Preface and Acknowledgements
Jan Rothuizen
This is the first world standard for the definition and nomenclature of diseases in small animal medicine, and the authors hope this joint international initiative will be the start of many comparable efforts to bring veterinarians over the world to consensus.
Chapter 1: Introduction – background, aims and methods
Jan Rothuizen
This book is made for use in veterinary practice and for pathologists as an aid in making and understanding the diagnosis of all liver diseases of dogs and cats which are known to date. It is also meant to be a guide for the veterinary profession in the standardized diagnostic approach and nomenclature of liver diseases.
Chapter 2: Sampling and handling of liver tissue
Jan Rothuizen, Valeer J. Desmet, Ted S.G.A.M. van den Ingh, David C. Twedt, Susan E. Bunch, Robert J. Washabau
The diagnosis of most liver diseases depends essentially on histopathological examination of liver tissue. This is especially the case for parenchymal liver diseases, many biliary tract diseases, and tumors of the liver or biliary tract. The diagnosis of circulatory liver diseases depends largely on combined information obtained with laboratory examination, ultrasonography, and histopathological evaluation. The clinician has to combine the parts of the puzzle to make the diagnosis. To date, ultrasonography plays the central role in diagnosis of most circulatory liver diseases.
Chapter 3: Ultrasonographic identification and characterization of congenital portosystemic shunts and portal hypertensive disorders in dogs and cats
Viktor Szatmári, Jan Rothuizen
In the first part of this chapter the hemodynamic, anatomic and pathophysiologic features of canine portal vein disorders are described. Understanding these principles is necessary for correct interpretation of the ultrasonographic images. In the second part of the chapter an ultrasonographic scanning protocol is described, which is recommended to be used for thorough evaluation of the portal venous system. A short section at the very end will discuss the specific features of feline portal vein disorders.
Chapter 4: Morphological classification of circulatory disorders of the canine and feline liver
John M. Cullen, Ted S.G.A.M. van den Ingh, Susan E. Bunch, Jan Rothuizen, Robert J. Washabau, Valeer J. Desmet
For the recognition of the lesions associated with the various circulatory disorders in dogs and cats, it is essential to understand the normal hepatic circulation, and to know the consequences of impaired hepatic perfusion as well as the histological pattern of portal venous hypoperfusion. The circulatory disorders of the liver in dogs and cats can be categorized as congenital portosystemic shunts, disorders associated with outflow disturbances resulting in passive congestion, and disorders associated with portal hypertension. The diagnosis of most of the circulatory diseases does not depend on histological evaluation of the liver. For congenital portosystemic shunts, ultrasonography is the diagnostic examination as explained in detail in Chapter 3. Arterioportal shunts are also diagnosed by ultrasonography. Primary portal vein hypoplasia, however, should be diagnosed on the basis of negative ultrasonography of the portal vasculature and the typical but non-specific findings of histology of the liver. Blood tests to find or exclude portosystemic collateral circulation (either acquired due to portal hypertension or due to congenital portosystemic shunts) are the plasma bile acid and ammonia concentration. Functional testing can be performed by postprandrial bile acid measurement or ammonia tolerance test (rectal or oral), respectively. Finally, there are several scintigraphic techniques using 99mTechnetium to demonstrate or quantify portosystemic shunting. The critical diagnostic steps of the vascular disorders of the liver are summarised in a table in the introduction on the circulatory disorders of the liver.
Chapter 5: Morphological classification of biliary disorders of the canine and feline liver
Ted S.G.A.M. van den Ingh, John M. Cullen, David C. Twedt, Tom Van Winkle, Valeer J. Desmet, J Rothuizen
The anatomy of the biliary system and the classification and morphology of the various biliary disorders in dogs and cats is presented. The biliary disorders can be grouped into four major categories: 1) biliary cystic disease and biliary atresia, 2) cholestasis and cholatestasis, 3) cholangitis and 4) diseases of the gall bladder. Histological examination of liver biopsies can substantially aid in the diagnosis of the first three categories. Changes in the portal tracts are the hallmarks of most of these biliary disorders. However, portal inflammation, fibrosis and bile duct proliferation are not restricted to biliary disorders and may also be seen in primary parenchymal disorders such as acute and chronic hepatitis, and primary vascular abnormalities. Differentiation in general is possible through careful histological examination and evaluation of the combination of the parenchymal, vascular and portal tract lesions present in the affected liver. In contrast to the parenchymal and neoplastic liver diseases the diagnosis of diseases of the biliary tract depends not only on histopathological evaluation, but largely on ultrasonography. In neutrophilic cholangitis and cholecystitis culture and cytological examination of bile is required to assess the diagnosis. The role of the different diagnostic methods is summarized by the end of this chapter.
Chapter 6: Morphological classification of parenchymal disorders of the canine and feline liver – 1
John M. Cullen, Ted S.G.A.M. van den Ingh, Tom Van Winkle, Jenny A. Charles, Valeer J. Desmet
The normal histology of the smallest liver unit and the normal features of its constituting components are described to recognize the various parenchymal disorders and to understand the terminologies used. The parenchymal disorders can be grouped into seven categories: 1) reversible hepatocellular injury: cell swelling, steroid induced hepatopathy and steatosis, and 2) hepatic amyloidosis (this chapter), 3) hepatocellular death: apoptosis and necrosis, and 4) acute and chronic hepatitis and cirrhosis (Chapter 7), 5) hepatic abscesses and granulomas, 6) hepatic metabolic storage diseases and 7) miscellaneous conditions (Chapter 8).
Chapter 7: Morphological classification of parenchymal disorders of the canine and feline liver – 2
Ted S.G.A.M. van den Ingh, Tom Van Winkle, John M. Cullen, Jenny A. Charles, Valeer J. Desmet
This chapter presents the various forms of hepatocellular death: apoptosis and necrosis, the morphological patterns of necrosis in the liver, and the response of the liver to hepatocellular injury. The definition and characteristics of acute and chronic hepatitis and cirrhosis are given, including copper associated chronic hepatitis, lobular dissecting hepatitis and cirrhosis associated with superficial necrolytic dermatitis. Moreover, examples of specific infectious and non-infectious causes of hepatocellular necrosis and hepatitis are given. In addition, a histological grading and staging system for acute and chronic canine hepatitis, a semiquantitative histological evaluation of hepatic copper accumulation, and a histological evaluation of presence and extent of steroid induced hepatopathy, probably evoked by therapeutic intervention by corticosteroids, are provided. Finally, the lesions and clinical significance of non-specific reactive hepatitis and eosinophilic hepatitis and hepatic eosinophilic granuloma are presented.
Chapter 8: Morphological classification of parenchymal disorders of the canine and feline liver – 3
Tom Van Winkle, John M. Cullen, Ted S.G.A.M. van den Ingh, Jenny A. Charles, Valeer J. Desmet
Hepatic abscesses and granulomas usually occur by haematogenic spread from the portal vein or in neonates from the umbilical vein and a wide variety of causative organism is given. The various hepatic metabolic storage diseases in dogs and cats mentioned in the literature are summarized including the enzymatic defect, the hepatic cells involved and their morphological aspect. Finally, miscellaneous conditions are presented including cytoplasmic and nuclear alterations in hepatocytes, Kupffer cells and hepatic stellate cells as well as extramedullary haemopoiesis.
Chapter 9: Morphological classification of neoplastic disorders of the liver in dogs and cats
Renée G.H.M. van Sprundel, Bart Spee, John M. Cullen, Jan Rothuizen, Ted S.G.A.M. van den Ingh
The neoplastic disorders of the liver in dogs and cats can be classified as: 1) nodular hyperplasia, 2) primary hepatic epithelial neoplasia in the dog: a) hepatocellular adenoma, b) hepatocellular carcinoma, c) scirrhous hepatocellular tumour, d) cholangiocellular adenoma, e) cholangiocellular carcinoma, f) cholangiolocarcinoma, and g) neuroendocrine carcinoma, 3) primary hepatic epithelial neoplasia in the cat: a) hepatocellular adenoma, b) hepatocellular carcinoma, c) cholangiocellular adenoma, d) cholangiocellular carcinoma, e) small cell carcinoma subdivided in I) neuroendocrine carcinoma and II) small cell carcinoma with HPC characteristics , 4) mixed hepatocellular and cholangiocellular carcinoma, 5) hepatoblastoma, 6) primary hepatic vascular and mesenchymal neoplasia, 7) hematopoietic neoplasia, 8) metastatic neoplasia.
Links
ECVIM-CA: European College of Veterinary Internal Medicine
ACVIM: American College of Veterinary Internal Medicine
WSAVA: World Small Animal Veterinary Association
ECVP: European College of Veterinary Pathologists
ACVP: American College of Veterinary Pathologists
ECVCP: European College of Veterinary Clinical Pathology
EASL: European Association for the Study of the Liver
AASLD: American Association for the Study of Liver Diseases
Generously sponsored by Hill’s
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