High bilirubin - how long to clear?

RE: High bilirubin - how long to clear?

Andrew Kent — Fri, 22 Jan 2021 21:33:56 GMT

Hopefully good news. Ultimately we tend to give these dogs a good few weeks before doing much more anyway so seems a reasonable plan!

RE: High bilirubin - how long to clear?

Beats — Fri, 22 Jan 2021 19:36:08 GMT

Follow-up:

I put the ultrasound probe on for interest (important to clarify i am not a good ultrasonographing vet) and the gall bladder looked large-normal, without evidence of bile duct distension that I would normally associate with extrahepatic bile duct obstruction. Certainly could have been though and now improving (or still is and my imaging is not up-to-scratch).

I'm getting a bit twitchy about still having yellow skin, but appears better otherwise each day so will keep fingers crossed will come with time.

RE: High bilirubin - how long to clear?

Beats — Thu, 21 Jan 2021 19:23:34 GMT

Thanks Andy.

That makes sense then as a possibility then. I'll keep that in mind for future cases also. I guess at least management (to level I can provide) is likely to be similar-ish in a case that is clinically improving if was acute pancreatitis with AKI - would maybe explain the persistent and very high bilirubin, in absence of marked ALT changes if that was the case though. Thanks again.

RE: High bilirubin - how long to clear?

Andrew Kent — Thu, 21 Jan 2021 15:43:35 GMT

I suppose the most common I see might be acute pancreatitis (with associated extra-hepatic bile duct obstruction) with acute kidney injury.

RE: High bilirubin - how long to clear?

Beats — Thu, 21 Jan 2021 15:29:04 GMT

OK. thanks for advice again Andy! You're a true star!

Presented initially acutely unwell wtih V+, lethargy and anorexia of less than 3 days duration, and was severely azotemic and jaundiced (with bottom of range platelets).

I'd thought was unlikely with post-hepatic cause to have such marked azotemia coincident (BUN, phos off scale, CREA 1100) without improvement on fluids (well hydrated 12 hours later Crea still 700-800, and persisted high for most of week.

Is now eating well (having had nothign voluntarily for a week) and might be able to remove feeding tube by this stage, so probably won't do further diagnostics unless fails to continue to improve or worsens.

Are there any major differentials of post-hepatic cause of jaundice that would fit with severe persistent azotemia at same time?

RE: High bilirubin - how long to clear?

Andrew Kent — Thu, 21 Jan 2021 13:45:51 GMT

It would be unusual to have leptospirosis without significant ALT elevation so would wonder if this has always been post-hepatic rather than hepatic. Could just be an atypical case but worth checking for sure.

Andy

RE: High bilirubin - how long to clear?

Beats — Thu, 21 Jan 2021 13:01:43 GMT

[quote userid="2451" url="~/001/veterinary-clinical/small-animal/medicine/f/discussions/29615/high-bilirubin---how-long-to-clear/227984#227984"]Was the ALT high or just the ALP?[/quote]

ALT was never higher than 180 (so less than 2 x URL), has since normalised.

I guess checking for biliary obstruction at this point would make sense. I'll see how doing clinically today.

Urine is still very yellow with high bilirubin.

RE: High bilirubin - how long to clear?

Andrew Kent — Thu, 21 Jan 2021 10:32:47 GMT

Hi Beats,

In most cases bilirubin reduces relatively quickly as the insult improves, however some dogs have higher levels of delta bilirubin which is protein bound and cannot be excreted in the urine so has a long half life (as long as protein so a few weeks) and that can lead to persistent hyperbilirubinaemia in some patients even after an insult has resolved.

Was the ALT high or just the ALP?

It may be worth further abdo imaging if things don't continue to evolve to exclude a concurrent post-hepatic disease.

Difficult to know how useful UDCA is in these situations but I would tend to use it. You can get compounded liquid to reduce the risk of tube blockage (or give orally rather than via the tube).

Andy