ADVERSITY
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ADVERSITYADVERSITY“Adversity causes some men to break, others to break records.”
-William A. Ward
Liver DiseasesLiver DiseasesHigh regenerative capacity; damage must be severe for
signs to appearDrug/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 others
Drug/Toxin Induced Liver DiseaseDrug/Toxin Induced Liver DiseaseSigns
◦Acute onset◦Anorexia◦vomiting/,
diarrhea/constipation◦PU/PD◦Jaundice (maybe)◦Melena, hematuria, or
both◦CNS signs (depression,
ataxia, dementia, coma, seizures)
Dx◦Hx of drug administration◦Painful liver on palpation◦Chem panel
↑ ALT (alanine aminotransferase) ↑ Total bilirubin, ↑ blood ammonia ↑ Serum bile acids Hypoglycemia, coagulopathy
◦Radiographs show enlarged liver◦Liver biopsy (unless coagulopathy suspected)
Drug/Toxin Induced Liver DiseaseDrug/Toxin Induced Liver Disease
Rx◦Antidotes◦Induce vomiting◦Activated charcoal◦IV fluids◦Vit K for clotting◦Antibiotics◦Special diets (Hill’s k/d or u/d)
Drug/Toxin Induced Liver DiseaseDrug/Toxin Induced Liver Disease
Liver TumorsLiver TumorsMetastatic tumors are more common
than primary tumors of liverSigns
◦Anorexia, lethargy, wt loss◦PU/PD◦Vomiting/diarrhea (?)◦Abdominal distension,
hepatomegaly◦Jaundice
Dx◦Anemia◦Chem Panel
Abnormal liver enzymes and liver function tests
Liver tumorsLiver tumorsDx
◦X-ray: Heptomegaly, Ascites (?)◦Biopsy of liver◦Abdominocentesis may show tumor cells
Rx◦Surgical removal is preferred treatment
Single masses have good Px Multiple nodules/Diffuse disease have poor Px
◦Chemotherapy doesn’t help primary tumors; better for metastatic lesions
Client info◦Guarded to poor Px generally◦Survival time: 6 mo-3 y
THINGS THAT MAKE THINGS THAT MAKE YOU GO HMMMMMM…..YOU GO HMMMMMM…..
“Is it good if a vacuum really sucks?”
Portosystemic ShuntsPortosystemic ShuntsShunts form between portal circ and systemic circ
allowing blood to bypass liver; Function of liver—detox blood
Congenital or acquiredBy-passing liver, allows many toxins into
systemic circulationCNS is most affected by the circulating toxins
Portosystemic ShuntsPortosystemic Shunts
Signs◦Dumb/numb, lethargic, depressed◦Ataxia, staggering◦Head-pressing (against a wall)◦Compulsive circling, apparent blindness◦Seizures, coma◦Bizarre behavior (esp cats)◦Signs often more pronounced shortly after a meal
Portosystemic ShuntsPortosystemic Shunts
Dx◦Chem panel
↓ serum protein, albumin (liver is usually small) ↓ BUN (liver converts ammonia → urea) ↑ ALT (alanine aminotransferase), ALP (alkaline
phosphatase) ↑ blood ammonia
◦X-rays Small liver Contrast material
◦ Inject into splenic vein◦By-passes liver
Portosystemic ShuntsPortosystemic Shunts
Rx◦Medical management seldom very successful
Low protein diet◦Sx
Ligation of shunt◦Total ligation often causes ↑ liver BP◦Partial ligation may be more practical◦A second Sx can be performed after few months to close off
shunt totally◦Client info
Px often very good following ligation For best results, Sx should be performed before 1 y
old Collateral circulation may develop, with relapse of
signs
Portosystemic ShuntsPortosystemic Shunts
Feline Hepatic LipidosisFeline Hepatic LipidosisIdiopathic (IHL) – cause unknownMost common hepatopathy in catsObese cats of any age, sex or breedStress may trigger anorexia
◦Diet change, ◦Boarding◦Illness, ◦Environmental change
IHLIHLAnorexia prolonged for 2 weeks causes
imbalance between breakdown of peripheral lipids and lipid clearance within liver◦Lipids accumulate in liver
Other mechanisms proposedEarly diagnosis and aggressive
treatment important◦60-65% of cases => complete recovery
IHLIHL
IHLIHLClinical Signs
◦Anorexia◦Obesity◦Wt loss (as much as 25% of body weight)◦Depression◦Sporadic vomiting◦Icterus◦Mild hepatomegaly◦+/- coagulopathies
IHLIHLDiagnosis
◦CBC - stress◦Biochem panel – Increased ALP, ALT, bilirubin,
Low albumin, Increase serum bile acids◦X-rays – mild hepatomegaly◦US liver hyperechoic◦Liver biopsy – severely vacuolized
hepatocytes
IHLIHLTreatment
◦High protein, calorie dense diet◦Feeding tube usually required
NG tube for short term liquid diets Gastrostomy tube best Esophagostomy tube
◦Tubes can remain in placeFor up to 3-6 weeks
IHLIHLTreatment
◦IV fluids◦Metoclopramide SQ 15 min prior to feeding◦Monitor weekly
CE◦Avoid stress in obese cats◦Early intervention is essential◦Any cat that stops eating is at risk◦Cats do not respond well to frequent diet
changes
Pancreatic Dysfunction (Exocrine)Pancreatic Dysfunction (Exocrine)Main function of Exocrine Pancreas → secretion of
dig enzymesLocated along duodenumDig enzymes secreted in an inactive form to
protect pancreas tissue
Pancreatitis—Inflammation of pancreasMay be chronic or acute Develops when dig enzymes are activated within gland →
autodigestion More common in obese animal; high-fat diets may predispose
animal to it Unpredictable results; some recover well, others worsen and die
◦Signs Older, obese dog or cat with Hx of recent high-fat meal Depression, anorexia, vomiting ± abdominal pain Shock, collapse may develop Often seen post-holiday
◦Table scraps of ham, gravy, etc
Pancreatic Dysfunction (Exocrine)Pancreatic Dysfunction (Exocrine)
PancreatitisPancreatitisDx
◦ CBC, Chem panel Leukocytosis ↑ PCV Hyperlipidemia ↑ serum amylase, lipase
Rx◦ IV fluids, electrolytes◦ NPO 3-4 d◦ Antibiotics◦ Butorphanol for pain◦ Start back on low fat diet 1-2 days after vomiting
stopsClient info
◦ Avoid obesity/overfeeding◦ Feed low-fat treats◦ Px is difficult to assess
Exocrine Pancreatic InsufficiencyExocrine Pancreatic InsufficiencyThe pancreas stops making dig enzymesMay occur spontaneously (GerShep) or due to chronic
pancreatitis (cats)Signs
◦Wt loss◦Polyphagia◦Coprophagia, pica◦Diarrhea, fatty stool◦Flatulence
Dx◦Normal CBC
Rx◦Supplement pancreatic enzymes with each meal
Pancrezyme Viokase-V
◦Low fiber dietClient 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
Exocrine Pancreatic InsufficiencyExocrine Pancreatic Insufficiency
Perineal HerniaPerineal HerniaIntact male dogs; atrophy of levator ani muscle; rectum
herniates Signs
◦Reducible perianal swelling◦Tenesmus (feeling of full colon)◦Dyschezia (difficult defecation)◦Urethral obstruction
If bladder is herniatedDx
◦Rectal palpation reveals hernia sac
Rx◦Stool softeners (Colace)◦Enemas◦Surgical repair
CastrationClient info
◦Keeping stool soft may help reduce straining True for all dogs
◦Castration recommended testosterone is suspected as a predisposing factor
Perineal HerniaPerineal Hernia
Perianal FistulaPerianal FistulaExact etiology unknown; thought to start as an
inflammation of sweat and oil glands around anusBacteria grow well in the moist, warm region of these
glandsInfection invades into deeper tissuesMost commonly affects G Shep (84% of dogs diagnosed)Signs
◦ Intact male, older (>8 y)◦ Tenesmus◦ Dyschezia, pain on exam◦ Fecal incontinence◦ Bleeding, foul odor of perianal area
Dx—PE to r/o anal sac disease/perirectal tumor Rx
◦ Medical—usually not successful Clip hair, keep clean Flush with saline Antibiotics
◦ Surgical—difficult because of nerves/blood vessels Remove infected tissue Cryosurgery Laser surgery Cautery
◦ Client info Painful—be cautious of biting many complications of Sx
◦ Fecal incontinence◦ Anal stenosis
Perianal FistulaPerianal Fistula
Perianal Gland AdenomaPerianal Gland AdenomaSigns
◦ Intact male, older ◦ Single or multiple masses that may ulcerate
Not metastatic◦ Pruritis in anal area◦ Bleeding◦ Firm nodules in perianal skin
Dx—PE, biopsyRx
◦ Surgical removal◦ Radiation◦ Cryosurgery◦ Castration—causes regression of tumors
Client info◦ Gently cleanse area daily with baby wipes◦ Castration at early age helps prevent it