Page 2748 - Cote clinical veterinary advisor dogs and cats 4th

Icterus: Management 1430.e1

Icterus: Management
VetBooks.ir Icterus

• Moderate to severe anemia • Mild or no anemia
• Normal to slight increase in alanine amino- • No red blood cell regeneration
transferase and alkaline phosphatase activity • Moderate to severe increase in
alanine aminotransferase and
alkaline phosphatase activity

Evaluation for hemolysis
Abdominal ultrasonography

Changes in hepatic Gallbladder or Abdominal Mass in gallbladder,
parenchyma suggestive bile duct distention effusion common bile duct,
of primary liver disease or duodenum

• Consider toxins (see
Hepatotoxins, p. 1231) Hepatobiliary Repeat abdominal Abdominocentesis Exploratory
• Consider leptospirosis scintigraphy ultrasound exam(s) with cytology, culture, surgery
• Consider biopsy (perform bilirubin analysis
coagulation profile first) or
aspirate for histologic
examination, cytologic
evaluation, and bacterial culture Bacteria or toxic/ • Gallbladder mass:
degenerative cholecystectomy
polymorphonuclear • Bile duct mass: CCD
leukocytes or • Duodenal mass: resect
bilirubin ≥2 × serum and CCD; or decompress
No obstruction level (i.e., tube drainage) to
Obstruction
stabilize before resection

Medical treatment
Monitor or biopsy Evidence of pancreatitis? Exploratory
Explore if deteriorates surgery
No Yes

Exploratory surgery Management • Necrotizing cholecystitis:
• Bile duct obstructed beyond cystic of pancreatitis cholecystectomy
duct: CCD • Ruptured gallbladder: repair
• Cholecystoliths: cholecystectomy or cholecystectomy
• Choledocholiths: flush or remove and • Ruptured bile duct beyond Clinical
cholecystectomy ± choledochotomy cystic duct: ligate and CCD Algorithms
• Cholelith at sphincter: sphincterotomy • Torn hepatic duct: ligate
or sphincteroplasty
• Bile duct mass: CCD
• Duodenal mass: resection and CCD
• Pancreatic mass: CCD

CCD, Cholecystoduodenostomy.
(Modified from Slatter DH: Textbook of small animal surgery, ed 3, St. Louis, 2003, Saunders.)

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