HEPATOBILIARY SYSTEM

AND ASSOCIATED AILMENTS

IN DOGS
 PREVIEW
PREVIEW
• INTRODUCTION.

• ANATOMY OF HEPATOBILIARY SYSTEM.

• FUNCTION OF LIVER.

• CONDITION AFFECTING THE HEPATOBILIARY

SYSTEM.

• JAUNDICE AND ASCITES.

• TREATMENT.

• CONCLUSION .
 INTRODUCTION

• The HEPATOBILIARY SYSTEM :

refers to the liver, gall bladder and
bile ducts, and how they work
together to make Bile.

Bile consists of water, electrolytes, bile acids, cholesterol,

phospholipids and conjugated bilirubin. Some components are
synthesised by liver cells, the rest are extracted from the
blood by the liver.
 INTRODUCTION
 Largest visceral organ

 Functions – multiple

 Injurious agents: myriads

 Clinical signs: variable

 Size :
Carnivores 3-4% body weight
Omnivores 2% body weight
Herbivores 1% body Weight
 ANATOMY
Bile
canaliculi

Interlobular
duct

Lobar duct
(B4 leaving liver)

Hepatic duct Position of Gallbladder :

within a fossa between the rt medial &
quadrate lobes.
Common
bile duct
 ANATOMY
• Biliary tree :
– Various channels that collect
bile from the hepatic
parenchyma and transport it to
the duodenum constitute the
biliary tree.

• Portal triad : Consist of the

following structure -
• Hepatic artery.
• Hepatic portal vein.
• Common bile duct.
• Lymphatic vessels.
• Branch of vagus nerve.
 FUNCTIONS OF THE LIVER - I
• Metabolic :
Synthesizes Protein : Albumin major protein.

Carbohydrates homeostasis : via gluconeogenesis

and glucogenolysis.

Lipid metabolism : degraded to Acetylcoenzyme A a

key molecule in synthesis of ATP, Cholesterol and
phospolipids.

Stores Vits and Minerals.

Metabolises hormones and Drugs.

Converts fattyacid to Ketones.

 FUNCTIONS OF THE LIVER - II

• Humoral function:
 Insulin degraded 50%.

 T4 to T3 conversion.

 Aldosterone, estrogen, androgen, ADH – all are

inactivated by the liver.

 Production of Blood clotting factors.

• Immunogenic function:
 Kupffer cells phagocytose antigen.
 BILE PRODUCTION

• Produced in the hepatocytes; Secretion of bile - one of the major

function of liver.

• Consist of water, electrolytes, Bile acids, bile salts, bilirubin,

cholesterol, and certain products of organic metabolism.

• Bile acids are synthesized from cholesterol.

• Bile salts formed within hepatocytes & secreted as (Na+) (K+)

salts.
 BILE PRODUCTION
• Biles secreted into the duodenum, reabsorbed in the ileum, and
then carried back to the liver for reexcretion. . 90% of bile is
recirculated (process called enterohepatic circulation).

• functions in the digestion and absorption of fats and fat-soluble

vitamins.

• serves as a vehicle for excretion of bilirubin (major waste), excess

cholesterol, and metabolic end-products that cannot be eliminated
in the urine.

• Major waste in Bile is Bilirubin, conjugated with glucoronic acid.

 COMMON AFFECTION OF LIVER

• Liver Tumors - Cancers can develop in many areas in and

around the liver and come in many forms. HCC
(hepatocelluar carcinoma)
– Metastatic Colorectal Cancer
– Neuroendocrine Cancer
– Other Metastatic Tumor

• Benign Liver Lesions

– Hepatic Cyst
– Hemangioma
– Adenoma
– Focal Nodular Hyperplasia (FNH)
 COMMON AFFECTION OF LIVER

• Biliary mucoceles
– accumulation of mucinous bile in the gall bladder, cystic duct
and common bile duct resulting in variable degrees of bile
duct obstruction, leading to distension and eventually rupture
of the gallbladder.

– Affected dogs are 3–14 yr old; there is no gender

predisposition

– Predisposing factors:
– middle to older age dogs,
– hyperlipidemia or hypercholesterolemia,
– gallbladder dysmotility,
– cystic hyperplasia of the gallbladder mucosa
 COMMON AFFECTION OF LIVER

• Acute Liver Failure

– condition characterized by the sudden loss of 70 percent or more of the
liver's function due to sudden, massive, hepatic necrosis (tissue death in
the liver).

– can affect the body through a number of system failures:

• Gastrointestinal: vomiting, diarrhea, blood in the stool (hematochezia)

• Nervous system: hepatic encephalopathy (brain disease related to liver failure)

• Hepatobiliary: the liver plus the gallbladder; jaundice, necrosis (tissue death) of the liver
cells and bile duct cells.

• Renal: the tubules of the kidney may be injured from toxins/metabolites

• Immune/Lymphatic/Hemic: imbalances in the blood and lymphaticsystems, may lead to

coagulant (clotting) complications
 COMMON AFFECTION OF LIVER

• Acute Liver Failure

– Causes :
• Infectious agents or toxins.

• poor flow of fluids into the liver and surrounding tissues

(perfusion).

• hypoxia (inability to breathe).

• drugs or chemicals that are destructive to the liver (hepatotoxic).

• also occurs due to extensive metabolic disorders :

– protein synthesis (albumin, transport protein, pro-coagulant
and anticoagulant protein factors)
– glucose absorption
–
 COMMON AFFECTION OF LIVER

Extrahepatobiliary tract disease

Basically leads to obstruction of the common bile duct.

– Associated with following conditions :

• Inflammation (eg, pancreatitis, duodenitis, etc),
• Cholelithiasis,
• gallbladder mucocele,
• choledochitis/cholecystitis,
• neoplasia,
• parasitic infection,
• fibrosis, and strictures,
• Trauma.
 SYMPTOMS OF LIVER AFFECTION
Affected pet show variety of physical symptoms; very few are
specific for liver disease; most are signs of multiple
diseases and conditions.
Generalised Symptoms :
Loss of appetite Dehydration
Weight loss Increased thirst/water intake (polydipsia)
Nausea Increased frequency of urination
Vomiting (often intermittent but
(pollakiuria)
usually chronic)
Increased volume of urine output
Depression, Lethargy, Weakness
Disinterest in normal activities (polyuria)
(apathy)
Unkempt hair coat
Diarrhea (less common than Abdominal enlargement or distention
vomiting) (bloated appearance)
 SYMPTOMS OF LIVER AFFECTION

More specific symptoms :

Jaundice :

 yellow staining of the skin and

mucous membranes, caused by build-up of
the bile pigment, bilirubin, in circulation.

 Can turn a dog’s urine into bright,

yellowish-orange color (bilirubinuria).

 causes a yellow appearance to the

whites of the eyes, mucous membrane of the
tongue, gums and ear pinnas.)
Contd/-
 SYMPTOMS OF LIVER AFFECTION

Abnormal fecal color and consistency :

 Acholic feces – or changes in fecal color –caused by an

absence of bile pigments in the intestinal tract due to
abnormal retention in the blood, which makes the dog’s stools
pale and putty-colored

 Normally indicates complete bile duct obstruction

associated with liver disease.

Contd/-
 SYMPTOMS OF LIVER AFFECTION

Spontaneous bleeding disorders :

 often have problems with coagulation, or clotting of

their blood, called “coagulopathies”.

 the upper gastrointestinal tract – usually the stomach

and duodenum, is most commonly affected by coagulation
disorders associated with liver disease.

 leads to gastrointestinal bleeding/hemorrhage, which

is detected in dogs’ stools.

 Affected dogs may also vomit blood and/or have visible

blood in their urine.
Contd/-
SYMPTOMS OF LIVER AFFECTION

Fluid in the abdomen (Ascites)

Blood in the feces (hematochezia)

Blood in the urine (hematuria)

Blood in the vomitus (hematemesis)

Contd/-
 SYMPTOMS OF LIVER AFFECTION

Neurological and behavioral changes:

 Commonly seen in late-stage of liver disease.
 Caused by high levels of circulating toxins that normally
are removed by a healthy liver.
 When these toxins accumulate in the brain, the dog
develops a condition called hepatic encephalopathy,

Contd/-
 SYMPTOMS OF LIVER AFFECTION

Signs/Symptoms:
• Aggression • Dementia
• Agitation • Stupor
• Disorientation • Pacing
• Restlessness • Head-pressing
• Trembling (tremors) • Blindness
• Circling • Excessive salivation (drooling)
• Lack of coordination (ataxia) • Generalized seizures
• Staggering • Collapse
• Aimless wandering • Coma
• Mental dullness

Contd/-
 SYMPTOMS OF LIVER AFFECTION

Debilitating skin disorder (referred as hepatocutaneous

syndrome) :
Seen in Dogs with advanced liver disease. Signs are :

Sores/lesions on the footpads (thickened, crusted,

ulcerated).
Foot pain.
Reluctance to rise, walk, exercise or play.
Itchiness (pruritis) of the feet.
Redness between the toes (interdigital erythema)
Sores/lesions on the ear flaps, external genitalia,
oral cavity, eyes, elbows, lower abdomen or elsewhere

Contd/-
JAUNDICE

Contd/-
 EVALUATION OF LIVER FUNCTION
• Laboratory tests:
• ALT, AST, Alkaline phosphatase,
• Serum albumin, Gamma globulin.
• PT
• Antinuclear antibody
• Chronic active Hepatitis

• Antimitochondrial antibody
• Primary biliary chirosis

• Radiologic techniques
• Ultrasound although Cholangiograpy can be used.
 SUMMARY
• Liver function includes:
• Protein synthesis.
• Drugs fat and hormone metabolism.
• Immunological function.
• Bilirubin formation and excretion.
• Glucose homeostasis.
 SUMMARY
• For acute hepatitis:
• Postpone all elective procedures

• For unexpected high transaminase levels :

• Repeat LFT’s, if stable or decreasing can proceed with surgery.

• If chronic Liver disease pre Op issues includes:

• GI haemorrhages
• Ascitis electrolyte imbalances
• Hypoglycemia
• Coagulopathy and bleeding disorder.
 SUMMARY
• In Chronic liver disease intra-operatively:
• Avoid or reduce drugs that are eliminated through liver.
• IV induction agents are considered safe.
• Inhalation agents
• Use Isoflurane, avoid halothane
• Opiods can be used.
• Maintain intravascular volume
• Consider replacing 50 ml of 25% Albumin for each liter of ascites fluid removed.

• If chronic Liver disease pre Op issues includes:

• GI haemorrhages
• Ascitis electrolyte imbalances
• Hypoglycemia
• Coagulopathy and bleeding disorder.
 QUIZ
• The liver, biliary tree and the gallbladder occupy th e right upper quadrant of
the abdominal cavity, in contract with diaphragm.
• 75% of blood entering the liver is venous blood from the portal vein. 25% of the
blood supply to the liver is arterial blood from the hepatic artery.
• A complex fluid containing water, electrolytes and a battery of organic
molecules including bile acids, cholesterol, phospholipids and bilirubin that
flows through the biliary tract into the small intestine.
• The grouping of bile duct, hepatic arteriole and portal venule is called a portal
triad.
• Many waste products are eliminated from the body by secretion into bile and
elimination in feces

• As bile flows through the bile ducts it is modified by adding watery bicarbonate-
rich secretion from the ductal epithelium
 QUIZ
• Bile acid is derived of cholesterol synthesis in the hepatocyte.

• Bile acids have detergent action on particles of dietary fat which causes fat globules to
break down or be emulsified into minute, microscopic droplets.

• Approximately 95% of the bile acids delivered to the duodenum are absorbed back into
blood within the ileum

• Major waste excreted through Bile is conjugated Bilirubin (conj with glucoronic acid).

• In blood bilirubin is bound to albumin.

• Terminal branches of the hepatic portal veins and hepatic artery empty together and
mix as they enter sinusoids in the liver

• Bile aids in the digestion of fats.