25. Clinical approach to patients with icterus (jaundice)

Question 1

Jaundice definition

Answer 1

the yellow staining of serum or tissues by an excessive amount of bile pigment or bilirubin

Question 2

Origin of Jaundice

Answer 2

Pre hepatic
hepatic
post hepatic

Question 3

what needs to be present in order for Jaundice to occur

Answer 3

there needs to be a large, persistent increase in bile pigment production
or
major impairment of its excretion

Question 4

^ Br

Answer 4

detectable by lab tests

Question 5

^^ Br

Answer 5

Plasma appears yellow

Question 6

^^^Br

Answer 6

Jaundice

Question 7

causes of Prehepatic Jaundice

Answer 7

Babesia
IMHA
Toxicosis - snake, onion/ garlic, paracetamol, Zn
Bacteria - mycoplasma haemofelis

Question 8

Clinical signs of Prehepatic Jaundice

Answer 8

Hypercholic faeces

Question 9

Lab D of Prehepatic Jaundice

Answer 9

Decreased; PCV
Increased ; Hb, Reticulocytes, Br I in serum, BrII in urine

Question 10

Influence of haemolysis in Prehepatic Jaundice

Answer 10

increase Hb degradation –> ^Br
Decreased RBCs –> hypoxia –> cholestasis

Question 11

Hepatic Jaundice

Answer 11

decreased uptake and conjugation due to hepatic disease
decreased excretion

Question 12

causes of Hepatic Jaundice

Answer 12

• Severe/acute hepatitis
• Plants
• Abnormal conjugation
• Neoplasia
• Abnormal excretion
• Bacteria
• Intrahepatic cholestasis
• Parasites
• Extrahepatic infection
• Sepsis
• Cholangiohepatitis
• Mycotoxins

Question 13

Clinical signs of Hepatic Jaundice

Answer 13

hypercholic faeces

Question 14

Lab D of Hepatic Jaundice

Answer 14

Increased ; Br, ALT, ALP, GGT, AST

Question 15

Post Hepatic Jaundice

Answer 15

obstruction of biliary duct

Question 16

Cause of Post Hepatic Jaundice

Answer 16

Stones in biliary tract
duodenal foreign body
pancreatitis

Question 17

Clinical signs of Post Hepatic Jaundice

Answer 17

Grey faeces

Question 18

Lab D of Post Hepatic Jaundice

Answer 18

Increased; Br, ALP, GGT, AST

Question 19

Normal serum total bilirubin in dogs

Answer 19

<0.6mg/dl

Question 20

Normal serum total bilirubin in cats

Answer 20

<0.3mg/ dl

Question 21

why might bilirubinaemia be normal for dogs

Answer 21

canine renal tubules have a low resorptive threshold for bilirubin & process Br to a limited extent

Question 22

Parameters to measure for Bilirubin

Answer 22

Blood total Br
Blood total Br I
Blood total Br II
Faecal stercobilinogen
Urine Br
Urine UBG

Question 23

Prehepatic Jaundice Lab values from serum

Answer 23

Increased ; BrI, BrII, Free Hb, UBG, Urea, Retiulocytes

Question 24

Prehepatic Jaundice Lab values from urine

Answer 24

Increased ; Br, UBG, Hb

Question 25

Prehepatic Jaundice Lab values from faeces

Answer 25

Increased stercobilinogen

Question 26

hepatic Jaundice Lab values from serum

Answer 26

increased Br I, BrII, UBG, BA

Question 27

hepatic Jaundice Lab values from urine

Answer 27

Increased ; Br
Decreased UBG
No Hb

Question 28

hepatic Jaundice Lab values in faeces

Answer 28

No stercobilinigen

Question 29

posthepatic Jaundice Lab values in faeces

Answer 29

No stercobilinigen

Question 30

posthepatic Jaundice Lab values in serum

Answer 30

Increased ; BrII, BA
no UBG

Question 31

posthepatic Jaundice Lab values in urine

Answer 31

Increased Br
Decreased UBG
no Hb

Question 32

Treatment of Jaundice

Answer 32

treat cause
IVFT, Electrolytes, antiemetics, gastroprotectants
AB
plasma, vit K
Antiox
UDCA