Page 357 - Problem-Based Feline Medicine

18 – THE THIN, INAPPETENT CAT 349

Treatment Clinical signs

Acute or suppurative cholangiohepatitis is treated Clinical signs vary with the type and severity of the
primarily with antibiotics, ideally based on the inflammation, and with the anatomical extent of the
results of culture and sensitivity testing. disease, although the correlation is poor.
● Ampicillin (10–40 mg/kg PO q 8 hours), amoxy-
Characteristically, any combination of weight loss,
cillin (11–22 mg/kg PO q 8–12 hours), amoxycillin
vomiting or diarrhea may be seen.
clavulanate (12.5–25 mg/kg PO q 12 hours), or
cephalexin (10–30 mg/kg PO q 8–12 hours) are Vomiting is particularly evident if the pathology
good empirical choices. involves the stomach or proximal small intestine and
● Metronidazole in combination with the above antibi- may occur every few days to weeks. Vomiting is usu-
otics, provides broader anaerobic cover. Use at a lower ally unrelated to feeding, and is more frequently com-
dose (7.5–10 mg/kg PO q 12 hours) because of hepa- posed of fluid rather than food.
totoxicity and the increased potential for neurological
Diarrhea may be soft and semi-formed to watery in
signs in animals with pre-existing hepatic disease. In
consistency, with or without steatorrhea. Occasionally
addition it may have immunomodulating properties.
large bowel diarrhea with tenesmus, mucus and hema-
Immunosuppressive therapy is used if there is a lym- tochezia may be present.
phocytic component to the pathology, and in more
Clinical signs are usually chronic and may initially be
chronic cases, although definitive evidence of efficacy
intermittent.
is lacking.
● Prednisolone (2–4 mg/kg q 12–24 hours), gradually Weight loss initially results from malabsorption and
tapering the dose. later from inappetence. In some cases, progressive
● Other immunosuppressive agents may be consid- weight loss is the only clinical sign.
ered in non-responsive cases.
Flatus and borborygmi may be reported.
Fluid therapy and nutritional support will be required if
Initially, polyphagia or a normal appetite may be
anorexia is present.
seen, but this frequently progresses to inappetence as
Supportive and adjunctive therapy is often recom- the disease increases in severity.
mended on an empirical basis.
Intestinal thickening, mesenteric lymphadenopathy
● Ursodeoxycholic acid (10–15 mg/kg PO q
or abdominal pain may be revealed by abdominal
24 hours) is a hydrophilic bile acid which has cyto-
palpation.
protective properties.
● Parenteral vitamin K1 (0.5 mg/kg SC q 12 hours Occasionally, severe small intestinal disease leading to
for 3 days) may be provided for those cases show- protein leakage into the gut lumen (protein-losing
ing evidence of a coagulopathy. enteropathy) leads to extreme weight loss and
● S-adenosylmethionine (18 mg/kg PO q 24 hours) hypoproteinemia. Although usually polyphagic, if the
and vitamin E have antioxidant properties and may condition is associated with severe inflammatory or
be useful supplements. malignant disease, anorexia may occur. Vomiting and
diarrhea may rarely be accompanied by ascites and
peripheral edema.
INFLAMMATORY BOWEL DISEASE*

Classical signs Diagnosis
● Weight loss. The diagnosis of inflammatory bowel disease is
● Chronic vomiting and/or diarrhea. made based on exclusion of all other causes of the
● Variable appetite. clinical signs in association with appropriate
histopathology.
See main references on page 307 for details (The Cat ● Intestinal infiltration with inflammatory cells is
With Weight Loss and a Good appetite). non-specific.