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"The question about the biochemistry is really interesting, because what your question now is, is 'what is it, and where is it?' And the problem that we have is that the liver enzymes aren't gonna tell us, because it's really hard to separate hepatic from post-hepatic on bloods. ALP is very insensitive in the cat and will go up with both hepatic and post-hepatic. ALT will go up with hepatic and post-hepatic. Bilirubin will be up. So what?!"

We recorded this case-based interactive session about how to work up the jaundiced cat with one of the world's leading Small Animal Medicine specialists and teachers, ⁠Prof Jill Maddison⁠ at session our live event in 2022.
Prof Jill Jill Maddison, BVSc, DipVetClinStud, PhD, SFHEA, MRCVS, is a professor of general practice, the director of professional development, and the BVetMed and CertAVP course director at Royal Veterinary College. She is also a coordinator for London Vet Show and is a consultant at a local veterinary practice and at Beaumont Sainsbury Animal Hospital in London. Dr Maddison is the senior editor of the second edition of Small Animal Clinical Pharmacology and the senior editor of Clinical Reasoning in Small Animal Practice. She has lectured worldwide on clinical problem-solving, small animal internal medicine, and clinical pharmacology. 
In this session she helps us reason through a case of jaundice in a cat to create a deeper understanding, rather than a simple list of facts. She also shifts some long-standing beliefs around diagnostic testing in liver disease in both dogs and cats.

Topic list:
5:07 Where to begin your workup.
6:05 Defining the problem and localising the problem: Pre-hepatic, hepatic or post-hepatic?
9:17 How much does dehydration actually affect PCV?
10:43 Bilirubin - how useful is it?
"It’s the most over-interpreted test I reckon. I have so many vets tell me, “Oh, the bilirubin is 16, it has to have a problem with its liver…” No, it probably just has inflammatory disease."
13:14 Dd’s for hepatic disease in cats.
14:20 Dd’s for post-hepatic causes of jaundice.
16:04 Biochem in jaundice: ALP, ALT, GGT.
"The problem that we have is that the liver enzymes aren't going to tell us."
19:51 Why bile acids are useless in the diagnosis of liver disease.
"The bile acids don't tell you anything more than you already know. There is no relationship between the level of bile acids and the prognosis or reversibility of the lesion."
24:25 Can't I just trial-treat?
26:16 Ultrasound.
28:27 Signalment: how useful is it?
29:36 Cholesterol and liver disease.
30:52 Pancreatic lipase and pancreatitis in cats.
"What we found was that we had 24% false negatives. So we had a quarter of our cats who had what seemed to be pancreatitis that did not have an increased Pli."
36:54 Hepatic lipidosis.

For more world-class specialists in an easy-to-consume format join our community of Vet Vault Nerds at vvn.supercast.com.
Visit thevetvault.com for the show notes for this episode.
Join us in at Vets on Tour in Wanaka, New Zealand on 13 - 18 August 2023 for great CE, more live podcasting and snow... lots of snow!




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