Page 438 - Problem-Based Feline Medicine

430 PART 7 SICK CAT WITH SPECIFIC SIGNS

● Administer ursodeoxycholic acid for choleresis and
FELINE INFECTIOUS PERITONITIS (FIP)*
modulation of “noxious” bile acids.
● Long-term immunosuppressive therapy (steroids
+/− metronidazole) is often required in cats with Classical signs
persistent clinical signs or abnormal laboratory
● 50% of cats are < 2 years of age.
values. Some cats that fail to respond to pred-
● Weight loss, anorexia, vomiting and
nisone may respond to chlorambucil (0.2 mg/kg
lethargy.
PO q 48 h).
● Jaundice +/- cyclical fever.
Supportive care as dictated by the animal’s needs. ● Protein-rich ascites in “effusive” form.
● Vitamin K for coagulopathy (3–5 mg per cat PO q
1
24 hours as needed). See main reference, page 372 (The Pyrexic Cat).
● Fluid therapy to combat dehydration and electrolyte
disturbances.
● Nutritional therapy is important to reduce the Clinical signs
hepatic workload and augment recovery.
Young cats (< 2 years old) and from a multicat envi-
– Jejunostomy or gastrostomy tubes and feeding a
ronment are most susceptible.
pureed commercial or esophagostomy tubes and
feeding a commercial liquified diet are best tol- Signs are referable to chronic inflammation of the kid-
erated. neys, liver, visceral lymph nodes, intestines, lungs, eyes
– Feed a protein-modified diet as dictated by the and brain.
status of renal function and signs of hepatic
Chronic, progressive inappetance, weight loss, fever
encephalopathy (rare).
and depression.
– Control vomiting with famotidine (0.2 mg/kg
SID PO) or metoclopramide (0.2–0.5 mg/kg q Signs may be cyclical at first.
8 h) or constant rate infusion at 1–2 mg/cat/24 h.
Jaundice and ascites may occur in cats with chronic
liver involvement.
Prognosis Dyspnea from pleural effusion occurs in about one in
five cats.
Long-term follow-up on a large number of cats with
cholangitis has not been performed. CNS signs include seizures, personality changes, nys-
tagmus, head tremor and hyperesthesia.
The prognosis with neutrophilic cholangitis is less
favorable than for cats with lymphocytic cholangitis. Vomiting may occur with granuloma formation in the
intestines, or inflammation in other organs such as the
Cats with the neutrophilic form that survive the initial
liver.
treatment period of several months have a reasonable
chance for long-term survival. Ocular signs include bilateral uveitis, perivascular exu-
dates, retinal hemorrhage or detachment.
Cats with lymphocytic cholangitis may survive com-
fortably for months to years with appropriate therapy.
Diagnosis
Prevention Diagnosis is based on history, clinical signs and char-
acteristic histologic lesions on tissue biopsy.
Medical/surgical correction of biliary obstructive
● Parenchymal lesions are characterized by multi-
lesions when recognized.
focal hepatic necrosis with pyogranulomatous
Treatment of inflammatory (lymphocytic-plasmacytic) inflammation.
lesions involving the intestinal mucosa (i.e., inflamma- ● Pyogranulomas may be grossly evident on the cap-
tory bowel disease). sule of the liver.