ADVERSITY

1
ADVERSITY

• Adversity causes some men to break, others to
  break records.
• -William A. Ward

2
Liver Diseases

• High regenerative capacity damage must be severe
  for signs to appear
• Drug/Toxin induced Liver Disease
• Acute liver failure requires gt70 of liver to be
  affected
• Susceptible to toxin ingestion (portal
  circulation)
• Some drugs have a Hx of liver toxicity
• Acetaminophen
• Phenobarbital
• others

3
Drug/Toxin Induced Liver Disease

• Signs
• Acute onset
• Anorexia
• vomiting/, diarrhea/constipation
• PU/PD
• Jaundice (maybe)
• Melena, hematuria, or both
• CNS signs (depression, ataxia, dementia, coma,
  seizures)

4
Drug/Toxin Induced Liver Disease

• 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)

5
Drug/Toxin Induced Liver Disease

• Rx
• Antidotes
• Induce vomiting
• Activated charcoal
• IV fluids
• Vit K for clotting
• Antibiotics
• Special diets (Hills k/d or u/d)

6
Liver Tumors

• Metastatic tumors are more common than primary
  tumors of liver
• Signs
• Anorexia, lethargy, wt loss
• PU/PD
• Vomiting/diarrhea (?)
• Abdominal distension, hepatomegaly
• Jaundice
• Dx
• Anemia
• Chem Panel
• Abnormal liver enzymes and liver function tests

7
Liver tumors

• Dx
• 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 doesnt help primary tumors better
  for metastatic lesions
• Client info
• Guarded to poor Px generally
• Survival time 6 mo-3 y

8
THINGS THAT MAKE YOU GO HMMMMMM..

• Is it good if a vacuum
• really sucks?

9
Portosystemic Shunts

• Shunts form between portal circ and systemic circ
  allowing blood to bypass liver Function of
  liverdetox blood
• Congenital or acquired
• By-passing liver, allows many toxins into
  systemic circulation
• CNS is most affected by the circulating toxins

10
Portosystemic Shunts
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Portosystemic 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

12
Portosystemic 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

13
Portosystemic 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

14
Feline Hepatic Lipidosis

• Idiopathic (IHL) cause unknown
• Most common hepatopathy in cats
• Obese cats of any age, sex or breed
• Stress may trigger anorexia
• Diet change,
• Boarding
• Illness,
• Environmental change

15
IHL

• Anorexia prolonged for 2 weeks causes imbalance
  between breakdown of peripheral lipids and lipid
  clearance within liver
• Lipids accumulate in liver
• Other mechanisms proposed
• Early diagnosis and aggressive treatment
  important
• 60-65 of cases gt complete recovery

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IHL
17
IHL
18
IHL

• Clinical Signs
• Anorexia
• Obesity
• Wt loss (as much as 25 of body weight)
• Depression
• Sporadic vomiting
• Icterus
• Mild hepatomegaly
• /- coagulopathies

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IHL

• Diagnosis
• 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

20
IHL

• Treatment
• 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 place
• For up to 3-6 weeks

21
IHL

• Treatment
• 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

22
Pancreatic Dysfunction (Exocrine)

• Main function of Exocrine Pancreas ? secretion of
  dig enzymes
• Located along duodenum
• Dig enzymes secreted in an inactive form to
  protect pancreas tissue

23
Pancreatic Dysfunction (Exocrine)

• PancreatitisInflammation of pancreas
• May 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

24
Pancreatitis

• Dx
• 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 stops
• Client info
• Avoid obesity/overfeeding
• Feed low-fat treats
• Px is difficult to assess

25
Exocrine Pancreatic Insufficiency

• The pancreas stops making dig enzymes
• May occur spontaneously (GerShep) or due to
  chronic pancreatitis (cats)
• Signs
• Wt loss
• Polyphagia
• Coprophagia, pica
• Diarrhea, fatty stool
• Flatulence
• Dx
• Normal CBC

26
Exocrine Pancreatic Insufficiency

• Rx
• Supplement pancreatic enzymes with each meal
• Pancrezyme
• Viokase-V
• Low fiber diet
• 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

27
Perineal Hernia

• Intact 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 herniated
• Dx
• Rectal palpation reveals hernia sac

28
Perineal Hernia

• Rx
• Stool softeners (Colace)
• Enemas
• Surgical repair
• Castration
• Client info
• Keeping stool soft may help reduce straining
• True for all dogs
• Castration recommended testosterone is suspected
  as a predisposing factor

29
Perianal Fistula

• Exact etiology unknown thought to start as an
  inflammation of sweat and oil glands around anus
• Bacteria grow well in the moist, warm region of
  these glands
• Infection invades into deeper tissues
• Most commonly affects G Shep (84 of dogs
  diagnosed)
• Signs
• Intact male, older (gt8 y)
• Tenesmus
• Dyschezia, pain on exam
• Fecal incontinence
• Bleeding, foul odor of perianal area

30
Perianal Fistula

• DxPE to r/o anal sac disease/perirectal tumor
• Rx
• Medicalusually not successful
• Clip hair, keep clean
• Flush with saline
• Antibiotics
• Surgicaldifficult because of nerves/blood
  vessels
• Remove infected tissue
• Cryosurgery
• Laser surgery
• Cautery
• Client info
• Painfulbe cautious of biting
• many complications of Sx
• Fecal incontinence
• Anal stenosis

31
Perianal Gland Adenoma

• Signs
• Intact male, older
• Single or multiple masses that may ulcerate
• Not metastatic
• Pruritis in anal area
• Bleeding
• Firm nodules in perianal skin
• DxPE, biopsy
• Rx
• Surgical removal
• Radiation
• Cryosurgery
• Castrationcauses regression of tumors
• Client info
• Gently cleanse area daily with baby wipes
• Castration at early age helps prevent it