Page 358 - Problem-Based Feline Medicine

350 PART 6 CAT WITH WEIGHT LOSS OR CHRONIC ILLNESS

● Inflammatory bowel disease is an idiopathic treatment involves immunosuppressive therapy in
condition. combination with dietary management.
Initial diagnostic investigation should aim to exclude A therapeutic dietary trial may be undertaken as part
other causes of gastrointestinal signs and may include: of the diagnostic evaluation (to eliminate dietary sensi-
● Routine hematology and biochemistry and serum tivity), as the initial stage of treatment, or in combina-
basal total T concentrations. tion with immunosuppressive therapy, depending on
4
– Stress leukogram and occasionally eosinophilia. the severity of the clinical signs.
– Serum globulins may be increased as part of the ● A nutritionally balanced, highly digestible diet
chronic immune stimulation. In severe cases should be used.
hypoproteinemia may result from protein-losing ● Usually a single protein, single carbohydrate source
enteropathy. diet is used (hypoallergenic), preferably one to
● Fecal analysis and culture to exclude fecal parasites which the cat has not previously been exposed.
and enteric pathogens. ● Use of diets with hydrolized protein (e.g. Hill’s z/d
● Radiography and ultrasonography should be per- or Royal Canin HA) may be efficacious in some
formed. cats. Hydrolization reduces the molecular weight of
– Radiography is frequently unremarkable, dietary proteins to < 10000 so they are not detected
although increased gas may be present in intes- by the immune system.
tinal loops. ● A high-fiber diet has proven beneficial in cases with
– Ultrasonography may show evidence of thick- large intestinal involvement.
ened or abnormal intestinal walls. Abdominal ● Minimum duration of the trial should be 3 weeks,
lymph node enlargement may be present. but may be longer. If an improvement is seen, the
● A dietary trial is a valuable tool to determine if cat should then be challenged with the original diet
signs resolve when the cat is fed a novel single pro- to confirm sensitivity.
tein and carbohydrate diet.
Immunosuppressive therapy is required in the major-
Assessment of serum cobalamin and folate concentra- ity of cases:
tions, breath hydrogen analysis and sugar permeability ● Prednisolone (2–4 mg/kg PO q 12–24 hours) is
studies may be supportive of inflammatory bowel disease. used at higher initial doses, which are gradually
reduced to the lowest maintenance dose.
Definitive diagnosis requires multiple intestinal biop-
● Metronidazole (7.5–15 mg/kg PO q 12 hours) is used
sies either by endoscopy, laparoscopy or laparotomy:
either as sole therapy in mild cases, or in addition to
● Gastrointestinal endoscopy permits visual evalua-
prednisolone for those cats in which the response to
tion of the mucosa, but the superficial nature of the
prednisolone is inadequate. Metronidazole has activity
mucosal biopsies obtained by this technique limits
against anaerobic bacteria, protozoa and may be anti-
their diagnostic value.
inflammatory and influence cell-mediated immunity.
● Laparotomy allows the collection of full-thickness
● Other more potent immunosuppressive therapy may
biopsies, and gross evaluation and biopsy of other
be required in some cases.
abdominal organs if required.
FELINE LEUKEMIA VIRUS (FELV)*
Differential diagnosis
The principal differential diagnoses are those conditions Classical signs
causing inappetence and weight loss in conjunction with
● Younger cats, often less than 6 years of
gastrointestinal signs, namely other causes of enteropa-
age, clinical signs variable.
thy, chronic pancreatitis, cholangiohepatitis, gastroin-
● Inappetence, weight loss and lethargy.
testinal neoplasia and apathetic hyperthyroidism.
● ± Neoplasia (lymphoma) – lymph node
enlargement, organomegaly, solid masses.
Treatment
● ± Anemia – pica, lethargy, pale mucous
As the etiology of the immune response in inflamma- membranes, tachycardia.
tory bowel disease is unknown, the principal form of