run blood work often when an animal is on certain medications.
The liver will rebuild itself so liver injury must be severe to show up on bloodwork.
Portal system takes substance from digestive system to liver to be metabolized.

3. Drug/Toxin Induced Liver Disease
Signs
Anorexia
vomiting/, diarrhea/constipation
PU/PD
Jaundice
Melena, hematuria, or both
CNS signs (depression, ataxia, dementia, coma, seizures)
If the liver is damaged it can cause toxins to build up in the blood because p is not metabolizing the toxins.
Could be due to an over dose of drugs or due to long term use of medications.

4. Drug/Toxin Induced Liver Disease
Diagnosis
Hx of drug administration
Painful liver on palpation
Chemistry panel
↑ liver enzymes
Evidence of coagulopathy
Liver biopsy
Bleeding disorder because liver hold the clotting factors. If impaired p could have a clotting issue.
Liver punch biopsy (DOVE ) 3 minutes

5. Drug/Toxin Induced Liver Disease
Treatment
Antidotes
Induce vomiting
Activated charcoal
IV fluids
Vit K for clotting
Antibiotics
Special diets (Hill’s L/d)
Activated charcoal to prevent p from absorbing toxins that have built up.
Antidote is a medication that counteracts toxins.

6. “Choose your friends carefully, your enemies will choose you.”
SO TRUE
“Choose your friends carefully, your enemies will choose you.”
-Yassar Arafat

7. Portosystemic Shunt (PSS)
Blood from GI tract bypasses liver, allows many toxins into systemic circulation
CNS is most affected by the circulating toxins
Bypasses hepatic detoxification: Toxins absorbed by the intestines skips over the liver and goes straight into the blood stream. The liver will appear small and atrophied (wasted away). This is because blood is not going to liver like it should.
Ductus venosus: this is normal in a fetus while in the mother. It bypasses the liver (from the umbilical vein straight to the vena cava) due to the liver not being fully developed(only a small amount goes to the liver during this time). The fetus gets nutrients and stuff from the mother while in the womb. This should close after birth.

9. Skips the liver and goes straight to vena cava vein from the portal vein.
Bypasses hepatic detoxification, leading to increase in systemic toxins.
In the fetus, the ductus venosus shunts a portion of the umbilical vein blood flow directly to the vena cava. Thus, it allows oxygenated blood from the placenta to bypass the liver. With a shunt the ductus venosus does not close resulting in a congenital shunt.

10. Portosystemic Shunts Signs Dumb/numb, lethargic, depressed
Ataxia, staggering
Head-pressing
compulsive circling, apparent blindness
Seizures, coma
Bizarre behavior
Signs often more pronounced shortly after a meal
After eating because body has started absorbing nutrients and then skips the liver.
Ataxia/head pressing: toxins built up
Start to show signs at 6 months of age

11. Portosystemic Shunts Diagnosis Chemistry panel
Evidence of abnormal liver function
X-rays
Small liver (microhepatica)
Contrast material
By-passes liver
The shunt will light up. They can use a CT to identify it.

12. Portosystemic Shunts Treatment Client info
Medical management seldom very successful
Low protein diet
Surgery
Ligation of shunt
Total ligation often causes ↑ liver BP(portal hypertension)
Partial ligation may be more practical
Client info
Prognosis often very good following ligation
For best results, Surgery should be performed before 1 y old
Total can lead to blood going through liver to quickly causing hypertension(remember this liver has not had blood flow in a while). This could lead to toxic shock, cardiovascular collapse, and abdominal pain. Partial, body could get used to it and then they could have a second surgery to finish closing the shunt. This allows the liver time to adjust to the increased blood flow.
Partial: not fully tying off the shunt (Second surgery is usually done 1 month after first surgery)

13. Feline Hepatic Lipidosis
Idiopathic – cause unknown
Fatty liver disease
Obese cats of any age, sex or breed
Stress may trigger anorexia
Diet change
Boarding
Illness
Environmental change
You never want a cat to stop eating. It can be very dangerous. 2 weeks without eating will result in lipid build up within the liver.
If not treated it could lead to liver failure.
Cause is unknown, but stress seems to be a trigger for this condition.

14. Idiopathic Hepatic Lipidosis
Anorexia prolonged for 2 weeks causes imbalance between breakdown of peripheral lipids and lipid clearance within liver
Lipids accumulate in liver
Early diagnosis and aggressive treatment important
60-65% of cases have complete recovery

15. Idiopathic Hepatic Lipidosis
Enlarged liver and hepatocytes.

16. Idiopathic Hepatic Lipidosis
Clinical Signs
Anorexia
Obesity
Wt loss (as much as 25% of body weight)
Depression
Sporadic vomiting
Icterus
Mild hepatomegaly
+/- coagulopathies
Could be bleeding tendencies.

17. Idiopathic Hepatic Lipidosis
Diagnosis
History of stress
Chem panel
Evidence of abnormal liver function
CBC
X-rays – mild hepatomegaly
Liver biopsy
Nonregenerative anemia, stress neutrophilia(increased release of neutrophils), lymphopenia.
Elevated liver values.

18. Idiopathic Hepatic Lipidosis
Treatment
High protein, calorie dense diet
Feeding tube usually required
Nasogastric tube for short term liquid diets
Esophagostomy tube
Gastrostomy tube best
Tubes can remain in place
For up to 3-6 weeks
Nasogastric tube: through nostril into stomach.
Esophagostomy tube: placed through incision on neck, does not go into stomach. Cats don’t tolerate well.
Gastrotomy tube: goes through abdominal wall into stomach. Best option if cat can handle anesthesia.
Feeding tubes must be flushed before and after use.

19. Esophagostomy tube We actually used these tubes a lot in ICU.
Nasogastric tube (DOVE) 10 minutes

20. Gastrostomy tube PEG tube placement (DOVE) 10 minutes
(percutaneous endoscopic gastrostomy)
They actually use an endoscope to place it

21. Idiopathic Hepatic Lipidosis
Treatment
IV fluids
Metoclopramide SQ 15 min prior to feeding
Monitor weekly
Client Education
Avoid stress in obese cats
Any cat that stops eating is at risk
Cats do not respond well to frequent diet changes
Metoclopramide: helps with nausea. They are usually very nauseous.
Can use Diazepam as an appetite stimulant.
Recheck bloodwork every 2 weeks until liver values start to go down.
Prognosis is guarded % chance of a cure.

22. Pancreatic Dysfunction (Exocrine)
Main function of Exocrine Pancreas → secretion of digestive enzymes (Amylase and lipase) into the small intestines
Secretes bicarbonate to neutralize stomach acids
Regulates blood glucose (secretes insulin)
Located under the stomach and duodenum
Digestive enzymes secreted in an inactive form to protect pancreas tissue
Digestive enzymes, produced and stored within the pancreas, are released into the Sm. Intestines routinely. When stimulated by food, it secretes more enzymes.
Inactive form meaning enzymes are activated after reaching the duodenum.

24. Pancreatic Dysfunction (Exocrine)
When digestive enzymes are activated within gland → autodigestion
Pancreatitis develops
Inflammation of the pancreas
More common in obese animal; high-fat diets may predispose animals to it
Unpredictable results; some recover well, others worsen and may die
Pancreatitis occurs when digestive enzymes are activated within the pancreas. Autodigestion develops resulting in an inflamed pancreas, resulting in tissue damage. Pancreatic enzymes are destroying its own tissue.

25. Pancreatitis
Signs
Older, obese dog or cat with history of recent high-fat meal
anorexia, vomiting
± abdominal pain
Shock, collapse may develop
Often seen post-holiday
Table scraps of ham, gravy, etc.

26. Pancreatitis Diagnosis Treatment CBC Chemistry panel
Elevation of pancreatic enzymes
Amylase and lipase
Treatment
IV fluids
NPO 3-4 d
Antibiotics
Pain management
Start back on low fat diet 1-2 days after vomiting stops
Do not offer food for hours – Pancreas needs to rest
If the p smells food then the pancreas will produce more digestive enzymes. We want the pancreas to rest.
The two enzymes. Amylase and lipase leak into the blood stream resulting in elevated values for both these enzymes.

27. Pancreatitis Client info Avoid obesity/overfeeding Feed low-fat treats
Prognosis is difficult to assess
Low fat diets are best because they are easily digested. This will help prevent other episodes.

28. Exocrine Pancreatic Insufficiency
The pancreas stops making digestive enzymes
May occur spontaneously or due to chronic pancreatitis
Signs
Wt. loss
Polyphagia
Coprophagia, pica
Diarrhea, fatty stool
Flatulence
Coprophagia: eating stool. Polyphagia: always hungry. Pica: craving food
Fatty stool: too much fat in stool, a sign that nutrients aren’t being absorbed properly

29. Exocrine Pancreatic Insufficiency
Treatment
Supplement pancreatic enzymes with each meal
Pancrezyme
Viokase-V
Client info
EPI is irreversible; life-long treatment
Pancreatic enzyme replacement is expensive
With enzyme replacement, dog will regain weight, diarrhea will stop
Must be given with every meal