Today the sweet little slightly less yellow kitty went home. He is on his way to recovery but until he's gained some weight and isn't yellow anymore, I won't say we've achieved victory!
So back to yesterday. I asked several questions and here are the answers (they may not be all inclusive but they represent the top things that come to my mind and in my experience).
1. What are the possible causes of his signs (anorexia, vomiting, lethargy) and exam findings (jaundice, weight loss)?
-infectious diseases - a whole lot of those - some of which can affect the liver directly or indirectly
-hepatic lipidosis - aka "fatty liver" syndrome = the body breaks down fat for energy, this fat "overwhelms" what the liver can process and it eventually fails (keep in mind THIS syndrome is not the primary issue - something causes kitty to go off food - be it an upper respiratory infection, a foreign body, etc)
-autoimmune disease - especially one that causes red blood cell breakdown - the pigments are what cause the jaundice - so it's NOT a liver issue, it's call pre-hepatic
-inflammation - cats can get hepatitis, in fact, they often get cholangiohepatitis (inflammation of the gallbladder AND liver)
2. What tests do you think they did?
-a physical exam (ok I know they already did that, but this is often undervalued and overlooked - by clients and doctors as well! - as a KEY component in getting a diagnosis)
-an x-ray or two
-exploratory surgery with biopsies
Ok, they did NOT do all of the above, but they would've all been a reasonable progression in this case. They did run blood work and they did an x-ray. The blood work was pretty normal but the x-ray showed what looked like a foreign body so they recommended surgery. Skipping the ultrasound saves the client money and the cat time (yes, we cut animals with a problem in less than 6 months! --sorry that's a bit of personal lashing out at some MD's who ignored me). Anyhow, the ultrasound would've said - "hmm..not sure on this...most of it looks normal but the stomach..needs to be opened..so..go in!"
No, they don't really talk but knowing what I know I can tell you that. Ultrasonography has value don't get me wrong. We use it ALL the time. Cases like these are the prime example of why it's just cost and time efficient to "cut to the chase" and cut!
3. What possible next steps are there for kitty?
Based on what I've said above, you are thinking surgery. True. A very good next step. Sometimes medicine can help though. Fluids and drugs that help things move along through the intestines, antibiotics for liver or GI infections, etc.
And here's what are ALL wondering: What did happen and what did we find to be the cause?
Come back tomorrow and I'll let you see!