Page 1111 - Small Animal Clinical Nutrition 5th Edition

Hepatobiliary Disease 1157

VetBooks.ir Table 68-2. Diseases of the liver and biliary tract commonly Table 68-3. Frequency distribution of liver diseases in dogs
seen in dogs and cats.*
and cats.
Disease categories
Liver Etiology Dogs* Frequency (%)
25
Reactive hepatitis
Hepatitis** Immune mediated Chronic hepatitis/cirrhosis 17
Viral Portosystemic shunts 16
Bacterial Liver tumors (primary, metastases) 14
Drug induced Malignant lymphoma 14
Reactive Other conditions 12
Toxins Extrahepatic cholestasis 2
Lobular dissecting Cats**
Storage disorders** Copper toxicosis Lipidosis (idiopathic and secondary) 26
Lipidosis Cholangitis 25
Amyloidosis Neoplasia (malignant and benign) 20
Steroid-induced hepatopathy Reactive hepatopathies 16
Circulatory disorders** Hereditary portosystemic shunt Other conditions 8
Portal vein hypoplasia Vascular anomalies 5
Portal vein thrombosis
Arteriovenous fístula *Adapted from Rothuizen J, Meyer HP. History, physical exami-
Neoplasia Metastases nation, and signs of liver disease. In: Ettinger SJ, Feldman EC,
Malignant lymphoma eds. Textbook of Veterinary Internal Medicine: Diseases of the
Hemangiosarcoma Dog and Cat, 5th ed. Philadelphia, PA: WB Saunders Co, 2000;
Hepatocellular carcinoma 1272-1277.
Biliary tract **Twedt DC. 175 consecutive liver biopsies in cats:
Cholangitis** Bacterial/immune mediated Unpublished data. College of Veterinary Medicine and
(Neutrophilic/lymphocytic) Drug induced Biomedical Sciences, Colorado State University, Fort Collins,
Cholecystitis Bacterial Colorado.
Choleliths Bilirubin
Cholesterol
Neoplasia Cholangiocarcinoma
Extrahepatic cholestasis Pancreatitis
(Not covered by above) Pancreatic/intestinal tumor Table 68-4. Clinical signs that most often accompany primary
liver disease in dogs.*
*Adapted from Meyer HP. Hepatic encephalopathy: An
overview. In: Proceedings of the Hill’s European Symposium on Signs Frequency of occurrence (%)
Canine and Feline Liver Disease, Amsterdam, 2000, ISBN 0- Apathy and listlessness 60
9540567-0-1, pp 24-28. Reduced appetite 59
**Hepatic encephalopathy may be present. Vomiting 58
Weight loss 50
Polydipsia/polyuria 45
Diarrhea 27
Reduced endurance 27
ic disease include: 1) anorexia, nausea and vomiting, 2) im- Ascites 25
paired nutrient digestion, absorption and metabolism, 3) Neurologic signs 12
Icterus 12
increased energy requirements and 4) accelerated protein catab- Acholic feces 7
olism with impaired protein synthesis (Marks et al, 1994).
Nutritional management of hepatobiliary disease is usually *Adapted from Rothuizen J, Meyer HP. History, physical exami-
nation, and signs of liver disease. In: Ettinger SJ, Feldman EC,
directed at clinical manifestations of the disease rather than the eds. Textbook of Veterinary Internal Medicine: Diseases of the
specific cause. The goals of nutritional management for hepa- Dog and Cat, 5th ed. Philadelphia, PA: WB Saunders Co, 2000;
tobiliary disease include: 1) maintaining normal metabolic 1272-1277.
processes and homeostasis, 2) avoiding and managing HE, 3)
providing substrates to support hepatocellular repair and regen-
eration, 4) decreasing further oxidative damage to damaged treatment. This section considers the expected clinical signs of
liver tissue and 5) correcting electrolyte disturbances (Center, liver disease and the difficulties in interpreting them.
1998; Blackburn and O’Keefe, 1989). Table 68-4 lists the most important clinical signs and the fre-
quencies with which they occur in primary liver diseases.These
PATIENT ASSESSMENT signs occur in a variety of combinations in many liver diseases.
Physical findings are often similar and include lethargy, neuro-
History and Physical Examination logic signs, low body condition score (BCS), icterus and ascites.
Recognition of liver disease based on history and clinical signs GI abnormalities include anorexia, vomiting and diarrhea
is usually difficult. Signs are often nonspecific and few indica- (Center, 1995). Ptyalism (hypersalivation) is especially com-
tions of liver disease are found on physical examination. Con- mon in cats (Figure 68-1) with HE. Hematemesis suggests GI
sequently without appropriate laboratory evaluation, liver dis- ulceration, which can also be a complication of hepatobiliary
orders are often overlooked and either the patient recovers disease. The anorexia, GI disturbances and metabolic alter-
without treatment or becomes worse despite symptomatic ations associated with liver disease often contribute to chronic