Cat case help - high tBIL

Re: Cat case help - high tBIL

Catriona MacIntyre — Mon, 08 Jun 2015 19:50:40 GMT

[quote user="Laura Marshall"]Hi Tom, Interesting case. I agree with what Andrew said re differentials, esp sepsis induced cholestasis. The albumin may well be reduced due to being a negative phase protein. I posted to throw one other thought into the mix - which always crosses my mind in young purebred cats who are doing odd things - and suggest FIP as another differential.

[/quote]

FIP popped into my head too

Re: Cat case help - high tBIL

Anthony Todd — Fri, 05 Jun 2015 22:34:06 GMT

I know you weren't, Seen them myself, wasn't thinking properly.

Re: Cat case help - high tBIL

Robin Grimmer — Fri, 05 Jun 2015 22:25:56 GMT

I wasn't being facetious. A linear FB is a specific condition:

Linear foreign bodies can especially be dangerous. A linear foreign body is usually a length of string or yarn with a larger object or clump of material at either end. One end is usually lodged in the stomach or proximal small intestine and the other end continues to travel through the intestines. The material becomes tightly stretched and the intestines may "accordion up" on themselves or be lacerated by it.^[17] This is especially common in cats who may enjoy playing with a ball of string or yarn. Sometimes the linear foreign body anchors in the mouth by catching under the tongue.^[

Re: Cat case help - high tBIL

Anthony Todd — Fri, 05 Jun 2015 20:31:33 GMT

[quote user="Robin Grimmer"]A cocktail stick, although straight, does not constitute a linear foreign body![/quote]

Yeah, sorry, thanks for that, got my "linears" and my "straights" mixed up.

Re: Cat case help - high tBIL

John Flynn — Fri, 05 Jun 2015 20:26:50 GMT

[quote user="Kate Richardson"]I have never seen elevated bilirubin due to sample haemolysis[/quote]

APologies - had this the wrong way round. the common testing interference from haemolysis is to DECREASE bilirubin levels! OOps :-)

Re: Cat case help - high tBIL

Robin Grimmer — Fri, 05 Jun 2015 19:40:29 GMT

J[quote user="Anthony Todd"]

[quote user="Tom Ward"]concern over linear FB[/quote]

[quote user="Tom Ward"]Ex lap performed [/quote]

What did you see which could have been a linear FB? [cocktail stick??]

[/quote]

A cocktail stick, although straight, does not constitute a linear foreign body!

Re: Cat case help - high tBIL

Tom Ward — Fri, 05 Jun 2015 19:14:55 GMT

Many thanks for all your help, cat making good recovery. Suspect it was a suppurative cholangiohepatitis, repeat scan showed normal liver architecture again, but over time ALT levels started to rise slightly. Cat now eating reasonably well, hopefully on the up!

Re: Cat case help - high tBIL

Anthony Todd — Wed, 03 Jun 2015 19:20:56 GMT

[quote user="Tom Ward"]concern over linear FB[/quote]

[quote user="Tom Ward"]Ex lap performed [/quote]

What did you see which could have been a linear FB? [cocktail stick??]

Re: Cat case help - high tBIL

Martin Atkinson — Wed, 03 Jun 2015 11:53:03 GMT

[quote user="Kate Richardson"]

If I had to make a full list of differentials, then FIP would be on the list, but it would be reasonably low down at this stage

[/quote]Agreed.

Re: Cat case help - high tBIL

Kate Richardson — Wed, 03 Jun 2015 11:51:20 GMT

If I had to make a full list of differentials, then FIP would be on the list, but it would be reasonably low down at this stage

Re: Cat case help - high tBIL

Martin Atkinson — Wed, 03 Jun 2015 10:24:17 GMT

[quote user="Robin Grimmer"]I wouldn't say anything rules out FIP! Globulin isn't mentioned, but if metabolism is switched to making globulins then albumin can be reduced.[/quote]The only thing that is constant in FIP is a high globulin level, every other test has a much lower specificity. A high FCoV is not diagnostic of FIP just as negative FCoV test would not rule it out but low/normal protein almost certainly does.

Re: Cat case help - high tBIL

Robin Grimmer — Wed, 03 Jun 2015 09:38:31 GMT

[quote user="Martin Atkinson"]

[quote user="Robin Grimmer"]Yep I'd also consider FIP. [/quote]The OP mentions low albumin and I would have thought would have mentioned high globulin if it was raised so that should rule out FIP. Never (knowingly) seen a case of toxo so can't comment on that.

[/quote]

I wouldn't say anything rules out FIP! Globulin isn't mentioned, but if metabolism is switched to making globulins then albumin can be reduced.

Re: Cat case help - high tBIL

Martin Atkinson — Wed, 03 Jun 2015 08:58:57 GMT

Re: Cat case help - high tBIL

Kate Richardson — Wed, 03 Jun 2015 08:53:40 GMT

Hi I would still consider acute pancreatitis most likely, regardless of the snap test, and agree with Martin, a quantitative PLI is better (IMO). But even if normal PLI I wouldn't rule out pancreatitis. Does he have any weight loss? I would be less concerned about liver function if no weight loss and prior to this illness he has been well I assume? Cats often develop hyperbilirubinaemia when sick and inappetant for any reason, so unless it is sky rocketing or not resolving, and if the cat doesn't continue to improve clinically, I would continue your current treatment, poss add anti-emetics if still inappetant, monitor his electrolytes especially potassium if you can and supplement if necessary. B12 won't hurt either and maybe destolit if the bilirubin isn't coming down. If still not improving, then revisit the liver and biliary tract.

I have never seen elevated bilirubin due to sample haemolysis, but that's not to say it is impossible. How is he today?

Re: Cat case help - high tBIL

John Flynn — Tue, 02 Jun 2015 20:44:42 GMT

[quote user="Tom Ward"]I am pondering what could be causing the elevation in TBIL in the absence of liver enzyme activity or falling HCT? What have I missed?[/quote]

Unlikely to be relevant, but if the cat is hard to blood sample can get (obvious) haemolysis in the sample that wasn't in the cat and that can cause high bilirubin on the analysis maybe?

Re: Cat case help - high tBIL

Robin Grimmer — Tue, 02 Jun 2015 19:24:42 GMT

Yep I'd also consider FIP. Does the cat hunt at all? I once had a young cat present with severe jaundice. The cause was Toxoplasmosis and the cat made a full recovery with appropriate treatment.

Re: Cat case help - high tBIL

Laura Marshall — Tue, 02 Jun 2015 12:34:04 GMT

Hi Tom, Interesting case. I agree with what Andrew said re differentials, esp sepsis induced cholestasis. The albumin may well be reduced due to being a negative phase protein. I posted to throw one other thought into the mix - which always crosses my mind in young purebred cats who are doing odd things - and suggest FIP as another differential.

Re: Cat case help - high tBIL

Martin Atkinson — Tue, 02 Jun 2015 11:55:44 GMT

The low albumin suggests reduced liver function and cats don't elevate their liver enzymes as much as dogs so I would want other measures of liver function i.e bile acids, cholesterol and GGT. I would have been worried about acute pancreatits with the history and don't like the SNAP test so would send a sample off for fPL. Don't forget the other reason for raised bilirubin - XS breakdown of haemoglobin - you don't mention the RBC count and/or if there is a regenerative picture. I presume from what you have said you didn't biopsy anything and I know it takes a brave man to biopsy intestine, liver and pancreas and take a bile sample for culture but while I was there I would have taken the opportunity (after a buccal clotting time and a shot of Vit K mind you).

Re: Cat case help - high tBIL

Andrew Kent — Tue, 02 Jun 2015 11:54:35 GMT

Hi Tom,

Cats just love to be odd with their blood findings and we do sometimes see cats with elevated TBil and normal liver enzymes with cholestatic disease so I wouldn't entirely rule that out.

The other possibilities are functional cholestasis (also known as sepsis-associated cholestasis) which is caused by impaired bile transport due to the effect of endotoxins (or other cytokines etc), or anorexia associated elevations which is sometimes seen in cats presumably due to detective clearance/conjugation due to substrate deficiency.

It seems to be relatively common to see in sick cats for whatever reason (probably sepsis associated) but if it is increasing then it would be worth revisiting the biliary tract - is the cholesterol normal?

Andy