1887

Jaundice

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Abstract

PLEASE NOTE THAT A MORE RECENT EDITION OF THIS TITLE IS AVAILABLE IN THE LIBRARY

Bilirubin is the waste product of haem protein degradation. The primary source of haem proteins is senescent erythrocytes; myoglobin and haem-containing enzyme systems in the liver are additional sources. Mononuclear phagocytic cells, primarily in the bone marrow and spleen. engulf old erythrocytes, after which haem oxygenase in the phagocytic cells opens the protoporphyrin ring of haemoglobin, forming biliverdin. Biliverdin is converted to fat-soluble bilirubin IXa, which is then released into the circulation where it is bound by albumin. This chapter considers Normal bilirubin formation and disposal; Pathophysiology of hyperbilirubinaemia; and Diagnosis.

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Figures

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14.1 (a) Haematocrit tubes from a cat that had received an incompatible transfusion. (b) Serum from a dog with immune-mediated intravascular haemolysis. The tube shows hyperbilirubinaemia and haemoglobinaemia.
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14.2 Saline agglutination test demonstrating erythrocyte clumping on gross inspection. Agglutination was confirmed by microscopic examination, confirming a diagnosis of immune-mediated haemolytic anaemia.
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14.3 Subcutaneous bruising associated with leakage from a femoral arterial catheter site following surgery to repair a congenital portosystemic shunt. The dog only became icteric after surgery.
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14.4 Bile obtained via ultrasound-guided cholecystocentesis from a cat with acute (bacterial) cholangitis.
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14.5 Acholic faeces from a dog with severe intra-hepatic cholestasis.
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14.6 Abdominal ecchymoses associated with bile duct avulsion following blunt abdominal trauma. The bleeding tendency was caused by vitamin K deficiency.
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14.7 Abdominal fluid from a dog with lethargy, vomiting and abdominal effusion. The gall bladder had ruptured for unknown reasons, resulting in bile peritonitis.
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14.9 Jaundice can be indicated by (a) a yellow sclera, (b) yellow oral mucous membranes and (c) marked bilirubinuria.
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14.13 Suggested algorithm for evaluation of a dog or cat with jaundice (Modified from with permission from Elsevier.) EHBD = extra-hepatic bile duct; FIP = feline infectious peritonitis; LEA = liver enzyme activity.

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