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Today's Ve T erinary Prac T ice | s eptember/ o ctober 2016 | tvpjournal.com TH e ye LL o W ca T: dia G nos T ic & TH era P e UT ic s T ra T e G ies Peer r eviewed 40 Table 1. Hyperbilirubinemia in Cats: Differential Diagnoses & Clinical Signs Anorexia Lethargy Fever Lymphadenopathy Vomiting/diarrhea Weight loss Anemia Abdominal pain Other C L ini CAL Sign S Pre H e P ati C Hy P erbi L irubinemia Mycoplasma species 23 x x x x x x x Hypothermia Physiologic murmur Increased heart rate/respiratory effort secondary to anemia Cytauxzoon felis 24 x x x x Dehydration Evidence of shock Progression to moribund dyspnea and hypothermia Feline infectious peritonitis x x x x x x x x Effusive/wet FIP: Ascites, pleural effusion Dry FIP: Ocular and neurologic signs Babesia species x x x x x x x x Feline leukemia virus x Immune suppression Secondary infection Feline immunodeficiency virus x x x x Oral inflammation Secondary infection and lymphoma i mmune-mediated hemolytic anemia 8,25 x x x x Signs of primary IMHA, excluding identifiable causes Pica e rythrocyte PK deficiency 26 x x x x x x Pica i ncreased erythrocyte osmotic fragility 27 n eonatal isoerythrolysis 28 x Cessation of nursing, failure to thrive Disseminated intravascular coagulation Pigmenturia Acute kidney injury Death t ransfusion reaction 29 x x Erythema or pruritus Vocalization Dyspnea or tachypnea Tachycardia or bradycardia Tremor, convulsion Shock Cardiopulmonary arrest h ypophosphatemia 30,31,a x x x x Clinical signs usually consistent with acute hemolysis Weakness Tachypnea, tachycardia Microangiopathic hemolytic anemia 32,b x x x x x x x x Clinical signs vary with condition and severity Hyperthermia Obtundation Cardiopulmonary arrest Drugs, toxins, envenomation, oxidative stress c Clinical signs nonspecific and depend on underlying etiology; may include clinical signs associated with Microangiopathic hemolytic anemia (above) and allergic reaction (eg, swelling, pain, redness, focal inflammation) Cholangitis In contrast to dogs—in which hepatic disease is usually located in the liver parenchyma—feline liver disease typically targets the biliary system, and is most commonly seen as cholangitis. The World Small Animal Veterinary Association l iver Standardization Group clarified the terminology, defining feline cholangitis as neutrophilic (acute or chronic), lymphocytic, or secondary to liver flukes. 11 COMMON CAUSES OF POSTHEPATIC HYPERBILIRUBINEMIA Extrahepatic Bile Duct Obstruction Cholelithiasis may be obstructive and is, thus, ap - proached as a cause of extrahepatic bile duct ob- struction (EHBO). Other causes of EHBO include tumors, nonneoplastic masses, cholecystitis, inspissat - ed bile, cholangitis, and pancreatitis. The prognosis, even following successful surgery, is guarded.