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tvpjournal.com | September/October 2016 | T O day' S Ve T erinary Prac T ice TH e ye LLOW ca T: dia G n OST ic & TH era P e UT ic ST ra T e G ie S Peer r eviewed 43 can be difficult to appreciate in sedentary cats, and sick cats often hide, further delaying the owner's observation of more obvious clinical signs. Dog owners may notice changes in the color of urine or feces, but it is much less likely for cat owners to report pigmenturia or acholic feces in this fastidious species. It is also relatively unusual for cats to have dietary indiscretion of toxins, household products, medications, or human food, but certainly the potential for exposure should be investigated during the anamnesis. The prevalence of multi-cat households also confounds the owner's ability to appreciate changes in appetite, water consumption, or elimination habits. Physical Examination A complete physical examination, including body temperature, pulse, respiratory rate, fundic examination, cardiovascular auscultation, and abdominal palpation, is essential. Physical findings may indicate potential underlying etiologies, such Table 2. (continued) Hyperbilirubinemia in Cats: Differential Diagnoses, Diagnostics, & Hyperbilirubinemia in Cats: Differential Diagnoses, Diagnostics, & t reatment D i FF erenti AL D i A gn OS e S D i A gn OS ti CS tre A t M ent OP ti O n S H e P ati C H y P erbi L irubinemia h epatic lipidosis 33,34 (idiopathic or secondary) CBC Serum biochemical profile Urinalysis FeLV/FIV testing Bile acids fPLI blood test Ultrasound-guided liver FNA Vitamin K1, 1 mg SC Q 12 H Nutrition via E-tube Cholangitis 35,36 (bacterial, acute or chronic neutrophilic, lymphocytic) Ultrasound-guided or laparoscopy- assisted cholecystocentesis and liver FNA Cytology Culture and sensitivity Amoxicillin and clavulanic acid, 62.5 mg/cat Q 12 H Enrofloxacin, 5 mg/kg Q 24 H Metronidazole, 75 mg/kg Q 12 H Prednisolone, 2 mg/kg Q 24 H, taper to 0.5−1 mg/kg Q 24 H Cyclosporine, 5 mg/kg PO Q 24 H Ursodeoxycholic acid, 10–15 mg/kg Q 24 H i nfectious disease (FIP 37 , virulent systemic feline calicivirus, Francisella tularensis 38 ) Infectious disease testing Supportive care Treatment of underlying infection Drugs, toxins 39,40 Various toxin assays S-adenosyl-methionine, 90 mg/cat Q 24 H Silimarin, 2−5 mg/kg Q 24 H Vitamin E, 50 IU Q 24 H Amyloidosis 41 (familial, Siamese, others) FNA of liver Cytology Supportive care Sepsis Systemic inflammatory response syndrome 42 Various diagnostics Supportive care Treatment of underlying condition POS t H e P ati C H y P erbi L irubinemia Cholelithiasis 43,44 Abdominal ultrasound Ursodeoxycholic acid, 5−15 mg/kg Q 24 H Surgery e xtrahepatic biliary obstruction 45 Abdominal ultrasound FNA of affected tissue Ursodeoxycholic acid, 5−15 mg/kg Q 24 H Treatment of underlying condition surgically or medically t riaditis 46 fPLI blood test Abdominal ultrasound FNA of liver Cholecystocentesis Cytology Culture and sensitivity Small intestinal endoscopic biopsy Supportive care: hydration, perfusion, acid–base balance Buprenorphine, 0.01 mg/kg sublingual Q 8 H Maropitant, 1 mg/kg SC Q 24 H Antibiotics Nutrition via E-tube Single anti-inflammatory dose of glucocorticoid Liver flukes 47 (Platynosomum concinnum) Fecal examination Ultrasound-guided cholecystocentesis and bile cytology Abdominal ultrasound Praziquantel, 10−30 mg/kg Q 24 H for 3 days Surgery if EHBO EHBO = extrahepatic biliary obstruction; FeLV = feline leukemia virus; FIP = feline infectious peritonitis; FIV = feline immunodeficiency virus; FNA = fine needle aspiration; fPLI = feline pancreatic lipase immunoreactivity; PCR = polymerase chain reaction