Treating liver disease in the avian patient

The liver plays a major role in the body's metabolism and, as such, is subject to a multitude of insults-infectious, toxic, metabolic, nutritional, traumatic, and neoplastic. Consequently, liver disease is not uncommon in avian and other exotic patients. As diagnostic modalities (and our experience in using them and interpreting them) improve, veterinarian are becoming more aware of the presence of (often subclinical) liver disease in their patients, and often of the specific nature of that disease. Through new research, veterinarians also are more able to appreciate the liver's unique function and metabolism and the role it plays in the function of the body as a whole. This understanding has led to a better awareness of how the liver responds to disease, and this has allowed refinements in the treatment of diseased and damaged livers. However, treating liver disease is not just about treating the organ; the patient as a whole must be supported and treated until a successful resolution has been achieved. Treatment therefore must be aimed at supporting the patient, treating the specific condition, and creating an environment that allows the liver to heal and regenerate. This article briefly reviews the anatomy and physiology of the liver and how it responds to insult. Treatment of liver disease then is discussed using the aims described above. (C) 2004 Elsevier Inc. All rights reserved.

Endogenous ursodeoxycholic acid and cholic acid in liver disease due to cystic fibrosis

Focal biliary cirrhosis causes significant morbidity and mortality in cystic fibrosis (CF). Although the mechanisms of pathogenesis remain unclear, bile acids have been proposed as potential mediators of liver injury. This study examined bile acid composition in CF and assessed altered bile acid profiles to determine if they are associated with incidence and progression of liver injury in CF-associated liver disease (CFLD). Bile acid composition was determined by gas-liquid chromatography/mass spectrometry in bile, urine, and serum samples from 30 children with CFLD, 15 children with CF but without liver disease (CFnoLD)), and 43 controls. Liver biopsies from 29 CFLD subjects were assessed histologically by grading for fibrosis stage, inflammation, and disruption of the limiting plate. A significantly greater proportion of endogenous biliary ursodeoxycholic acid (UDCA) was demonstrated in CFnoLD subjects vs. both CFLD subjects and controls (2.4- and 2.2-fold, respectively; ANOVA, P = .04), and a 3-4 fold elevation in endogenous serum UDCA concentration was observed in both CFLD subjects and CFnoLD subjects vs. controls (ANOVA, P < .05). In CFLD, there were significant correlations between serum cholic acid and hepatic fibrosis, inflammation, and limiting plate disruption as well as the ratio of serum cholic acid/chenodeoxycholic acid to hepatic fibrosis, inflammation, and limiting plate disruption. In conclusion, elevated endogenous UDCA in CFnoLD suggests a possible protective role against liver injury in these patients. The correlation between both cholic acid and cholic acid/chenodeoxycholic acid levels with histological liver injury and fibrosis progression suggests a potential monitoring role for these bile acids in CFLD.

Nonalcoholic fatty liver disease: is all the fat bad?

Nonalcoholic fatty liver disease is now a major cause of liver disease in developed countries, largely as a result of an epidemic of obesity, diabetes and sedentary lifestyles. This has resulted in raised clinical awareness and diagnostic refinement. The entity encompasses several histologic patterns from benign steatosis to nonalcoholic steatohepatitis, the latter having a significant risk of progressive fibrosis and the development of cirrhosis. Labor-atory tests and imaging are not able to distinguish steatosis from steatohepatitis, which requires liver biopsy. However following an assessment of several risk factors, patients can be stratified for the potential risk of fibrosis, allowing the rational use of liver biopsy. This review will describe the various patterns of nonalcoholic fatty liver disease and relate this to disease pathogenesis and progression. Strategies for management, including experimental interventions, will be discussed.