Adrenal function in cats with cholestatic liver disease.

Cats with cholestatic liver disease experience significant morbidity and mortality when they undergo invasive procedures under anesthesia. Although inadequate adrenal response might account for these outcomes, adrenal function in cats with cholestatic liver disease has not been documented, to our knowledge. The goal of our study was to describe adrenal function in these cats. Twenty-seven cats with a serum bilirubin >230 µmol/L (3 mg/dL) and serum alanine aminotransferase >2 times the upper limit of normal had pre- and 60-min post-adrenocorticotropic hormone (ACTH) cortisol analysis after administration of 5 µg/kg cosyntropin intravenously. The change in cortisol concentrations (delta cortisol) was calculated. Pre- and post-ACTH cortisol concentrations were compared to reference values. Pre-ACTH, post-ACTH, and delta cortisol values were compared between cats surviving to discharge or for 30 d postdischarge. Mean pre-ACTH cortisol levels (205 ± 113 nmol/L [7.4 ± 4.2 µg/dL]) and post-ACTH cortisol levels (440 ± 113 nmol/L [15.9 ± 4.1 g/dL]) in cholestatic cats were significantly greater than reference values in clinically normal cats. There was no association of pre- or post-ACTH cortisol with survival. Cats with a delta cortisol <179 nmol/L (6.5 µg/dL) were more likely to be non-survivors at 30 d post-discharge ( p = 0.037) than cats with delta cortisol >179 nmol/L (6.5 µg/dL). Results indicate that cats with cholestasis have high basal and ACTH-stimulated cortisol values. A delta cortisol <179 nmol/L (6.5 µg/dL) defines a population of cats that have decreased 30-d survival.

Bacterial cholangiohepatitis in a dog.

A 9-year-old female Yorkshire terrier was presented for vomiting and diarrhea. Blood chemistry tests revealed hepatic dysfunction, cholestasis, and inflammation. Liver ultrasonography and liver biopsy were consistent with cholangiohepatitis. Fine-needle aspiration of the gallbladder revealed the presence of bacteria later identified as Clostridium spp. The cholangiohepatitis was successfully treated.

Hepatobiliary scintigraphy in the evaluation of feline liver disease.

Hepatobiliary scintigraphy (HBS) was performed in 10 cats with histologically documented hepatobiliary disease. The scintigraphic patterns were classified into one of 5 categories: normal, primary hepatocellular dysfunction, primary intrahepatic cholestasis, mixed hepatocellular and intrahepatic cholestasis, and extrahepatic obstructive patterns. Initial attempts were made to correlate specific disease entities with HBS patterns, but a consistent relationship could not be determined. A correlation between the histological severity of a given hepatic disease and the HBS pattern was made. All cats (n = 5) with a mixed hepatocellular and intrahepatic cholestasis scintigraphic pattern with normal gallbladder function had a histologically severe form of their individual hepatic disease. Three of the 4 cats with an intrahepatic cholestasis pattern and normal hepatocellular and gallbladder function had histologically mild or moderate forms of their individual hepatic diseases. One cat had an extrahepatic obstructive pattern where no radiopharmaceutical was identified in the gallbladder or small intestine by 3 hours postinjection. This study suggests that HBS can be useful in cats with hepatobiliary disease to assess the severity of hepatic dysfunction, and to determine if extrahepatic biliary obstruction is present. Correlation between HBS patterns and specific disease entities such as hepatic lipidosis or cholangitis-cholangiohepatitis syndrome could not be made in this study.

Feline cholangiohepatitis complex.

Feline cholangiohepatitis complex causes a diffuse intrahepatic cholestasis of unknown etiology. Recognized histologic forms include acute suppurative cholangitis/cholangiohepatitis, long-term nonsuppurative cholangitis/cholangiohepatitis, and biliary cirrhosis. Treatment of cholangiohepatitis complex varies based on histologic type. Thus a liver biopsy is necessary for definitive diagnosis and treatment. Because cholangiohepatitis complex causes diffuse hepatic change, percutaneous needle biopsies are often sufficient for obtaining a diagnosis. Antibiotics are used to treat all forms of feline cholangiohepatitis complex, but steroids may be of equal or greater importance for use in the treatment of long-term nonsuppurative cholangiohepatitis. Prognosis is guarded for cats with any form of cholangiohepatitis complex due to the variable response to treatment seen in many cats. Spontaneous remission occasionally occurs.

Ultrasonographic findings in horses with cholelithiasis: eight cases (1985-1987).

Cholelithiasis and/or obstructive biliary tract disease was diagnosed ultrasonographically in 8 horses, 5 to 15 years old. Ultrasonographic findings revealed greater than normal amount of hepatic parenchyma in the right side of the abdomen in 8 horses and in the left side in 3 horses. The echogenicity of the liver was greater than normal, and thick distended bile ducts were seen in all horses. Choleliths were imaged ultrasonographically in 6 horses. Subsequently, postmortem findings in 6 horses revealed periportal and intralobular fibrosis, moderate bile duct dilatation, proliferation, and cholestasis. One or more choleliths were found in all horses. Ultrasonographic findings accurately depicted the histologic changes in the hepatic parenchyma in horses with cholelithiasis.

Destructive cholangiolitis in seven dogs.

In seven dogs presented with clinical signs and laboratory data suggestive of extrahepatic cholestasis, destructive cholangiolitis was diagnosed. The diagnosis was based on the absence of extrahepatic cholestasis at laparoscopy, laparotomy and/or post-mortem examination, and the presence of specific liver lesions i.e. loss of bile ducts in the smaller portal areas. The disease is compared with drug-induced (chlorpromazine) cholestasis in man. In two dogs clinical signs were preceded by longstanding respectively repeated sulphonamide medication.

Serum bile acid analysis in dogs with experimentally induced cholestatic jaundice.

Serum bile acid (SBA) concentration was determined weekly for 4 weeks in dogs with experimentally induced hyperbilirubinemic liver disease. Obstructive jaundice was created in 6 dogs by surgical ligation of the common bile duct, and hepatocellular jaundice was created in 6 sham-operated dogs by administration of dimethylnitrosamine; 6 other sham-operated dogs served as controls. Serum bile acid concentration increased rapidly after bile duct ligation (from 0.6 +/- 0.1 to 69.2 +/- 15.3 mumol/L at 3 days), peaked at 14 days (247.8 +/- 54.1 mumol/L), and then gradually decreased (179.9 +/- 27.1 mumol/L at 28 days). Serum bile acid concentration in dimethylnitrosamine-treated dogs increased more gradually to 38.9 +/- 10.7 mumol/L at 28 days, at which time the serum bilirubin concentration was comparable with that of bile duct-ligated dogs. Mean total SBA values in bile duct-ligated dogs were significantly (P less than 0.01) higher than those in control and dimethylnitrosamine-treated dogs at days 3 through 28, with no overlap of individual values. Serum bile acid concentration at day 28 correlated positively (P less than 0.01) with cholestasis and bile duct proliferation observed in liver biopsy specimens, but did not correlate with necrosis or inflammation. Serum bile acid concentration also correlated positively (P less than 0.01) with serum bilirubin and cholesterol concentrations and with serum alkaline phosphatase and alanine transaminase activities. Results of the study reported here indicated a relationship between SBA concentration and cholestasis in dogs; extrahepatic bile duct obstruction resulted in the highest SBA values.(ABSTRACT TRUNCATED AT 250 WORDS)

Clearance of indocyanine green in dogs with partial hepatectomy, hepatic duct ligation, and passive hepatic congestion.

Clearance of 5 submaximal doses of indocyanine green (ICG) was measured in 5 dogs to determine the maximal removal rate (0.188 mg/kg of body weight/min) and Michaelis constant (Km, 1.25 mg/kg). From these results, 5 mg of ICG/kg of body weight was chosen on the basis of the recommendation that the dose should be at least 4 X Km to achieve sensitivity as a measure of hepatic function and independence from hepatic blood flow. Clearances of low (0.5 mg/kg) and high (5 mg/kg) doses of ICG were measured in 35 healthy dogs to determine reference values. Fractional disappearance was 15.1 +/- 10%/min for the low dose and 3.9 +/- 1%/min for the high dose; plasma half-life was 6.3 +/- 3.6 minutes and 19 +/- 4.8 minutes, respectively. The sensitivity of 2 doses of ICG was evaluated in dogs with 20% and 40% hepatectomy, nonhyperbilirubinemic obstructive cholestasis, or hepatic congestion; sham-operated dogs served as controls. Fractional disappearance and plasma half-life of ICG in the 40% hepatectomy and hepatic congestion groups were significantly different (P less than 0.05) from those in controls using both ICG doses, indicating that both doses were affected by hepatic perfusion, as well as hepatic mass. The fractional disappearance of the dye in the cholestasis group also differed significantly (P less than 0.05) from that of the controls at the high dose. Plasma clearance of both doses by dogs with 20% hepatectomy was not significantly different from that of controls.

Plasma amino acid analysis in dogs with experimentally induced hepatocellular and obstructive jaundice.

Plasma amino acid concentrations were determined weekly for 4 weeks in 6 sham-operated control dogs, in 6 sham-operated dogs after induction of liver disease with dimethylnitrosamine (DMNA), and in 6 dogs after surgical ligation of the common bile duct. Results were compared with standard biochemical indices of liver function and with histologic changes in serial liver biopsy specimens. Concentrations of most amino acids increased after 2 weeks in DMNA-treated dogs, whereas they were normal or decreased in bile duct-ligated dogs. With increasing severity of the liver disease, the molar ratio (normal mean +/- SEM = 3.48 +/- 0.14) in DMNA-treated dogs decreased to 2.42 +/- 0.19 by 2 weeks and to 1.17 +/- 0.09 by 4 weeks. The ratio remained normal in bile duct-ligated dogs. Molar ratio and aromatic amino acid concentrations correlated better with hepatic necrosis and inflammation than did standard biochemical indices (eg, bilirubin, liver enzymes). Therefore, plasma amino acid analysis and determination of the molar ratio may be useful in the differential diagnosis of hepatocellular and obstructive jaundice in dogs. A decrease in the molar ratio may reflect portal hypertension and hepatocellular disease.

Extrahepatic cholestasis in the dog and the differentiation of extrahepatic and intrahepatic cholestasis.

The clinical and pathological features of extrahepatic cholestasis in 19 dogs are presented. The condition was most often caused by partial or complete occlusion of the choledochal duct due to neoplastic diseases (12 cases), inflammatory processes (3 cases), or eventration and incarceration of the liver (1 case). In only three cases was the condition due to intraluminal obstruction of the choledochal duct. The anamnestic, laboratory and pathological parameters of these 19 dogs were compared with the findings in 21 dogs with intrahepatic cholestasis. Statistical analysis of these parameters indicated that the presence of acholic faeces, the degree of icterus and the level of plasma gamma GT where the only parameters of value in the clinical differentiation of extrahepatic from intrahepatic cholestasis. Histological examination of liver biopsies is a simple aid to a confident in vivo diagnosis of extrahepatic cholestasis.

Bile acid concentrations in the diagnosis of hepatobiliary disease in the dog.

The clinical usefulness of measuring serum bile acid concentrations as a diagnostic test for hepatobiliary disease, was examined in 150 dogs that were suspected of having hepatic disease. Serum values of total bilirubin (TB), alkaline phosphatase (ALP), alanine transaminase (ALT), and albumin were also measured. Fasting serum bile acid (FSBA) values were determined, using a solid-phase radioimmunoassay for total conjugated bile acids or a direct enzymatic spectrophotometric method. A definitive diagnosis was established by histologic examination of the liver. On the basis of histologic findings, dogs were assigned to groups (1 to 8, respectively) including: extrahepatic bile duct obstruction, cirrhosis, portal systemic vascular anastomosis (PSVA), hepatic necrosis, intrahepatic cholestasis, steroid hepatopathy, neoplasia, and secondary disease. Dogs in group 8 had no morphologic evidence of hepatobiliary disease or had mild hepatic lesions. Test efficacies of FSBA, TB, ALP, ALT, and albumin were expressed using 4 indices: sensitivity, specificity, and positive-predictive and negative-predictive values. The diagnostic efficacy of FSBA was examined alone and in combinations with the other tests. There was wide overlapping of FSBA values among dogs in groups 1 to 7, and there was wide overlapping of ALT and ALP values among dogs in all groups. The specificity of FSBA for the diagnosis of liver disease exceeded 90% at values greater than or equal to 30 mumol/L and reached 100% at greater than or equal to 50 mumol/L. Individual liver tests with the best sensitivity for each group were:FSBA and ALP for extrahepatic bile duct obstruction; FSBA for cirrhosis and PSVA; ALT for hepatic necrosis; and ALP for intrahepatic cholestasis, steroid hepatopathy, and neoplasia. Combinations of tests with the best sensitivity for each group were: FSBA + ALP for extrahepatic bile duct obstruction; FSBA + ALT for cirrhosis and PSVA; FSBA + ALT and TB + ALT for hepatic necrosis; and FSBA + ALP for intrahepatic cholestasis, steroid hepatopathy, and neoplasia. Individual tests had the best sensitivity.(ABSTRACT TRUNCATED AT 250 WORDS)

Cholestasis.

Cholestasis can be caused by extrahepatic and intrahepatic pathogenic mechanisms that affect cellular and subcellular functions. The retention of bile results in numerous biochemical abnormalities, some of which are useful as clinical tests. The clinicopathologic findings are often suggestive of the underlying hepatobiliary disorder but are seldom diagnostic.

Chronic active hepatitis in Doberman pinschers.

Eleven Doberman Pinschers were affected with a disease that had clinical signs, serum biochemical abnormalities, and histologic features of chronic active hepatitis. Intrahepatic cholestasis and accumulations excess hepatic copper were prominent features. Most of the dogs deteriorated within weeks to months, and 6 died within 9 months after the 1st signs of disease were noticed.