Icterus Flashcards
When can hyperbilirubinemia be observed with the naked eye?
BILI > 2.5-4 mg/dL
What causes pre-hepatic icterus? What are 3 examples?
RBC lysis
- IMHA
- Mycoplasma hemofelis
- toxins
What causes hepatic icterus? What are 4 examples?
liver damage - abnormal liver function and intraheptic bile flow where hepatocytes are unable to metabolize bilirubin
- hepatitis - chronic, infectious, toxic
- cholangiohepatitis
- neoplasia
- sepsis
What causes post-hepatic icterus? What are 5 examples?
abnormal bile flow or obstruction
- pancreatits
- cholecystitis
- bile duct/GB rupture
- GBM
- stones, inflammation, sludge blockage
What clinical signs are associated with pre-hepatic icterus?
SIGNS OF ANEMIA
- tachypnea, tachycardia, murmur
- weakness, pale MM, weight loss
- epistaxis, melena
- decreased RBC/HCT
- increased PCV/TS
What clinical signs are associated with hepatic icterus?
- feels ill
- elevated liver enzymes
- decreased glucose, cholesterol, albumin
- hyperbilirubinemia
- vomiting, diarrhea
What clinical signs are associated with post-hepatic icterus?
- can feel ill or BAR
- higher magnitude of hyperbilirubinemia
- vomiting, diarrhea, lethargy
- abdominal pain
An icteric patient presents with pale MM, tachycardia, tachypnea, and bounding pulses. What is likely the cause of icterus?
hemolysis –> anemia!
(pre-hepatic)
An icteric Labrador presents ill with weight loss, poor appetite, and PU/PD. What is likely the cause of icterus?
hepatic icterus
- Labrador - chronic hepatitis, copper hepatopathy
- signs of chronic liver disease
An icteric Sheltie presents with tense abdominal palpation, but is overall BAR. What is likely the cause of icterus?
post-hepatic icterus
- Sheltie is predisposed to pancreatitis and GBM
- signs align
What diagnostics are performed to differentiate between pre-hepatic, hepatic, and post-hepatic icterus?
- CBC - anemia (HCT, codocytes), leukocytosis associated with hepatitis
- CHEM - liver enzymes, bilirubin, albumin, glucose, cholesterol
- U/S - echogenicity, architecture (liver and surrounding organs)
- LIVER BIOPSY - copper hepatopathy
- UA
What treatments are recommended for cases of IMHA causing icterus?
- corticosteroids
- Doxycycline
- antiplatelets and anticoagulants for PTE
What treatment is recommended for cases of pancreatitis causing icterus?
- fluid therapy
- nutritional support
- antiemetic
- analgesia
+/- antibiotics, plasma
What treatment is recommended for cases of copper hepatopathy causing icterus?
- low copper diet
- D-penicillamine - copper chelation
- hepatoprotectants - SAMe, vitamin C/E
- anti-inflammatory prednisone (+ antifibrotic)
