Page 449 - Problem-Based Feline Medicine

21 – THE YELLOW CAT OR CAT WITH ELEVATED LIVER ENZYMES 441

Laparotomy allows for cholecystectomy and treatment Pathogenesis
of peritonitis.
Rupture of the extrahepatic biliary tree may occur with
blunt or penetrating abdominal trauma, necrotizing
Treatment
cholecystitis and cholelithiasis (rare). Leakage of sig-
Surgically remove calculi causing clinical signs of nificant volumes of bile into the peritoneal cavity
hepatobiliary disease. induces tissue inflammation. Unconjugated bile acids
are most irritating, as they alter the permeability of vas-
Assess patency of biliary tree during surgery. If the gall-
cular structures within the peritoneal membranes.
bladder appears inflamed, consider cholecystectomy.
● Administer vitamin K 12–24 hours prior to surgical Altered membrane permeability promotes transmural
intervention. bacterial migration into the peritoneal cavity, septic
● Perform concurrent liver biopsy to assess the extent inflammation and septicemia.
of hepatic inflammation.
Non-septic inflammation causes intra-abdominal fluid
Culture bile fluid for the presence of aerobic/anaerobic sequestration, contraction of circulating blood volume
bacterial pathogens. and dehydration which may induce hypovolemic shock.
● Use broad-spectrum antibiotic therapy effective
against enteric pathogens. Good first-choice drugs Diagnosis
which reach therapeutic biliary concentrations
Suggestive history with other evidence of trauma.
include cephalosporins, penicillins, doxycycline,
metronidazole, clindamycin and the quinolones. Liver enzymes (ALP, ALT) are mildly to moderately
Base antimicrobial therapy on the results obtained increased. Moderate-to-severe hyperbilirubinemia is
from biliary culture and susceptibility testing. often present.
Fluid therapy is administered to hypovolemic cats or Cytologic examination of abdominal effusion confirms
those requiring correction of electrolyte derangements. the diagnosis.
● The effusion is turbid and golden brown-to-green in
Prognosis appearance. Inflammatory cells (macrophages and
neutrophils) and bilirubin crystals are generally seen.
The prognosis in most cases is guarded. Those cats
which are not extremely debilitated or that have necro-
tizing cholecystitis have a more favorable prognosis. Treatment
Immediate surgical correction of bile leakage.
RUPTURED BILE DUCT ● Perform cholecystectomy if concurrent necrotizing
cholecystitis is present.
● Provide adequate post-operative drainage.
Classical signs
Correct fluid and electrolyte derangements intra-
● Malaise, weight loss.
venously using a balanced electrolyte solution with
● Low-grade abdominal pain.
electrolyte supplements as needed. Colloids may be
● Abdominal effusion +/- jaundice.
needed for correction of hypoalbuminemia if present.
Broad-spectrum antibiotic therapy, as per cholecystitis,
Clinical signs
if septicemia is present.
There is often a history of trauma.
General malaise, weight loss and abdominal pain pre- Prognosis
dominate.
A guarded prognosis is warranted in most cats. Cats
Abdominal effusion +/− jaundice may be present. having pronounced effusion, chronic debilitation, or
Intervals ranging from 3 days to 3 weeks before the clinical evidence of sepsis at the time of diagnosis have
presentation may be observed. a poor prognosis.