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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 48 prognosis. Nonsurgical causes, such as pancreatitis and cholangitis, are medically managed and the prognosis is impacted by the severity of disease, response to treatment, and owner commitment. Triaditis The effective treatment of triaditis is complicated, but is initiated with supportive care targeting hydration, perfusion, electrolyte and acid–base balance, pain, and vomiting; then targets the aspect of the disease constellation that appears to be having the greatest impact on the patient. Antibiotics are administered in patients in which there is the potential for sepsis, gastrointestinal translocation, positive bacterial cultures, or a left shift with band neutrophils on the CBC. Corticosteroids are usually avoided in the face of a positively identified bacterial component, although a single anti-inflammatory dose of glucocorticoid may be used to counter the inflammatory mediators. With - out strong evidence of a bacterial infection, corticoste- roids are often used to treat each separate component of feline triaditis: inflammatory bowel disease, pancre - atitis, and lymphocytic-plasmacytic cholangitis. Nutritional support in the form of E-tube placement is often implemented. Liver Fluke Medical treatment for liver fluke infection may be attempted with praziquantel (20−30 mg/kg Q 24 H for 3 days), but rare, severe cases may require surgery to remove a posthepatic biliary obstruction as identified with abdominal ultrasound. IN SUMMARY A thoughtful approach to hyperbilirubinemia, starting with localization of the disease and including the calculated consideration of differentials unique to that location, greatly enhances the efficient and effective di - agnosis and treatment of the "yellow cat." Organizing the effort in terms of pre-hepatic, hepatic, and post-he - patic conditions is a logical and time-tested approach that has been successfully applied to many icteric cats. CBC = complete blood count; EBHO = extrahepatic biliary obstruction; E-tube = esophagostomy tube; Fe l V = feline leukemia virus; FIP = feline infectious peritonitis; FIV = feline immunodeficiency virus; FNA = fine needle aspiration; IMHA = immune-mediated hemolytic anemia; PCV = packed cell volume; PK = pyruvate kinase; r BC = red blood cell References 1. Sherding r G. Feline jaundice. J Fel Med Surg 2000; 2(3):165- 169. 2. Sherding r G. Icterus. In Washabau r J, Day MJ (eds): Canine and Feline Gastroenterology. St. l ouis: Elsevier, 2013, pp 140- 147. 3. Jenkins KS, Dittmer KE, Marschall JC, et al. Prevalence and risk factor analysis of feline haemoplasma infection in New Zealand domestic cats using a real-time PC r assay. J Feline Med Surg 2013; 15:1063-1069. 4. Duarte A, Marques V, Correia JH, et al. Molecular detection of haemotropic Mycoplasma species in urban and rural cats from Portugal. J Feline Med Surg 2015;17:516-522. 5. Walker V r , Morera GF, Gómez JM, et al. Prevalence, risk factor analysis, and hematological findings of hemoplasma infection in domestic cats from Valdivia, Southern Chile. Comp Immunol Microbiol Infect Dis 2016; 46:20-26. 6. Hartmann K. Clinical aspects of feline retroviruses: A review. Viruses 2012; 4:2684-2710. 7. Hartmann K, Addie D, Belák S, et al. Babesiosis in cats: ABCD guidelines on prevention and management. J Feline Med Surg 2013; 15(7):643-646. 8. Kohn B, Weingart C, Eckmann V, et al. Primary immune- mediated hemolytic anemia in 19 cats: Diagnosis, therapy, and outcome (1998-2004). J Vet Intern Med 2006; 20(1):159-166. 9. Grahn r A, Grahn JC, Penedo MC, et al. Erythrocyte pyruvate kinase deficiency mutation identified in multiple breeds of domestic cats. BMC Vet Res 2012; 8:207-217. 10. Verbrugghe A, Bakovic M. Peculiarities of one-carbon metabolism in the strict carnivorous cat and the role in feline hepatic lipidosis. Nutrients 2013; 5:2811-2835. 11. Van den Ingh TS, Van Winkle T, Cullen JM, et al. Morphological classification of parenchymal disorders of the canine and feline liver: 2. Hepatocellular death, hepatitis and cirrhosis. In r othuizen J, Bunch SE, Charles JE, et al: WSAVA Standards for Clinical and Histological Diagnosis of Canine and Feline Liver Diseases. Philadelphia: Elsevier, 2006, pp 85-101. 12. Wardrop KJ. Coombs' testing and its diagnostic significance in dogs and cats. Vet Clin North Am Small Animal Pract 2012; 42:43-51. 13. Wang KY, Panciera D l , Al r ukivat r K, et al. Accuracy of ultrasound-guided fine-needle aspiration of the liver and cytologic findings in dogs and cats: 97 cases (1990-2000). JAVMA 2004; 224(1):75-78. 14. Wagner KA, Hartmann FA, Trepanier l A. Bacterial culture results from liver, gallbladder, or bile in 248 dogs and cats evaluated for hepatobiliary disease: 1998-2003. J Vet Intern Med 2007; 21:417-424. 15. Peters l M, Glanemann B, Garden OA, et al. Cytological findings of 140 bile samples from dogs and cats and associated clinical pathological data. J Vet Intern Med 2016; 30:123-131. 16. r othuizen J, Twedt DC. l iver biopsy techniques. Vet Clin North Am Sm Anim Pract 2009; 39:469-480.8. 17. Koster l , Shell l , Illanes O, et al. Percutaneous ultrasound- guided cholecystocentesis and bile analysis for detection of Platynosomum spp.-induced cholangitis in cats. J Vet Intern Med 2016; 30(3):787-793. 18. Harvey AM, Holt PE, Barr FJ, et al. Treatment and long-term follow-up of extrahepatic biliary obstruction with bilirubin cholelithiasis in a Somali cat with pyruvate kinase deficiency. J Feline Med Surg 2007; 9(5):424-431. 19. Black V, Adamantos S, Barfield D, et al. Feline non- Craig b . Webb Craig B. Webb, PhD, DVM, Diplomate ACVIM (Small Animal Internal Medicine), is a professor in the clinical sciences department at Colorado State University (CSU) and head of the small animal medicine section. Dr. Webb specializes in gastroenterology and hepatology and, along with Drs. David Twedt and Eric Monnet, teaches the CSU CE Endoscopy & Laparoscopy course as well as the ACVIM Dry-Lab Laparoscopy course. Dr. Webb's research interests include chronic enteropathies, oxidative stress, nutraceuticals, and the use of stem cell therapy in small animal patients. He received his DVM from the University of Wisconsin–Madison.