Feline HCM Cat Care Primer

From a discussion with a reader and a good reminder for us all:

Your cat will need to see a cardiologist and you will depend on the cardio for guidance about most of the regular care of the cat. Shots, other wellness issues-the regular vet. But you'll need to coordinate care between the two. Always have copies of cardio visit sent to vet; and regular vet info sent to cardio. The cardio should be consulted before any annual shots are given to make sure he's up to it. The cardio should be consulted for any contraindications with any other meds the regular vet wants to give. The regular vet needs to know how is the cat doing and what meds the cat is on from the cardio and what issues to look for.

*DO NOT allow your cat to be given steroids at any time-pill, injection, or asthma meds as these cause complications with heart disease cats. They retain fluid and that is not what the cat needs. For all other issues, stick only to antibiotics. If desperately needed for an illness, must consult with cardio first.

Keep copies of all visits and test results. You'll need to refer to them, be up to date, for all visits with any vet. Keep a notebook about how your cat is doing and any issues or concerns you need to address with the vet.

Get organized for cat care. File box, files, pill cutter, pill containers, frig boxes on counter or in frig or pantry to contain meds, supplies, supplements, pills, etc. will make care faster and more organized space wise. Nothing rolling around and bouncing around. And that will keep you calmer. As your needs grow for more things for the cat, so will your need to organize it. Find what works for you.

Did he have an echo? That is the only sure way to tell if and what type of heart disease he has and how it is progressing. He should have one every 3-5 months depending on how he is doing; is he seeing an actual cardiologist? He should as that is the expert. He'll need an echo every time he ends up in the ER.

He should have blood work done every 3 or so months and always before he sees the cardiologist so that the cardio knows how the body is responding to heart meds.

Meds-Atenolol is a beta blocker to lower heart rate and to help lower blood pressure. He should have only about a 1/4 tab a day. Maybe later twice a day as the disease and heart worsen. Too much, and the rate is too low, he will be weak. Plavix-only needs 1/4 pill once a day. Maybe later twice a day. And maybe later also add in aspirin. (Aspirin is difficult as cats do not tolerate it well. But you'll use a buffered 80 mg every three days and no more often than that. It might cause gastro upset but in progressive HCM adding aspirin can be beneficial to preventing clots along with Plavix. We gave it on Wednesdays and Saturdays.) He should also be on Enalapril, an ACE inhibitor. It helps to reduce body's retention of sodium, therefore of water; and it keeps veins opened in case of a heart attack. There are other drugs he may need: Sprionolactone-a mild diuretic that helps save potassium; Isosorbide-to lower blood pressure but it changes the load on the heart (I can't recall exactly how it works, only know that Myrna was on it late in life.) There are other diuretics such as Torsemide to use later if needed.

The major med to use is a diuretic like lasix/furosemide. Talk to your vet now about getting this. A daily maintenance dose of 5mg will keep away congestion. Congestion in the lungs is an inability to breathe and get oxygen to the brain/body, making one weak. It is also painful as it feels as if one is drowning. It's not simply a cold as we think of it for humans. As congestion pops up, he'll need more of a dosage and more often during the day. The amount and number of doses will increase as the need increases.

You are treating not only the heart but the entire body. The heart disease will effect his liver and kidneys. Meds will also. You must be aware of needs for the entire body. He will need a good overall cat vitamin paste. He will need extra potassium when on lasix. We use Renal K gel and powder. As the disease progressed for Myrna, I also used Sundown potassium pills. She was near the end on mega doses of potassium. I also gave her kidney support goop and how I administered it changed over time. First, in her food; then she needed it by mouth via a syringe. I mixed up COQ10, vitamin C, E, Renal K powder, etc. with baby sweet potato (source of potassium) in a small dish, and gave her 3ml 2-3 times a day as the disease progressed. Then I added Nature Made iron pills cut into halves and gave them by mouth about twice a day. Iron is necessary for the production of red cells which the kidneys need. It was complicated because it caused gastro upset and I had to adjust the dose as needed. But her kidney values remained stable for the last year of her life after increasing. You can read more about it at the blog under the Med tab.

As the lasix works to get rid of fluid, the cat will drink a lot of water. The cat will at times become dehydrated. You must keep up the hydration. Lots of water bowls, add water to wet food, more wet food than dry. While the heart does not need liquid, the body does. It seems contrary but water is necessary for the overall health and particularly kidney function. As the lasix works, electrolytes will become depleted. That's why you will need the extra potassium. If the cat is not eating well, he will need some extra glucose. The cat won't need extra sodium and does not really need a salt free diet as the lasix is already getting rid of salt. But do cut back on treats and avoid crackers/chips, and table foods.

There may be times he won't eat and you'll need to feed by hand. That can be discussed later but you can read about it at the blog. I have many tricks and methods to suggest.

Learn to monitor the cat and how it is breathing and walking. If you see the cat lethargic, not interested in getting up or eating, go to the vet or cardio. If the cat has cold paws front OR back, go to the cardio or vet ER immediately. If the cat is lame, dragging a leg or legs, or is falling over, go to the vet ER or cardio immediately. If the cat vomits a lot and doesn't get up, go to the vet ER or regular vet immediately. If the cat is laying down and breathing hard and doesn't get up, the cat could be in CHF-congestive heart failure, or having a heart attack. Go to the vet ER or cardio immediately for care. If the cat isn't eating, but seems fine, skip the vet for now and read in the blog how to feed and what to feed by hand.

Learn to count the breathing to monitor for CHF or other heart issues-one up and down chest movement is one count. How many of those in 15 seconds? 6-10 is fine. 12 or more and the cat may need the ER. A cat's breathing fluctuates during any given time from really slow to really fast. But sustained, heavy breathing-not panting, not opened mouth-is an indication that something is wrong. Count the breaths and if you think it's high, count again after a few minutes of the cat being still. If you have a diuretic that you are giving, and you think it's breathing fast, give an extra 2-5mg of diuretic and see if the cat responds within an hour. If the cat does, then he's in CHF but responding and you can give more 2-5mg of extra lasix in four hours. But if the cat seems really bad off, meds also don't help, then rush him to the vet ER or cardio for oxygen and injected lasix and monitoring.

Find the closest cardio, regular vet, and one or two dependable ER or 24/7 animal hospital to have on hand to go to anytime you need the vet.

You can order a lot of supplements at Amazon, Entirely Pet, 1800PetMeds. Sundown potassium and Nature Made products are at the local stores. But shop for lowest prices-Kroger often has buy one/one free; Target has low prices.

And as for the meds, these should be available at the local human pharmacy. They are often cheaper than those from the vet. Kroger and Target had $4.00 generics and have lower prices on many of the meds you are using. Shop around as things change. Avoid Walgreens/CVS which are expensive.

There is a lot of information at the blog in tabs, categories, and as a word search you might find helpful.

But please do continue to feel free to discuss your cat with me and how you are doing. I'm here to help.

Good luck!

Roxanne Vistis Cardio-Has Slight Changes in Left Vent but Not Yet HCM

Roxanne saw the cardiologist yesterday just because that's what we do. Glad we did. She shows signs of changes in the left vent. No signs of heart disease but those changes often become HCM. The cardio said it could go either way. But no stress or too hot or too cold or too humid environments. And no steroid medications. And she will need annual cardio visits. We found with Cooper that heart disease can suddenly emerge from one year to the next-one year he was fine; the next he was not.

She gets car sick, though, and vomited and had diarrhea in the crate on the way there. But while there, she was very calm. She sat quietly for the exam; her heart beat was steady, not racing due to being in a new place.

No meds are recommended at this time since the heart rate is steady and there are no other signs of actual heart disease. The walls of the heart are not seriously thickened; there's no congestion; etc. She described the walls to be as appearing to be uneven.

So, we will keep an eye on her.

Here are the vet's notes:

"There was no evidence of serious cardiac disease during today's echocardiogram. The only questionable abnormality that was found is that the wall of Roxanne's left ventricle are slightly thickened. This may be completely normal for Roxanne or it could be an early indicator of hypertrophic cardiomyopathy (HCM). There is no need for any type of treatment at this time. She is not considered to be at risk for congestive heart failure or blood clot formation. I advise rechecking her echocardiogram in 1 year. If progressive changes in the heart are seen at that time, Roxanne will be diagnosed with HCM and we will consider beginning cardiac medications. If there is no change in her echocardiogram, we will consider these measurements to be normal for Roxanne."

Diuretics Needed to Fight Congestion-Increase As Needed

Remember to fight congestion, your HCM cat needs a daily dose of lasix even if CHF-congestive heart failure-hasn't yet occurred. It might and it's better to be ahead than behind. If your cat is becoming more and more congested despite lasix, that means you must increase the amount per dose and the number of doses per day. Diuretics work best when given over a course of a day instead of all at once. Too much at once and it puts a load on the kidneys to do the diuresis process. Too much at once, and it will leave the body soon and leave the body without diuretic coverage for the rest of the day. Depending on your schedule, 2-3 times a day is good for an average HCM cat; 4 times a day for cats fighting constant congestion. Don't forget the kidney support-potassium each day for cats on a diuretic. Vitamins E, C, COQ10, and iron for those on higher doses and especially for cats taking Torsemide. Torsemide depletes the body of needed electrolytes and is tough on the kidneys. The kidneys need kidney support for the diuresis process. More info is in the Med notes here in Facebook and the Med tab at the blog.

Katharine Hepburn Has Cardio Checkup-Passes!

Katharine Hepburn had her annual cardio checkup today and all is well. Grade 1 heart murmur as usual-which we all know doesn't mean a thing. Size of murmur doesn't indicate heart disease nor indicates a lack of heart disease. A louder murmur doesn't mean a more severe heart condition and a low murmur does not mean a lack of a heart disease. Katharine gets an annual checkup because she has a murmur (and all murmurs should be checked with an echo because (again) size of sound does not matter but the presence of a murmur may indicate heart disease) AND because she is Myrna Loy's sibling.

Myrna Loy's Necropsy from After Her Death of 8/19/15

The following is the necropsy (autopsy) report of Myrna Loy after her death 8/19/15 of HCM.

The report shows various physical changes and damage to the heart, kidneys, and lungs due to HCM which were somewhat known, and most of which is to be expected with heart disease. The report drills down the damage to the cellular level which may be of interest.

Part of the problem of dealing with congestion was that the damage to the thoracic duct allowed an acidic like fluid to flow from the duct into the lungs. This opaque, milky-white fluid is called chylous or chylothorax. It created pockets in the pleural cavity, pockets where fluid formed and remained and was often difficult to remove. We tried to decrease it by giving Myrna Rutin. Apparently, once chylous appears, the pet is not expected to live for very long due to the damage chylous causes and because its appearance means further left sided heart damage, which means a heart that is failing. Myrna lived eight months after it first appeared in December 2014. When we delivered her body to MSU for the necropsy, the receiving vet was surprised to read that she had lived eight months with the condition and had lived eight months with an almost constant need to have fluid removed from the pleural cavity. 

While the report notes signs of hypertension-or high blood pressure-at no time at the end of her life did she have hypertension/high bp noted by a vet or cardiologist. She had an occurrence in 2013 after her heart attack but no further signs once it cleared up. 

The report notes mild kidney disease. We worked really hard to see that her kidneys retained as much function as possible. The various vitamins, supplements, potassium, and iron that we gave her improved kidney function and allowed te BUN and creatinine to remain stable. The numbers had increased beginning in September 2014 but remained fairly stable to her death (BUN 35, creatine 2.6.)  The report's findings about the state of her kidneys are proof that vitamins, supplements, potassium, and iron are necessary for improving kidney support and that they work. 

We were surprised to read that there were no gastro issues noted because she had had many vomiting episodes for the last few weeks of her life after her rear leg thrombosis in May.  The vomiting was attributed to a clot and her medicines. I suppose it was just the medicines, not to mention my finger constantly in her mouth, that caused the upset stomach.  While she weighed about 10lbs. in late 2014, she did lose a lot of weight suddenly in the last few weeks of her life, especially after being sick almost all of July 2015. But I hand fed her every time she was ill and refusing to eat and she never went for very long without eating enough. (Methods can be found in the blog History tab.) Her weight was still good at about 9.8lbs. 

After the initial report, I have listed definitions for various phrases used in the report.  

------------------------------------------------------------------------------------

Report processed at Michigan State University Veterinary College Diagnostic Center for Population and Animal Health

Rcvd Date:  8/19/2015 11:23:00 AM 

Gender: Female, MYRNA LOY, Feline, 6 years, Domestic Shorthair Cat 

History

Gross Description

Received Date/Time: 8/19/2015 12:31:00 PM

Verified Date/Time: 8/20/2015 5:51:05 AM

REPORT OF LABORATORY EXAMINATION

Necropsy Preliminary Report

A 6 year old spayed DSH died on 8/19/15. The cat had a history of clotting secondary to heart disease. Owner is concerned about gastric and renal disease.

A 4.45 kg (9lbs. 8 oz approx) female spayed cat is necropsied on 8/19/15. Autolysis is mild.  There are adequate visceral fat stores and the body condition score is 6/9.  The eyes are mildly sunken into the orbits, and mucous membranes are pale pink.  The thoracic cavity and pericardial sac respectively contain 15-20 ml of red, clear, slightly opaque fluid, and 5 ml of dark red clear fluid. The parietal surfaces of the pericardial sac and pleura are multifocally and loosely adhered to the thoracic wall by numerous fibrinous adhesions.  The edges of the cranioventral lung lobes are collapsed and plumb colored.  All lung lobes float in formalin.  The heart is enlarged weighing 20.1 g (0.45% of total body weight), and the right ventricular free wall and left ventricular free wall respectively measure 0.1 cm (RVF) and 0.8 cm (LVF).  The left atrioventricular valvular leaflets contain numerous, 0.2-0.3 mm in diameter, tan, firm, smooth nodules.  Lining the endocardial surface of the left ventricle are ~10, thin, white-pink, string-like bands of connective tissue (moderator bands) bridging the ventricular septum and the left ventricular free wall. The liver has slightly round edges and a prominent reticulated pattern.  The cortex of both kidneys is slightly granular.  There are no additional remarkable gross lesions.

Gross Diagnosis(es)

Heart:

Left ventricular concentric hypertrophy

Left atrioventricular endocardiosis

Excessive moderator bands

Liver: Mild hepatomegaly and centrilobular congestion 

Pericardial sac: Pericardial effusion

Lung: locally extensive atelectasis and mild fibrinous pleuritis

The heart was overall large and the left ventricle was markedly thickened, consistent with hypertrophic cardiomyopathy which is a condition in which the muscle of the heart thickens (especially on the left side) and compromises the contractility and blood-pumping efficiency of the heart.  Left sided heart failure often presents clinically with a thoracic/pleural effusion, as seen in this case; however, the slight milky consistency suggest a chylous/lymph component which can occur if there is damage to the thoracic duct.  In addition, the large liver and centrilobular congestion are common changes seen in right sided heart failure. There was also evidence of endocardiosis of the mitral valve, and excessive moderator bands, but the significance of these changes in relation to the enlarged heart is unknown.  Endocardiosis is a common age related degenerative of the valvular leaflets.  If severe, these lesions can cause leaky valves and eventually heart failure, but the changes were mild in this case.  Excessive moderator bands have been observed in normal cats and in cats with hypertrophic cardiomyopathy, but the significance is unknown.

Microscopic Description

Representative sections of brain, eye, heart, lung, liver, spleen, kidney, adrenal gland, thyroid gland with parathyroid gland, bone marrow, stomach, esophagus, and intestine are examined.  Within the heart there are severe coalescing regions of myofiber disarray, multifocal myofiber degeneration, and fibrosis. Disarrayed myofibers interweave and are separated by increased loose fibrillar eosinophilic interstitial fibrosis. Multifocal degenerative foci have variable myofiber size and staining with flocculent and hypereosinophilic sarcoplasm and loss of cross striations.  There is moderate medial thickening of small caliber vessels in the heart, and kidney.  In the kidney, there is mild to moderate, multifocal, segmental, membranous glomerulonephritis and tubular proteinosis.  In addition, there is mild multifocal interstitial infiltrates of lymphocytes, plasma cells, fewer neutrophils, and mild fibrosis. Hepatic (liver) sinusoids have mild congestion, which is most prominent around central veins.  Within the lung there is severe atelectasis and mild diffuse pulmonary edema characterized by small quantities of pale proteinaceous material and low numbers of macrophages in alveolar spaces.  There are no additional remarkable findings.

Morphologic Diagnosis(es)

Heart: Severe myofiber disarray, degeneration, and fibrosis

Lung: Atelectasis, mild edema, and alveolar histiocytosis

Liver: Mild centrilobular congestion

Heart and kidney: Moderate arteriosclerosis

Kidney: Mild to moderate, membranous glomerulonephritis and tubular proteinosis; Mild multifocal lymphoplasmacytic interstitial nephritis and fibrosis

Final Diagnosis(es)

Severe hypertrophic cardiomyopathy with bicavitary effusion and hypertension

Comments

Hypertrophic cardiomyopathy is the most common form of heart disease in cats, and although the disease appears inherited in some breeds (i.e., Maine Coon), the exact pathogenesis is unknown. In this case, diminished cardiac function most likely resulted in fluid accumulation in the thoracic cavity, lung, and pericardial sac. There was also evidence of renal disease and thickening of small vessels which are likely attributed to hypertension secondary to heart disease. Although there was a concern of fibrin thrombi and gastric hemorrhage, these changes were not evident during gross or histologic examination. No further testing is currently pending. 

________________________________________________________

Definitions of Words Found in the Necropsy

Severe coalescing (to come together to form a whole) regions of myofiber (myofiber is a multinucleated single muscle cell)  in disarray.

"Myofiber disarray" defines a nonparallel arrangement of cardiac myocytes (muscle cells of the heart). The presence of a sufficient quantity of myocardial fibers showing this change is considered to be a specific histological feature of hypertrophic cardiomyopathy.

Multifocal (multiple foci) myofiber-A cylindrical, multinucleate cell composed of numerous myofibrils that contracts when stimulated.   

Degeneration-decline

Fibrosis-thickening and scarring

Fibrillar-Any of various threadlike fibers or filaments that are constituent parts of a cell or larger structure. Fibrils make up the contractile part of striated muscle fiber in the body.

Hypereosinophilic- It occurs when an individual's blood has very high numbers of eosinophils. 

Eosinophilic -Eosinophils are a type of white blood cell. They help fight off infections and play a role in your body's immune response. They can also build up and cause inflammation...when the body produces too many eosinophils, they can cause chronic inflammation resulting in tissue damage.

Sarcoplasm is the cytoplasm of a myocyte (muscle fiber). The sarcoplasm of a muscle fiber is comparable to the cytoplasm of other cells, but it contains unusually large amounts of glycosomes (granules of stored glycogen) and significant amounts of myoglobin, an oxygen binding protein. The calcium concentration in sarcoplasma is also a special element of the muscular fiber by means of which the contractions take place and regulate.

It contains mostly myofibrils (which are composed of sarcomeres), but its contents are otherwise comparable to those of the cytoplasm of other cells. It has a Golgi apparatus, near the nucleus, mitochondria just on the inside of the cytoplasmic membrane or sarcolemma, as well as a smooth endoplasmic reticulum organized in an extensive network.

Lymphocytes-a form of small leukocyte (white blood cell) with a single round nucleus, occurring especially in the lymphatic system.

Plasma cells, are white blood cells that secrete large volumes of antibodies. They are transported by the blood plasma and the lymphatic system. 

Neutrophil granulocytes (also known as neutrophils or occasionally neutrocytes) are the most abundant type of granulocytes and the most abundant (40% to 75%) type of white blood cells in most mammals. They form an essential part of the innate immune system.  

Neutropenia-is an abnormally low count of neutrophils, a type of white blood cell that helps fight off infections. The lower your neutrophil count, the more vulnerable you are to infectious diseases.

Proteinaceous material-relating to, resembling, or being protein

Macrophages-type of white blood cell that engulfs and digests cellular debris, foreign substances, microbes, cancer cells, and anything else that does not have the types of proteins specific to the surface of healthy body cells

Arteriosclerosis-thickening, hardening and loss of elasticity of the walls of the arteries. This process gradually restricts the blood flow. 

HEART:

Heart/Cardiology/Coronary

Anatomy images of cardiology

Cardiology definitions

Hyptertension- Blood pressure is determined both by the amount of blood your heart pumps and the amount of resistance to blood flow in your arteries. The more blood your heart pumps and the narrower your arteries, the higher your blood pressure.             

Multifocally-Having to do with two or more foci or arising from two or more places.                

Fibrinous adhesions-an adhesion that consists of fine threads of fibrin r from an exudate of plasma or lymph, or an extravasation of 

blood.  

Cranioventral is an anatomical description of a direction and means directed "upwards" (cranial) and "to the front" (ventral).   

Autolysis- In biology, autolysis, more commonly known as self-digestion, refers to the destruction of a cell through the action of its own enzymes. 

Thoracic cavity - The thoracic cavity (or chest cavity) is the chamber of the body of vertebrates that is protected by the thoracic wall (rib cage and associated skin, muscle, and fascia).    

Parietal pericardium-The outer layer of the pericardium which is a conical sac of fibrous tissue that surrounds the heart and the roots of the great blood vessels.     

              

Pericardial sac-The pericardium (from the Greek περί, "around" and κάρδιον, "heart") is a double-walled sac containing the heart and the roots of the great vessels. The pericardial sac has two layers, a serous layer and a fibrous layer. It encloses the pericardial cavity which contains pericardial fluid.

Thoracic duct-thoracic duct is the largest lymphatic vessel of the lymphatic system. 

Chylothoracic-Chylothorax is a relatively rare condition in the cat in which lymphatic fluid or chyle accumulates in the pleural cavity. It results from lymph formed in the digestive system called chyle accumulating in the pleural cavity due to either disruption or obstruction of the thoracic duct.

Atrioventricular- Pertaining to the atria (the upper chambers of the heart) and the ventricles (the lower chambers of the heart).

Mitral valve (not to be confused with the congenital bicuspid aortic valve) and the tricuspid valve are known collectively as the atrioventricular valves because they lie between the atria and the ventricles of the heart and control the flow of blood. 

Endocardial surface of the left ventricle-endocardium is the innermost layer of tissue that lines the chambers of the heart. 

Ventricular septum -The interventricular septum (IVS) is the stout wall separating the lower chambers (the ventricles) of the heart from one another. The ventricular septum is directed obliquely backward to the right, and curved with the convexity toward the right ventricle; its margins correspond with the anterior and posterior longitudinal sulci (coronary groove which contains the trunks of the nutrient vessels of the heart, and is deficient in front, where it is crossed by the root of the pulmonary trunk. On the posterior surface of the heart, the coronary sulcus contains the coronary sinus.) 

        

Excessive moderator bands-   

The moderator band  is a muscular band of heart tissue found in the right ventricle of the heart...frequently extends from the base of the anterior papillary muscle to the ventricular septum. While normal, if excessive, they impair heart function.  

Left ventricular concentric hypertrophy-Left ventricular hypertrophy is enlargement and thickening (hypertrophy) of the walls of your heart's main pumping chamber (left ventricle).

Left atrioventricular endocardiosis-Mitral valve disease is a serious heart condition caused by the abnormal function of the valve that separates the upper and lower chamber of the left side of the heart. 

Endocardiosis is a valvular insufficiency. The most commonly affected site is the mitral valve. The condition results in slowly developing heart failure as the valves become swollen and shortened/misshapen, so the heart cannot pump blood effectively from the left ventricle to the circulation.

Leaky valves-The valves consist of flaps that open to let blood flow in one direction as it moves through the chambers of the heart. Then the valves close to keep blood from flowing backwards into the chamber it just left. Each valve typically has three flaps, except for the mitral valve, which has two. means that just after the heart squeezes and pumps blood forward, some blood will leak backward through the valve. Leaking through the valve is also called valve regurgitation.   

LUNGS:

Lungs/Pulmonary/Respiratory

Anatomy and definitions of the lungs

Pleura-each of a pair of serous membranes lining the thorax and enveloping the lungs in humans and other mammals.   

Pleural cavity is the thin fluid-filled space between the two pulmonary pleurae (visceral and parietal) of each lung.              

Pulmonary pleurae are the two pleurae of the invaginated sac surrounding each lung and attaching to the thoracic cavity. The visceral pleura is the delicate serous membrane that covers the surface of each lung and dips into the fissures between the lobes. The parietal pleura is the outer membrane which is attached to the inner surface of the thoracic cavity. It also separates the pleural cavity from the mediastinum. The parietal pleura is innervated by the intercostal nerves and the phrenic nerve.

Lung lobes- parts of the lung. 

Pleurisy (also known as pleuritis) is an inflammation of the pleura.  

Fibrinous pleuritis-fibroid tissue, damage in the pleural cavity. 

Pulonary edema-excess fluid in the lungs.

Pleural effusion-fluid around the lung. 

Atelectasis-a complete or partial collapse of a lung or lobe of a lung. Atelectasis can make breathing difficult and lower oxygen particularly if lung disease is already present.  It is a condition where the alveoli are deflated down to little or no volume.

Interstitial fibrosis -group of lung diseases affecting the interstitium (the tissue and space around the air sacs of the lungs)

Alveolar spaces-Pertaining to the alveoli, the tiny air sacs in the lungs.

Alveolar histiocytosis-Histiocytosis is a general name for a group of disorders or "syndromes" that involve an abnormal increase in the number of immune cells that are called histiocytes.

LIVER:

Liver:

Anatomy of the liver

Liver-slightly round edges and a prominent reticulated pattern (as if threads woven like a net)   

About Liver disease and heart failure -Damage done to a liver is due to right sided heart failure.

Hepatomegaly is the condition of having an enlarged liver. 

Congestive hepatopathy of the liver-also known as nutmeg liver and chronic passive congestion of the liver, is liver dysfunction due to venous congestion, usually due to congestive heart failure. The gross pathological appearance of a liver affected by chronic passive congestion is "speckled" like a grated nutmeg kernel; the dark spots represent the dilated and congested hepatic venules and small hepatic veins.

(Liver) sinusoids -A sinusoid is a small blood vessel that is a type of capillary similar to a fenestrated endothelium. 

---

KIDNEYS:

Kidneys/Renal/Nephrology

Anatomy and definitions of kidneys

Kidneys have a somewhat granular outer section (the cortex), containing the glomeruli and convoluted tubules, and a smooth, somewhat striated inner section (the medulla), containing the loops of Henle and the collecting tubules. 

Granular- A granular surface of the kidney may be present in both benign and malignant hypertension and is indicative of atrophy and fibrosis of the cortex due to the destruction of the small blood vessels. The degree of the granulation depends on the duration of the hypertension.

Renal cortex -is the outer portion of the kidney between the renal capsule and the renal medulla. 

Glomerulonephritis -acute inflammation of the kidney of tiny filters in your kidneys (glomeruli). Glomeruli remove excess fluid, electrolytes and waste from your bloodstream and pass them into your urine. 

Tubular proteinosis. -the accumulation of excess protein in the tissues. These proteins are normally filtered by the glomerulus and are almost completely reabsorbed in the proximal tubule. Diseases that interfere with proximal tubular function, such as tubulointerstitial nephritis, reduce reabsorption of these proteins and lead to tubular proteinuria. High concentrations of protein cause frothy or sudsy urine.