Page 330 - Problem-Based Feline Medicine

322 PART 6 CAT WITH WEIGHT LOSS OR CHRONIC ILLNESS

● Ampicillin (10–40 mg/kg q 8 hours PO), amoxi- require euthanasia. Once severe fibrosis, cirrhosis or
cillin (11–22 mg/kg q 8–12 hours PO), or ascites has developed the prognosis is usually guarded.
cephalexin (10–35 mg/kg q 8–12 hours PO)
● Add metronidazole for its effect against anaerobes
and its immune-modulating effects (7.5–10 mg/kg Prevention
every 12 hours PO). Do not use higher doses, as
Since it is not known what triggers the development of
these can be hepatotoxic.
lymphocytic cholangitis/cholangiohepatitis complex, it
Immunosuppressive agents: is currently not possible to prevent its onset.
● Immunosuppressive doses of corticosteroids
(prednisolone 2–4 mg/kg q 12–24 hours PO), then ACROMEGALY
taper over 1–3 months, and maintain on every other
day doses if needed.
Classical signs
● Other immunosuppressive agents may be consid-
ered, e.g. methotrexate (0.13 mg/cat every 12 ● Rare condition of older, typically, male cats.
hours × 3 doses PO, repeated once weekly) or chlo- ● Slow increase in body size, especially
2
rambucil (2–5 mg/m PO up to once every 48 h). affecting head and feet.
● Variable weight change with a good
Supportive therapies:
appetite.
● Ursodeoxycholic acid aids bile flow and is
● Usually diabetic; so polyuric and polydipsic.
believed to have hepatoprotective effects (10–15
mg/kg q 24 hours PO).
● Vitamin K1 is often required because fat malab- Pathogenesis
sorption results in poor absorption of fat-soluble
In cats, most cases of acromegaly are caused by the
vitamins like vitamin K and this can result in
development of a growth hormone-secreting tumor
abnormal hemostasis (0.5 mg/kg q 24 hours SC for
within the pituitary gland.
3–4 days, then once every 7–14 days).
● Vitamin E may be given for its anti-oxidative prop- Unlike the situation in the dog, increased levels of cir-
erties (50–200 IU/cat/day PO). culating progestogens or progesterone do not stimulate
● S-adenosylmethionine (SAMe) may be given for growth hormone secretion in the cat.
its hepato-protective and anti-oxidative properties
(18 mg/kg/day PO).
● Some authors suggest feeding either hypoallergenic Clinical signs
or high-fiber diets. Acromegaly is seen most typically in older, male,
–
● Milk thistle, 7 50 mg/kg q24h PO. mixed-breed cats.
Surgery will be required where complete biliary Affected cats slowly increase in size, with somewhat
obstruction occurs (cholecystotomy or cholecystoduo- disproportionate enlargement and thickening of the
denostomy). head and feet.
● Growth of the jaw bones may result in obvious
It is important to address any associated or underlying
interdental spaces and/or prognathism.
conditions, such as IBD, pancreatitis, extrahepatic bile
● A mild increase in respiratory noise may result from
duct obstruction or cholecystitis.
increased soft tissue thickness around the airways.
● Distortion of the joints can lead to destructive
Prognosis arthritis.
Prognosis is very variable and often unpredictable. Acromegalic cats develop insulin-resistant diabetes
Some cases respond well and only need temporary because excess growth hormone causes peripheral
treatment, others require continued therapy to maintain insulin resistance. However, early cases may have
remission, while others progress relatively rapidly and unstable diabetes rather than being truly resistant.