Page 471 - Problem-Based Feline Medicine

22 – THE CAT WITH ABDOMINAL DISTENTION OR ABDOMINAL FLUID 463

● Marked abdominal distention is occasionally the Large-volume abdominocentesis should be considered
predominant clinical sign. for ascites not responsive to diuretic treatment that is
causing diaphragmatic compression, stomach compres-
Other signs of heart disease variably present include
sion or abdominal discomfort.
jugular distention, murmur, gallop rhythm, tachycardia,
bradycardia and irregular rhythm.
Prognosis

Diagnosis The prognosis for cats with ascites due to right heart
failure is poor, because of the poor prognosis of most of
Radiography is useful to demonstrate pleural effusion
the underling heart diseases.
and large-volume peritoneal effusion.
For a specific heart disease, it is not known if the pres-
Echocardiography will assess myocardial function,
ence of peritoneal effusion in addition to pleural effu-
and valvular competency, and may demonstrate trans-
sion changes prognosis.
diaphragmatic peritoneal effusion. If echocardiography
is not available, non-selective angiocardiography is
useful to diagnose dilated and hypertrophic cardiomy- TRAUMATIC RUPTURE OF THE URINARY
opathy. BLADDER OR URETHRA**

Electrocardiography will characterize arrhythmias.
Classical signs
Abdominal ultrasonography will demonstrate peri-
● Acute depression, anorexia, dehydration,
toneal fluid.
vomiting, anuria.
Abdominocentesis usually reveals a modified transu-
date. Pathogenesis

Causes are listed in approximate decreasing order of
Differential diagnosis frequency. These causes include:
● Blunt abdominal trauma.
The main differential diagnosis for a cat presented in
– Motor vehicle trauma is the most common
acute heart failure characterized by cardiogenic
cause, followed by falling from heights,
shock, dyspnea and abdominal fluid is acute abdomi-
although a ruptured urinary bladder is not a com-
nal hemorrhage. Pulmonary crackles will usually be
mon injury, especially compared to other trau-
present in heart failure.
matic injuries (e.g. pelvic fractures, facial
The main differential diagnosis for a cat with chronic injuries). Trauma usually causes rupture at
heart failure characterized by pleural and peritoneal the apex of the bladder.
effusions is neoplasia. Other differential diagnoses ● Urethral catheterization.
include iatrogenic volume overload, hypoalbuminemia, – This is most likely to occur when treating ure-
feline infectious peritonitis and systemic bacterial and thral obstruction. Rupture usually occurs in the
mycotic infections. urethra or neck of the bladder. Urethral
obstruction may also spontaneously lead to ure-
thral rupture without catheterization.
Treatment
● Expression of the urinary bladder.
The treatment of heart failure is discussed in The Cat – This is most likely to occur when trying to
With an Enlarged Heart or Abnormal Heart Sounds. express the bladder in an unsedated cat with ure-
thral spasm following relief of urethral obstruc-
Specific treatment of peritoneal effusion is usually not
tion, or following cystocentesis.
required.
● Cystocentesis.
Diuretic therapy (e.g. furosemide, initial dose 1–2 – This rarely causes rupture of the bladder, but has
mg/kg bid) will help reduce abdominal fluid. occurred when performing cystocentesis on cats