| Abstract | Jetra je kompaktan organ crveno smeđe boje koji priliježe uz ošit. Najveća je žlijezda u
tijelu te je najveći unutarnji organ. Podijeljena je na četiri režnja, četiri podrežnja i dva izdanka, a
na visceralnoj površini je smješten žučni mjehur. Funkcija jetre izrazito je raznolika; stvara žuč
koja pomaže u probavi i otklanjanja otpadnih tvari iz krvi, detoksicira određene toksina i lijekove,
ima najveću metaboličku i biokemijsku ulogu u organizmu, skladišti vitamine, te stvara gotovo
sve faktore za zgrušnjavanje krvi. Oštećena jetra ima izrazito veliku sposobnost regeneracije, no
nadmašivanjem njenih kapacitetnih sposobnosti dolazi do razvijanja fibroze tkiva, te mogućeg
nastanka ciroze, završnog stadija bolesti jetre.
Upala jetre može biti akutna ili kronična, ovisno o osobinama i trajanju inzulta te
obrambenim mehanizmima same jetre psa.
Klinički znakovi bolesti hepatobilijarnog sustava su veoma raznoliki i uglavnom
nespecifični, poput anoreksije, depresije, povraćanja i proljeva, te sami klinički pregled nije
dovoljan za određivanje dijagnoze, stoga je nužan odabir određenih dijagnostičkih metoda u
daljnjem procesu dijagnosticiranja.
Rutinskom biokemijskom pretragom seruma može se uočiti povećana aktivnost jetrenih
enzima, poput ALT i AST enzima, te AP i GGT enzima koji su nešto specifičniji za bolesti
bilijarnog sustava. Rutinskom pretragom krvi može se uočiti prisutnost hipoalbuminemije, jer je
jetra jedino mjesto u organizmu gdje se albumini sintetiziraju. Nadalje, hiperbilirubinemija i
nastanak žutice može uputiti na bolesnu jetru, no to nije uvijek tako, stoga je daljnja dijagnostika
potrebna. Osim navedenog, može se zamijetiti povišena koncentracija ureje i kolesterola, te
smanjena koncentracija glukoze. Uvid o funkcionalnoj sposobnosti jetre, izlučivanju žuči i
enterohepatičkoj cirkulaciji može nam omogućiti provedba mjerenja koncentracije žučnih kiselina
u serumu prije i nakon obroka.
Od slikovne dijagnostike, rendgenografija abdomena upotpunjuje kliničku pretragu psa, te
omogućuje subjektivnu procjenu o veličini i položaju jetre, te o eventualno prisutnoj većoj jetrenoj
tvorbi. Za detaljniji pregled jetre, uključujući vaskularne i žučne strukture jetre te ravnomjernost
parenhima, preporučljivo je napraviti ultrazvučni pregled. No, osjetljivost UZV na jetrene bolesti
nije 100%-tna, odnosno ne možemo isključiti neke bolesti iako dijagnostičaru u tom trenutku nisu
vidljive.
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Temelj gotovo svih objektivnih dijagnoza za bolesti jetre je njena biopsija. S njom možemo
odrediti vrstu upale, neoplazije, bolesti parenhima ili se može aspirirati sadržaj žučnog mjehura.
Metode dijagnostike bira veterinar na temelju dostupnosti opreme, stanja životinje i financijskih
mogućnosti vlasnika, u svrhu dobivanja što točnijih rezultata dijagnostike, a time i dobrobiti psa. |
| Abstract (english) | The liver is a compact organ of a reddish-brown color which is located beneath the diaphragm. It
is the largest gland and also the biggest internal organ in a body. It has four lobes, four lobules and
two processes. The gallbladder is located on the visceral surface. The liver’s function is extremely
diverse; it produces bile that helps in digestion and removing waste products from blood,
detoxicates some of the toxins and drugs and it has the largest metabolic and biochemical function
in the organism. The liver also stores vitamins and produces almost every coagulation factor which
promotes blood clot formation. A damaged liver has a great regeneration ability, however
exceeding its capacity, the liver tissue starts developing fibrosis and might cause cirrhosis – the
end stage liver disease. Hepatitis can be acute or chronic, depending on the traits and the duration
of inzults(ovo nisam siguran, al nije inzults), as well as the defending mechanisms of the dog's
liver. Clinical signs of hepatobiliary diseases are highly diverse and usually non-specific like
anorexia, depression, vomiting and diarrhea, so just a clinical examination is not enough to make
a diagnosis. Therefore, choosing a specific diagnostic method is necessary in further diagnostic
processes. With a routine biochemistry panel screening, an increased activity of liver enzymes can
be found, like ALT and AST or AP and GGT which are somewhat more specific for biliary
diseases. In standard blood examination, a presence of hipoalbuminemia can be noticed, because
the liver is the only source of albumin production in the organism. Furthermore,
hyperbilirubinemia and jaundice development can lead to liver disease, but that is not always the
case. Hence, further diagnostic procedures are needed. Besides stated, in routinely done blood
examination, an elevated urea and cholesterol concentration can be observed, as well as reduced
glucose concentration. A better insight into the liver’s function, bile excretion and enterohepatic
circulation can be provided by measuring serum bile acid concentration. Radiographic evaluation,
a part of diagnostic imaging, is used to complement the physical examination findings in a dog,
and can help in the subjective evaluation of the size and liver position. Additionally, it provides
information about potential presence of liver masses. For more detailed liver screening, including
vascular and biliary liver structures, including parenchyma uniformity, it is recommended to
perform ultrasonography. However, ultrasonography sensitivity for liver disease is not 100%
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accurate, meaning that one can't exclude some diseases if they are not visible at that moment. The
foundation for almost all objective diagnosis for liver diseases is biopsy. It can determine
inflammation, neoplasia and parenchymal disease. In addition to this, we can use gallbladder
aspiration. The veterinarian chooses the diagnostic methods based on equipment availability, the
animal's condition and the financial status of the owner, all in order to get as accurate diagnostic
results as possible and thus improving the wellbeing of a dog.
liver, bile, diagnosis, blood examination, biopsy. |
