Which of the following is true about the portal system afferent blood supply?

Low pressure, 80% of blood supply that enters liver

Which diet is best for a cat with triaditis?

Novel protein/hypoallergenic diet

Which antibiotics are excreted in the active form in bile?

Amoxicillin, Cephazolin, Enrofloxacin

What is the treatment of choice for attenuating a portosystemic shunt (PSS)?

Gradual occlusion with Ameroid constrictor

DDX list = PSS & MVD. You measure Protein C levels. The results come back lower than normal. What does this mean?

The dog has a portosystemic shunt

Persistsent ductus venosus is often associated with which liver condition?

Intrahepatic porto-systemic shunt

Which of the following is a potential complication of complete ligation of a portosystemic shunt (PSS)?

Portal hypertension leading to ascites and abdominal pain

What is the primary mechanism by which the Ameroid constrictor works to attenuate a shunt?

Inducing a local inflammatory response leading to fibrosis

If ammonia levels are normal, what does that mean?

We cannot rule out hepatic encephalopathy yet

Which of the following is true about the portal system afferent blood supply?

Low pressure, 80% of blood supply that enters liver

Which is true about cholangitis in cats?

Its a non-obstructive biliary disease secondary to GI disease

Which surgical attenuation is ONLY used for intrahepatic portosystemic shunts?

Percutaneous transjugular coil embolization

Considering the top differentials for infectious causes, what is a good empirical therapy plan?

Ampicillin, metronidazole, fluoroquinolone

Inflammatory and infectious cholangitis

DDX list = PSS & MVD. You measure Protein C levels. The results come back normal. What does this mean?

The dog has microvascular dysplasia

What are the 2 most common etiologies of end-stage liver disease?

Inflammatory & vascular liver disease

What is the appropriate empirical treatment for cholangitis?

Ursodiol, SAM-e, prednisolone, antibiotics

What surgical approach will occlude the shunt the fastest?

Percutaneous transjugular coil embolization

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SA Med II - Liver

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Questions 84

Answers

1
Which of the following is true about the portal system afferent blood supply?
High pressure, 20% of blood supply, branches from hepatic artery
Low pressure, 20% of blood supply, branches from hepatic artery
High pressure, 80% of blood supply that enters liver
Low pressure, 80% of blood supply that enters liver
2
Which diet is best for a cat with triaditis?
Ultra low fat diet
Dynamatize mass gainer
Liver diet
Novel protein/hypoallergenic diet
3
look
Protein C
CT with angiography
Abdominal ultrasound
Bile acids
4
What is the most common complication seen when performing a total lobectomy of the liver?
Sepsis
Ascites
Portal hypotension
Hemorrhage
5
What test is used to detect decreased platelets seen in chronic hepatopathies & lepto?
PT
Fibrinogen
TEG
CBC
6
When performing a total lobectomy, which lobes require dissection around the vena cava?
Right lateral and quadrant
Quadrant and caudate
Right lateral and caudate
Left lateral and caudate
7
If chelation therapy is not possible, what is your go-to treatment for copper hepatopathy?
Anti-inflammatory dose of Prednisone
D-penicillamine
No treatment
Metronidazole
8
Which feline patient is at the highest risk for developing feline hepatic lipidosis?
BCS 8/9 that is not eating
BCS 2/9 that is not eating
BCS 8/9 that is eating ravenously
BCS 2/9 that is eating ravenously
9
Which antibiotics are excreted in the active form in bile?
Amoxicillin, Cephazolin, Enrofloxacin
Penicllin, Azithromycin, Gentamicin
Clindamycin, Metronidazole, Amoxicillin
Doxycycline, Cephalexin, Ampicllin
10
What is the treatment of choice for attenuating a portosystemic shunt (PSS)?
Gradual occlusion with Ameroid constrictor
Immediate surgical removal of the shunt
Use of a stent in the caudal vena cava
Complete ligation of the shunt
11
DDX list = PSS & MVD. You measure Protein C levels. The results come back lower than normal. What does this mean?
The dog does not have PSS or MVD.
The dog has microvascular dysplasia
The results are inconclusive. Run test again
The dog has a portosystemic shunt
12
Secondary bacterial cholangitis is common in cats with...
Toxoplasam gondii
Hyperthyroidism
Inflammatory cholangitis
Lymphosarcoma
13
Persistsent ductus venosus is often associated with which liver condition?
Extrahepatic porto-systemic shunt
Hepatic lipidosis
Intrahepatic porto-systemic shunt
Hepatic encephalopathy
14
What is the best treatment for a cat with FIP?
Abdominal drain, whole blood transfusion, & prednisolone
No treatment
Ursodiol, prednisolone, & IV fluids
Furosemide, prednisolone, & SQ fluids
15
Which disease affects Shar-Pei dogs and presents as a hepatopathy?
Lobular dissecting hepatitis
Amyloidosis
Lysosomal storage disease
Copper associated hepatopathy
16
Clinical signs of circling, head-pressing and seizures is typically associated with which liver condition?
Intrahepatic porto-systemic shunt
Hepatic encephalopathy
Hepatic lipidosis
Extrahepatic porto-systemic shunt
17
What test best differentiates hepatic from post-hepatic icterus in this patient?
Ultrasound
Bile acids
Radiographs
Liver biopsy
18
Which of the following is most commonly found in Bernese Mountain Dogs?
Mast cell tumor
Hepatocellular carcinoma
Histiocytic sarcoma
Lymphoma
19
Which of the following is NOT occluded by the pringle maneuver?
Hepatic artery
Cranial vena cava
Common bile duct
Portal vein
20
Which medication should you use a low dose (or avoid) if you know there is something wrong with the liver?
Doxycline
Levetiracetam
Midazolam
Ursodial
21
What is the the ONLY way to diagnose a cat with an inflammatory liver disease?
Ultrasound
PCR
Liver biopsy
Post-mortem histopathology=
22
How do you diagnose a platynosum fastosum infection in cats?
Liver biopsy
Fecal
FNA w/cytology
IgG + IgM titers
23
Which of the following is a potential complication of complete ligation of a portosystemic shunt (PSS)?
Hypoglycemia due to liver overload
Increased risk of intestinal perforation
Portal hypertension leading to ascites and abdominal pain
Rapid resolution of symptoms
24
Which breed of does is NOT predisposed to copper hepatopathy?
GSD
Doberman
Laborador
Bedlington terrier
25
What is the primary mechanism by which the Ameroid constrictor works to attenuate a shunt?
Rapid thrombosis inside the shunt
Inducing a local inflammatory response leading to fibrosis
Swelling of casein inside a stainless steel sheath
Using a silicone-coated band to immediately occlude the shunt
26
Which surgical attenuation is ONLY used for extrahepatic portosystemic shunts?
Self-retaining polyacrylic acid-silicone device
Percutaneous transjugular coil embolization
Thin film bands
Ameroid constrictor
27
If ammonia levels are normal, what does that mean?
Check a UA to definitievly rule out hepatic encephalopathy
The patient definitely does not have a hepatic encephalopathy
We cannot rule out hepatic encephalopathy yet
The pateint definitely has hepatic encephalopathy
28
How long does it typically take for an Ameroid constrictor to achieve gradual occlusion of a portosystemic shunt?
2-3 weeks
6-8 weeks
Within 24 hours
4-5 weeks
29
What type of crystals are typically seen with portosystemic shunts?
Calcium oxalate crystals
Struvite crystals
Cystine crystals
Ammonium biurate crystals
30
Which of the following is most commonly found in Scottish Terriers?
Hepatocellular carcinoma
Mast cell tumor
Histiocytic sarcoma
Lymphoma
31
Which of the following is true about the portal system afferent blood supply?
Low pressure, 80% of blood supply that enters liver
High pressure, 20% of blood supply, branches from hepatic artery
High pressure, 80% of blood supply that enters liver
Low pressure, 20% of blood supply, branches from hepatic artery
32
Key difference b/w the use of self-retaining polyacrylic acid-silicone device vs ameroid constrictor & thin film band?
Does not rely on inflammation
Is an extremely invasive procdure
Causes rapid occlusion
Higher risk of causing shunt to twist on itself
33
For an overweight cat, hospitalized w/ anorexia, what values show the earliest change of hepatic lipidosis starting?
Bile acids
Ammonia
BUN, Glu, Alb
ALT, ALKP, Tbili
34
Which is true about cholangitis in cats?
Its a non-obstructive biliary disease secondary to GI disease
Its a non-obstructive biliary disease secondary to primary liver disease
Its an obstructive biliary disease secondary to primary liver disease
Its an obstructive biliary disease secondary to GI disease
35
Which enzyme is NEVER elevated in cats with hepatic lipidosis?
ALT
TBILI
ALP
GGT
36
Dog has a history of a raw food diet. Which liver infection is at the top of your DDX list?
Mushroom intoxication
Salmonella
Leptospirosis
Lymphosarcoma
37
Which of the following is not indicated in the treatment plan for a patient with a bacterial liver infection?
Enrofloxacin
Amoxicillin
Metronidazole
Neomycin
38
Which surgical attenuation is ONLY used for intrahepatic portosystemic shunts?
Thin film bands
Ameroid constrictor
Percutaneous transjugular coil embolization
Self-retaining polyacrylic acid-silicone device
39
What should be the only veins that enter the caudal vena cava in between the hepatic and renal veins?
Phrenicoabdominal veins
Cranial & caudal mesenteric veins
Gastroduodenal vein
Splenic & renal veins
40
Which of the following can be diagnosed with biopsy, but not FNA?
Hepatocellular carcinoma
Mast cell tumor
Histiocytic sarcoma
Lymphoma
41
What percent of cats with hyperthyroidism have hepatic lipidosis?
75%
50%
95%
10%
42
Considering the top differentials for infectious causes, what is a good empirical therapy plan?
Penicllin, Azithromycin, Gentamicin
Ampicillin, metronidazole, fluoroquinolone
Doxycycline, Cephalexin, Ampicllin
Doxycyline, cefazolin, Amoxiliccin
43
Which parasite lives in the biliary ducts & gallbladder & triggers inflammatory disease & can cause obstruction in cats?
Cytauxzoon
Toxoplasma gondii
Leishmania
Platynosum fastosum
44
Which of the following would NOT be seen in a dog with Infectious Canine Hepatitis?
Ocular discharge
Icterus
CNS involvement
Nasal discharge
45
look
Toxin and endocrine (hyperthyroidism)
Portosystemic shunt or portal vein hypoplasia
Inflammatory and infectious cholangitis
Hepatic lipidosis and small cell lymphoma
46
DDX list = PSS & MVD. You measure Protein C levels. The results come back normal. What does this mean?
The results are inconclusive. Run test again
The dog does not have PSS or MVD.
The dog has microvascular dysplasia
The dog has a portosystemic shunt
47
What are the 2 most common etiologies of end-stage liver disease?
Inflammatory & vascular liver disease
Inflammatory disease & toxins
Vascular disease & leptospirosis
Toxins & leptospirosis
48
What is the appropriate empirical treatment for cholangitis?
Ursodiol, SAM-e, prednisolone, antibiotics
Colchicine and silymarin
Chlorambucil and prednisolone
Hypoallergenic diet trial and probiotics
49
What surgical approach will occlude the shunt the fastest?
Ameroid constrictor
Thin film bands
Self-retaining polyacrylic acid-silicone device
Percutaneous transjugular coil embolization
50
Which breed is MOST predisposed to congenital portosystemic shunts (PSS)?
Miniature schnauzer
Dobermans
Yorkshire terrier
Golden retrievers
51
What is the best treatment for a cat with a non-obstructive Platynosum fastosum infection?
Clindamycin
Fenbendazole
Praziquantel
Metronidazole
52
Patient comes in for icterus. What is the quickest way to rule out pre-hepatic icterus?
Point-of-care US
Total bilirubin
Bile acids
PCV/TS
53
Biliary obstruction can alter which of the following?
Sodium/Potassium levels
Vitamin K absorption
Calcium levels
ATP absorption
54
Which diet is best for a dog with copper hepatopathy?
Dynamatize mass gainer
Novel protein/hypoallergenic diet
Liver diet
Ultra low fat diet
55
What is the best diet to give a dog with copper-associated hepatopathy?
Low fat, high protein
High copper, low fat
Low copper, high protein
Low copper, high zinc
56
look
NSAIDs
Prednisolone
Cholestyramine and Vitamin K
Ursodiol and anti-oxidant (like SAM-e)
57
What neoplasia is common in Scottish Terriers with Vacuolar Hepatopathy?
Hemangiosarcoma
Transitional cell carcinoma
Multicentric lymphoma
Hepatocellular carcinoma
58
What is the EMERGENCY treatment for hepatic encephalopathy in an obtunded patient actively seizing?
PO diazepam, PO lactulose, IM antibiotics.
IV levetiracetam, lactulose enemas, IV antibiotics.
PO levetiracetam, lactulose enemas, IV propofol.
Low protein diet via NE tube, PO lactulose, IV mannitol.
59
What is the next best test to differentiate between a genetic urate crystal producer or PSS/PVH?
Abdominal ultrasound
Bile acids
CT with angiography
Ammonia
60
What is the recommended diet for the long-term treatment of hepatic encephalopathy or portosystemic shunt?
high fat diet
low fat diet
high protein diet
low protein diet
61
Which of the following is true about the arterial system afferent blood supply?
High pressure, 80% of blood supply that enters liver
Low pressure, 20% of blood supply, branches from hepatic artery
High pressure, 20% of blood supply, branches from hepatic artery
Low pressure, 80% of blood supply that enters liver
62
Which test is diagnostic if a portosystemic shunt is suspected?
Liver biopsy
Bile acids
Radiographs
Ultrasound
63
What test is used to detect decreased synthesis of coagulation factors in acute hepatic failure?
PT
CBC
Fibrinogen
TEG
64
What is the best treatment for a cat with a toxoplasma gondii infection?
Praziquantel
Metronidazole
Fenbendazole
Clindamycin
65
Which test will help differentiate if a patient has a portosystemic shunt or microvascular dysplasia?
Protein C
Ammonia levels
Bile acids
Liver biopsy
66
What are the two main causes of ascites in liver patients?
Hypoalbuminemia & cirrhosis
Hypoalbuminemia & portal hypotension
Hyperalbuminemia & cirrhosis
Hyperalbuminemia & portal hypotension
67
What is the #1 MAIN treatment for a cat with hepatic lipidosis?
IV fluid therapy
Give a lactulose enema
Ursodiol & SAMe
Place a feeding tube and give them calories
68
A cat that has been diagnosed with atopy & is being treated with Cyclosporine is at greatest risk for which parasite?
Cytauxzoon
Leishmania
Platynosum fastosum
Toxoplasma gondii
69
If a bile acids test is negative, what does that mean?
The patient definitely does not have a PSS
We cannot rule out a PSS yet
The pateint definitely has a PSS
Check a UA to definitievly rule out PSS
70
Milk thistle/silymarin is the specific antidote for...
Nitrate
Mushrooms
Marijuana
Water hemlock
71
Which diet is best for a dog with hepatic encephalopathy?
Ultra low fat diet
Novel protein/hypoallergenic diet
Dynamatize mass gainer
Liver diet
72
What is the characteristic appearance of a portosystemic shunt during surgery?
Multiple small veins with pulsating blood flow
Thick-walled vessel with smooth blood flow
Thick, rigid vessel with no blood flow
Thin-walled vessel with turbulent blood flow
73
What is the classic enzyme pattern in cats with hepatic lipidosis?
Elevated ALP with elevated GGT
Decreased ALP with elevated GGT
Elevated ALP with a normal GGT
Decreased ALP with a normal GGT
74
What is the most important artery to find when performing a cholecystectomy?
Cystic artery
Hepatic artery
Renal artery
Carotid artery
75
Which dog breed is most predisposed to Vacuolar hepatopathy?
Miniature poodles
Dobermans
Yorkshire terriers
Scottish terriers
76
What is the BEST test to diagnose a toxic liver injury?
Radiographs
History
FNA
Biopsy
77
What is the best surgical approach for a portosystemic shunt?
Ventral midline celiotomy
Right flank celiotomy
Left flank celiotomy
Paramedian celiotomy
78
Where is the portal vein located when searching for a portosystemic shunt (PSS)?
Within the gastric wall
At the junction of the spleen and pancreas
Near the renal veins
Caudal to the liver, within the epiploic foramen
79
As long as ____% of hepatocytes remain after toxic injury, the liver can regenerate and have normal function.
10%
25%
60%
1%
80
Which diet is best for a patient with reactive hepatopathy?
Ultra low fat diet
Dynamatize mass gainer
Liver diet
Novel protein/hypoallergenic diet
81
What is the biggest negative prognostic indicator in patients with inflammatory hepatopathies?
Hyperalbuminemia
Hypoglobulinemia
Ascites
Thrombocytosis
82
Which of the following are the 2 BEST treatments for medical management of non-obstructive biliary disease?
Ultra low fat diet & Prednisolone
Prednisolone, Metronidazole, & Clavamox2
Ursodial & ultra low fat diet
Ursodial & Clavamox
83
What test is used to detect increased fibrinolysis seen in end-stage liver disease (cirrhosis)?
Fibrinogen
TEG
CBC
PT
84
Which medication is only indicated in Shar-Pei patients with amyloidosis?
Colchicine
Lactulose
Spironolactone
SAMe

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