Case 8

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Misou's CBC results indicate a likely stress leukogram. The mild eosinophilia may be due to an inflammatory response, but because she goes outdoors, you deworm her with fenbendazole. Differential diagnoses for hyperbilirubinemia can be divided into prehepatic (e.g. hemolysis), hepatic (e.g. cholestasis from hepatocellular damage), and posthepatic (e.g. biliary tract obstruction) causes. Misou's laboratory results suggest hepatic or posthepatic causes since she does not appear to be overtly anemic for that degree of hyperbilirubinemia.

In a cat, elevations of alkaline phosphatase (ALP) activity are always clinically relevant since this enzyme has a short half-life and cats don't have a corticosteroid-induced isoenzyme.

You also note that she has mild hypokalemia, which you suspect may be due to her anorexia but can also occur with underlying gastrointestinal disease. You will treat this and monitor it for now as well.

You recognize that the hyperglycemia is likely stress-induced and the low T4 concentration is likely secondary to sick euthyroid syndrome or nonthyroidal illness. The elevation in the triglyceride concentration may be seen in patients with diabetes and hyperadrenocorticism (you suspect neither disease here), postprandial elevation, drugs, or liver disease.

QUESTION 2

Which of the following lists of differentials is least likely in Misou's case given her laboratory findings?

a) Hepatic lipidosis (primary or secondary), pancreatitis, biliary neoplasia

b) Feline infectious peritonitis (FIP), infiltrative bowel disease, hemotropic mycoplasma

c) Cholecystitis, hepatic lipidosis, hepatic neoplasia

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