Hepatobiliary Disease

This module focuses on reviewing the anatomy and physiology of the liver as a critical starting point to appreciate the pathophysiology leading to the various presentations of liver disease, understanding histopathology reports and to developing a rational approach to diagnosis and management.

Learning outcomes

To be able to

• Summarise the key points of hepatobiliary anatomy to aid clinical understanding of pathophysiology and histopathology.
• Outline the key physiologic processes in the liver.
• Briefly explain the ammonia cycle.
• Describe the way that the liver processes drugs and responds to disease.

This module covers the start of the clinical process with the first part looking at history, presentation and differential diagnosis. The second half covers blood tests that look at liver damage and liver function ensuring that the full implications and breadth of test results are considered, and the maximum information is obtained from the investigation undertaken.

Learning outcomes

To be able to

• Construct a differential list for jaundice (icterus).
• Summarise the causes of abdominal enlargement and reasons for ascites forming.
• Describe the key features of hepatic encephalopathy and why it occurs.
• Explain, in detail, what raised liver enzymes signify and what factors can be used to estimate liver function.

This module covers the next steps in defining liver disease discussing different imaging techniques, their strengths and weaknesses along with typical changes that will occur. Following imaging sampling of the liver diagnosis often requires sampling of the liver and bile. Various techniques are available with different benefits and risks that are discussed. Once diagnosis is reached, management needs to be rational and as evidence-based as possible; various options are presented to provide a broad overview of the principles of treatment.

Learning outcomes

To be able to

• Summarise the pros and cons of different types of imaging.
• Explain the benefits and risks of the various sampling options for investigating hepatobiliary disease.
• Understand the general principles of treatment and to design and communicate to an owner the option for management of their pet’s condition.

Two of the most common causes of primary hepatobiliary disease are inflammation and infection. This module provides a summary of common causes of acute and chronic hepatobiliary disease including the approach to diagnosis and management.

Learning outcomes

To be able to

• Outline the various causes of acute liver failure (ALF) and the approach to management of patients with ALF.
• Describe the pathophysiology of canine chronic hepatitis, listing the causes and explain the approach to diagnosis and prognosis.
• Explain the differences between the various forms of feline chronic liver disease, how they present along with appropriate treatment options for each form.

Portovascular anomalies and neoplasia are less commonly encountered than inflammatory and infectious disease as a cause of hepatobiliary disease depending on the patient demographic. This module discusses the presentation, diagnosis and management of PSS in dogs and cats detailing the various options available and the prognosis associated with different types of management.

Primary hepatobiliary neoplasia is relatively uncommon  with a variety of tumour types being documented. The approach to diagnosis and a brief outline of treatment options is presented.

Learning outcomes

To be able to

• Summarise the presentation of portovascular anomalies and how the diagnosis can be confirmed.
• Explain to an owner the treatment options available and published outcomes.
• Outline how hepatobiliary neoplasms present and the role of imaging and sampling in diagnosis.

Gall bladder disease seems to be becoming more common (commonly diagnosed) in cats and dogs particularly mucocoeles. This module will cover the approach to and management of acute and chronic gall bladder disease. Secondary hepatopathies are very common and are more of a whole patient approach to diagnosis, as vacuolar hepatopathy is so common the basics will be presented.

The final part of the module covers diseases that have not be covered elsewhere namely copper storage disease (also module 4), hepatic lipidosis and hepatic abscessation

There are a huge list of other diseases of the liver that are briefly presented for completeness and reference.

Learning outcomes

To be able to

• Describe the various presentation of gall bladder disease and their differentiation.

This module will present cases of hepatobiliary disease in cats and dogs for delegates to work through using a logical and evidenced-based approach.

Learning outcome

Consolidate learnings from modules 1-6 by applying them to two case examples.