PrintToon: Bilirubin Issues
Toon is a 12 year old spayed female Coonhound who was transferred from her regular veterinarian to VCA Alameda East Veterinary Hospital on a Friday evening for surgery to remove her gall bladder. Toon had been hospitalized at her regular veterinarian's office since Wednesday for vomiting, loss of appetite, and jaundice. Blood work performed by her veterinarian showed marked elevations in several liver values. One value in particular, total bilirubin, was 27. The normal range for this value is 0 to 0.9! Bilirubin is a substance that is normally cleared from circulation by the liver. When the liver is injured, or when bile flow is obstructed, the liver is unable to efficiently remove this substance. It accumulates within the tissues of the body and results in a jaundiced appearance. The whites of Toon's eyes, as well as her gums and skin were bright yellow in color. Toon had several benign soft tissue masses under her skin and seemed subdued, but was otherwise normal on physical examination. An abdominal ultrasound showed that Toon's entire biliary tree (the system of tubes that carry bile through the liver and to the gall bladder and small intestine) was dilated. This finding was highly suggestive of a biliary obstruction.
Toon was hospitalized in ICU overnight on intravenous fluids and anti-nausea 
medication. She was transferred to the surgery service on Saturday morning. In surgery, Toon's liver appeared abnormal. A large portion of her bile duct (the tube that carries bile from the gall bladder to the small intestine) was much larger than normal. It was filled with thick and mineralized bile. This unhealthy bile was removed. A catheter was passed through the bile duct into the small intestine to unblock the flow of bile. A stent, or small rubber tube, was sutured in place to ensure that this smaller portion of the bile duct remained open. Her gall bladder appeared unhealthy and was removed.
Toon returned to ICU for her recovery. Here, she received around the clock care and careful monitoring during the critical post operative period. Toon spent 5 days in ICU and was watched closely for potential complications such as infection and re-obstruction of the biliary tract. Over the course of that time, her liver values trended towards normal, her jaundice resolved, and she slowly regained her appetite. At her last recheck appointment, just 10 days post-op, her total bilirubin was down to 1.4. She is eating like a champ and acting like a dog again!
