25. Clinical approach to patients with icterus (jaundice) Flashcards
Jaundice definition
the yellow staining of serum or tissues by an excessive amount of bile pigment or bilirubin
Origin of Jaundice
Pre hepatic
hepatic
post hepatic
what needs to be present in order for Jaundice to occur
there needs to be a large, persistent increase in bile pigment production
or
major impairment of its excretion
^ Br
detectable by lab tests
^^ Br
Plasma appears yellow
^^^Br
Jaundice
causes of Prehepatic Jaundice
Babesia
IMHA
Toxicosis - snake, onion/ garlic, paracetamol, Zn
Bacteria - mycoplasma haemofelis
Clinical signs of Prehepatic Jaundice
Hypercholic faeces
Lab D of Prehepatic Jaundice
Decreased; PCV
Increased ; Hb, Reticulocytes, Br I in serum, BrII in urine
Influence of haemolysis in Prehepatic Jaundice
increase Hb degradation –> ^Br
Decreased RBCs –> hypoxia –> cholestasis
Hepatic Jaundice
decreased uptake and conjugation due to hepatic disease
decreased excretion
causes of Hepatic Jaundice
- Severe/acute hepatitis
- Plants
- Abnormal conjugation
- Neoplasia
- Abnormal excretion
- Bacteria
- Intrahepatic cholestasis
- Parasites
- Extrahepatic infection
- Sepsis
- Cholangiohepatitis
- Mycotoxins
Clinical signs of Hepatic Jaundice
hypercholic faeces
Lab D of Hepatic Jaundice
Increased ; Br, ALT, ALP, GGT, AST
Post Hepatic Jaundice
obstruction of biliary duct
Cause of Post Hepatic Jaundice
Stones in biliary tract
duodenal foreign body
pancreatitis
Clinical signs of Post Hepatic Jaundice
Grey faeces
Lab D of Post Hepatic Jaundice
Increased; Br, ALP, GGT, AST
Normal serum total bilirubin in dogs
<0.6mg/dl
Normal serum total bilirubin in cats
<0.3mg/ dl
why might bilirubinaemia be normal for dogs
canine renal tubules have a low resorptive threshold for bilirubin & process Br to a limited extent
Parameters to measure for Bilirubin
Blood total Br
Blood total Br I
Blood total Br II
Faecal stercobilinogen
Urine Br
Urine UBG
Prehepatic Jaundice Lab values from serum
Increased ; BrI, BrII, Free Hb, UBG, Urea, Retiulocytes
Prehepatic Jaundice Lab values from urine
Increased ; Br, UBG, Hb
Prehepatic Jaundice Lab values from faeces
Increased stercobilinogen
hepatic Jaundice Lab values from serum
increased Br I, BrII, UBG, BA
hepatic Jaundice Lab values from urine
Increased ; Br
Decreased UBG
No Hb
hepatic Jaundice Lab values in faeces
No stercobilinigen
posthepatic Jaundice Lab values in faeces
No stercobilinigen
posthepatic Jaundice Lab values in serum
Increased ; BrII, BA
no UBG
posthepatic Jaundice Lab values in urine
Increased Br
Decreased UBG
no Hb
Treatment of Jaundice
treat cause
IVFT, Electrolytes, antiemetics, gastroprotectants
AB
plasma, vit K
Antiox
UDCA
