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It further asserts the importance reflexive practice for decision-makers, policy-practitioners and researcher

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Although increases in bilirubin (likely a mixture of conjugated and unconjugated) are seen in dogs with hepatic failure (Toulza et al 2006) (likely due to a combination of reasons, such as inflammatory cytokine-mediated alteration in transporters, toxicity from accumulated bile acids, alterations in intrahepatic blood flow from fibrosis, hepatocyte swelling resulting in cholestasis), the high bilirubin is not specific for failure and can be seen in various diseases that are not associated with liver failure, e.g