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Small Animal Medicine: Exam 2 (Spring 2016) > L18: Clinical Approach To Icterus (Gallagher) > Flashcards

L18: Clinical Approach To Icterus (Gallagher) Flashcards

1
Q

Pigments that freely filter through the kidney

A

C. Bilirubin
Urobilinogen
Urobilin
Stercobilinogen

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2
Q

See bilirubin metabolism diagram

A

:)

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3
Q

What makes feces brown?

A

Stercobilin pigment (from urobilinogen)

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4
Q

Which forms of bilirubin are NOT freely filtered in the kidney?

A

Anything albumin-bound, so unconjugated bilirubin and delta bilirubin.

Conjugated bilirubin IS freely filtered

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5
Q

Bilirubinuria may precede hyperbilirubinemia, esp. In cats**

A

Any bilirubin in cat urine is significant

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6
Q

In dogs, NOT uncommon to see bilirubin in the urine (lower threshold)

A

May or may not be significant

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7
Q

When does icterus occur in serum?

A

Bilirubin >1.5 mg/dL

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8
Q

When does icterus occur in tissues?

A

> 2.0 mg/dL

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9
Q

Lipemia, hemolysis can falsely increase bilirubin

A

:)

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10
Q

3 main causes of icterus

A

1) Pre-hepatic (upstream increase in bilirubin that normal liver can’ adequately deal with)
2) Hepatic (hepatocytes can’t process adequately)
3) Post-hepatic (obstruction to flow)

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11
Q

1 cause of post-hepatic icterus in dog

A

Pancreatitis

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12
Q

Differentials for pre-hepatic icterus

A

Hemolysis (do PCV to rule out FIRST)**

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13
Q

Differentials for hepatic icterus

A 
Hepatitis
Hepatic lipidosis
Neoplasia
Cirrhosis
Toxins/Drugs
Hyperbilirubinemia of sepsis (more common in cats)
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14
Q

Differentials for post-hepatic icterus

A
  • pancreatitis
  • cholangitis
  • cholecystitis
  • choleliths
  • biliary neoplasia
  • GB mucocele
  • Duodenal dz
  • biliary duct obstruction

rule out next after ruling out pre-hepatic hemolysis

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15
Q

Cats like to get biliary dz, dogs like to get hepatic parenchymal dz

A

:)

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16
Q

Unusual for PSS alone to cause icterus - should look for other cause

A

:)

17
Q

Clinical approach to icterus

A
  • Hx
  • PE
  • CBC/Chem/UA
  • Abd. Imaging
  • fecal evaluation
  • liver function testing
  • PLI
  • coag testing
  • infectious dz testing
  • hepatic tissue sampling
18
Q

Important things to ask in hx of liver patient

A
  • vaccination status
  • drugs/toxins
  • travel history
  • acute vs. chronic dz
19
Q

Important things to assess on PE of liver patient

A
  • icterus
  • hepatomegaly
  • ascites
  • abd. Pain
  • MM color
20
Q

Things to evaluate on CBC for liver patient

A
  • PCV/HCT

- evidence of hemolysis: hemolyzed serum, schistocyes, spherocytes, etc.

21
Q

Things to evaluate on Chemistry in liver patient

A
  • bilirubin
  • liver enzymes
  • BUN, albumin, cholesterol, glucose
22
Q

Things to look for on UA in liver patient

A
  • bilirubinuria (bilirubin crystals)

- ammonium urate crystals

23
Q

Abd. Imaging in the liver patient

A
  • Rads: liver size, extrahepatic lesions

- US: evaluate liver parenchyma, biliary tree, extrahepatic lesions (GB mucocele, GIT changes, etc.)

24
Q

Fecal evaluation of liver patient

A

Melena may indicate chronic hepatitis or other dz that effects both the liver and GIT

Acholic feces indicate bile duct obstruction

Perform fecal sedimentation to look for liver flukes in cats, or tx presumptively with praziquantel

25
Q

Liver function testing in icteric patient

A
  • Bile acids rarely indicated, esp. If patient clinically icteric
  • Resting ammonia
26
Q

PLI test for pancreatitis

A
  • can have false neg. and false positive

- should also use US to look for pancreatitis (will see hypoechoic pancreas, abd. Effusion)

27
Q

When should you do coag testing on icteric patient?

A

-if liver dysfunctional or there has been a chronic biliary duct obstruction

28
Q

Chronic bile duct obstruction –> malabsorption of fat-soluble vitamins

A

This is why you should supplement vitamin K in cats prior to biopsy if PT/PTT prolonged

29
Q

Lepto affects the liver and what other major organ

A

Kidneys

30
Q

Hepatic tissue sampling types

A
  • cytology
  • histopath
  • culture
  • bile evaluation (easier to isolate bacteria from bile than liver parenchyma)
31
Q

Very high bilirubin is common in hemolysis patients: why?**

A

Cytokines inhibit the uptake of bilirubin in the liver

32
Q

Will bilirubin be elevated in dog with diabetes?

A

No, but ALP can be

33
Q

Cats commonly get neutrophilic or lymphocytic cholangitis

A

:)

34
Q

3 forms of bilirubin

A

1) Unconjugated: albumin bound, water insoluble
2) Conjugated: glucuronic acid, water soluble
3) Delta: covalently bound to albumin, long-lasting

Small Animal Medicine: Exam 2 (Spring 2016) (13 decks)

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