Chapter 9 Liver Disease Questions

  1. Which of the following is the most consistent laboratory finding with acute hepatitis?
  2. Elevation in ALT
  3. Low albumin
  4. Low BUN (Urea)
  1. Hypoglycemia seen in cases of acute hepatitis can result from which of the following?
  2. Cortisol deficiency
  3. Increased insulin secretion
  4. Overwhelming infection (sepsis)
  1. Which of the following is an important zoonotic rule out in a case of acute hepatitis?
  2. Canine parainfluenza virus
  3. Leptospirosis
  4. Rocky mountain spotted fever
  1. To screen for disseminated intravascular coagulation (DIC) in cases of acute hepatitis, which of the following should be measured?
  2. C-reactive protein
  3. D-dimers
  4. Serum ammonia
  1. An enteral feeding tube should be utilized if animals with acute hepatitis will not ingest _% of their recommended caloric intake as calculated from their resting energy requirement (RER).
  2. 50%
  3. 70%
  4. 85%
  1. With of the following would be a cause of ascites associated with chronic hepatitis?
  2. Decreased albumin production
  3. Lymphatic obstruction
  4. Systemic hypotension
  1. Which of the following would be a contraindication for performing a liver biopsy in a patient with suspected chronic hepatitis?
  2. Elevated c-reactive protein
  3. Hypoalbuminemia
  4. Prolonged PT and PTT
  1. Ursodiol (ursodeoxycholic acid) is contraindicated in liver patients with
  2. A portosystemic shunt
  3. Any degree of cholestasis
  4. Biliary obstruction
  1. Which of the following medications is indicated for a patient with hepatic encephalopathy?
  2. Colchicine
  3. Lactulose
  4. Ursodiol
  1. Hereditary copper toxicosis has been best described in which of the following breeds?
  2. Bedlington Terrier
  3. Soft Coated Wheaton Terrier
  4. Border Terrier
  1. When suspicious of Copper-associated Chronic Hepatitis which of the following samples should be collected for measurement of copper?
  2. Liver
  3. Urine
  4. Serum
  1. With primary copper accumulation and secondary hepatitis, copper accumulation occurs first in which zone of the hepatic acinus
  2. Zone 1
  3. Zone 2
  4. Zone 3
  1. Treatment of copper storage disease includes which of the following?
  2. Dietary zinc administration
  3. Penicillamine
  4. Both a and b but they should never be given simultaneously
  1. Bedlington terriers can be genetically screened as puppies for the COMMD1 mutation linked to copper toxicosis. Which of the following is true regarding results of this test?
  2. A positive result indicates that the individual is at risk
  3. A negative result means that the patient is unaffected
  4. Both a and b are true
  1. To help prevent hepatic Lipidosis in cats that are obese and on weight loss diets, weight loss should not
  2. Exceed 0.5 lb/month, or 5% of their body weight/month
  3. Exceed 1 1b/month, or 10% of their body weight/month
  4. Exceed 2 lb/month, or 20% of their body weight/month
  1. All of the following are examples of drugs linked to hepatoxicity EXCEPT
  2. Carprofen
  3. Diazepam
  4. N-acetylcysteine
  1. Which of the following is NOT a biochemical marker of liver function?
  2. Albumin
  3. ALT
  4. BUN
  1. Which of the following describes the appearance of the liver on ultrasound in cases of hepatocutaneous syndrome due to liver disease?
  2. Diffuse hyperechoic appearance
  3. Multinodular appearance
  4. Swiss-cheese appearance
  1. In addition to good supportive care, which of the following are additional treatments commonly prescribed to patients with hepatocutaneous therapy
  2. Intravenous infusions of amino acids
  3. Zinc supplementation
  4. Both a and b
  1. Compared to small breed dogs, large breed dogs are more likely to have
  2. An extra-hepatic shunt
  3. An intra-hepatic shunt
  4. Both types of shunts are more common in large breed dogs
  1. Which of the following signs would be more common in a cat versus a dog with a portosystemic shunt?
  2. Apparent blindness
  3. Polyuria
  4. Ptyalism
  1. Which of the following would not be a common finding in a dog with a portosystemic shunt?
  2. Ammonium biurate Crystalluria
  3. Elevated pre- and post-prandial bile acids
  4. Jaundice
  1. Which of the following imaging modalities cannot be used to diagnose a portosystemic shunt?
  2. Abdominal radiography
  3. Abdominal ultrasound
  4. Nuclear scintigraphy
  1. Measurement of which of the following serum proteins can help differentiate a portosystemic shunt from microvascular dysplasia?
  2. Factor X
  3. Protein C
  4. Thrombin
  1. Which of the following statements regarding liver cancers in cats is correct?
  2. More than 50% of liver tumors are benign
  3. Most are primary not metastatic tumors
  4. Both a and b are correct
  1. The most common type of primary hepatobiliary tumor in cats is
  2. Biliary cystadenoma
  3. Hepatocellular carcinoma
  4. Lymphosarcoma

Section 2 Post Hepatic Disease

  1. Prolongation in clotting times seen in cats with cholangiohepatitis or hepatic lipidosis results from malabsorption of which of the following vitamins?
  2. Vitamin D
  3. Vitamin E
  4. Vitamin K
  1. Culture of bile is strongly indicated with which of the following types of cholangiohepatitis in cats?
  2. Chronic
  3. Lymphoplasmocytic
  4. Neutrophilic
  1. The mainstay of treatment for cats with neutrophilic cholangitis is
  2. Antibiotic therapy
  3. Choleoretic drugs
  4. Glucocorticoids
  1. Which of the following represents a contraindication for the administration of ursodeoxycholic acid in a cat with cholangitis?
  2. Ascites
  3. Bile duct obstruction
  4. Hypoalbuminemia
  1. Congenital biliary cysts in cats are typically
  2. Complex
  3. Multiple
  4. Solitary
  1. Acquired biliary cysts in cats are typically
  2. Complex
  3. Multiple
  4. Solitary
  1. Which of the following breeds of cats are known for heritable hepatic cysts?
  2. Persian
  3. Rag doll
  4. Siamese
  1. For a cat with suspected congenital cysts in the liver, which of the following other organs should be evaluated for the presence of cysts?
  2. Kidneys
  3. Ovaries
  4. Pancreas
  1. In a cat, treatment of a biliary cyst causing bile duct compression may involve which of the following?
  2. Ultrasound guided aseptic aspiration of the fluid
  3. Surgical or laparoscopic deroofing (fenestration) of the cyst (provided the cyst does not contain bile)
  4. Surgical excision of the cyst or affected liver lobe.
  5. All of the above.
  1. The primary hormone responsible for gall bladder contraction and emptying is
  2. Cholecystokinin
  3. Pancreatic polypeptide Y
  4. Somatostatin
  1. Which of the following may be a heritable predisposing cause for gallbladder mucocoele?
  2. Hyperfibrinogenemia
  3. Hyperlipidemia
  4. Hyperuricosuria
  1. Which of the following endocrine disorders may predispose to a gallbladder mucocoele?
  2. Diabetes mellitus
  3. Hyperadrenocorticism
  4. Hypothyroidism
  1. Which of the following is the diagnostic test of choice for detection of a gallbladder mucocoele?
  2. Radiography
  3. Nuclear scintigraphy
  4. Ultrasound
  1. Bacterial infection or inflammation (cholecystitis) is a common concurrent finding with a gallbladder mucocoele for which of the following organs?
  2. Gallbladder
  3. Liver
  4. Pancreas
  1. The most appropriate treatment for a patient that is symptomatic for a gall bladder mucocoele is
  2. Medical management with antibiotics and choleretics
  3. Repeated ultrasound guided gall bladder drainage
  4. Stabilization followed by surgical cholecystectomy
  1. Which of the following treatments can be used for the treatment of asymptomatic cases of a gallbladder mucocoele?
  2. Choleretics
  3. Opioid analgesia
  4. Protein pump inhibitors
  1. Alternative medical treatment for asymptomatic cases of gallbladder mucocoele can include which of the following?
  2. Antibiotics
  3. Choleretics
  4. Low fat diets
  5. All of the above

Section 3 Nutrition

  1. The ideal diet to feed to a patient with liver disease should be a highly palatable diet with a
  2. low energy density
  3. moderate energy density
  4. high energy density
  1. For patients with liver disease, protein restriction is indicated only when
  2. Signs of hepatic encephalopathy are evident
  3. The patient is not hypoglycemic
  4. The serum albumin concentration is abnormal
  1. Why is protein restriction inappropriate for cats with liver disease?
  2. They are incapable of downregulating hepatic gluconeogenesis
  3. They are incapable of downregulating hepatic glycogenolysis
  4. They are incapable of downregulating hepatic B-oxidation of lipids
  1. For the diet of a cat or dog with liver disease, what percentage of the caloric content should be carbohydrates?
  2. Not more than 25%
  3. Not more than 35%
  4. Not more than 45%
  1. Why is a moderate amount of fiber beneficial in the diet of a patient with liver disease?
  2. Fiber helps to decrease the production and absorption of ammonia from the colon
  3. Fiber binds bile acids in the small intestinal lumen promoting their excretion from the body
  4. Both a and b are true

Section 4 Anesthesia

  1. Which of the following sedatives should be avoided in patients with liver disease?
  2. Acepromazine
  3. Butorphanol
  4. Midazolam
  1. Which of the following agents is most appropriate for maintenance anesthesia in patients with liver disease?
  2. Isoflurane
  3. Etomidate
  4. Propofol
  1. Hypoalbuminemia with liver dysfunction should be addressed prior to anesthesia to reduce the risk of intraoperative ______.
  2. Hemorrhage
  3. Hypotension
  4. Hypothermia
  1. Which of the following is contraindicated for post-operative pain management in a patient with hepatic dysfunction?
  2. Buprenorphine
  3. Metacam
  4. Morphine