Page 476 - Problem-Based Feline Medicine

468 PART 7 SICK CAT WITH SPECIFIC SIGNS

urethral obstruction, panleukopenia and other Abdominal distention may occur because of ileus,
causes of acute enteritis, acute pancreatitis and acute with intestinal fluid retention, flatus (especially in
pyelonephritis. acute gastroenteritis), thickening of the intestinal wall
(especially in chronic gastroenteritis, e.g. inflammatory
Differential diagnoses for a moribund cat with abdom-
bowel disease), or rarely because of ascites due to
inal distention include urethral obstruction, hepatic
protein-losing enteropathy. Enlarged intestines con-
encephalopathy, feline infectious peritonitis, advanced
tribute to the prominent abdominal contour characteris-
neoplasia, heart failure and hemoperitoneum.
tic of malnourished kittens with a heavy roundworm
burden.
Treatment ● Abdominal distention is usually mild except in
neonatal kittens where it may be severe.
Supportive care and treatment for hypotension or
● Distended loops of intestine may feel more or less
shock, including intravenous fluids, is required.
distinct than usual. Palpation may yield a
Broad-spectrum intravenous antibiotics, e.g. ampi- “squishy” or spongy sensation and create borbo-
cillin and gentamicin; cefoxitin (second-gener- rygmus.
ation cephalosporin); cefazolin (first-generation ● Thickened loops of intestine will feel more promi-
cephalosporin) combined with enrofloxacin and nent on abdominal palpation.
metronidazole or clindamycin; or imipenem-cilastatin
as a single agent. It should be remembered that
Diagnosis
enrofloxacin is not licensed for parenteral use in the cat,
and there are anecdotal reports of blindness following a Abdominal radiographs will always demonstrate
single injection. If “sulfur granules” are seen suggestive dilation of the intestines with air, and may demon-
of Actinomyces spp. or Nocardia spp., then initial strate dilation of the intestines with fluid. Neither
empirical therapy should consist of penicillin G or plain nor contrast radiographs are very useful to
ampicillin and trimethoprim-sulfa, or imipenem-cilas- evaluate thickness of the intestinal walls.
tatin.
Abdominal ultrasonography is very useful to rule out
Exploratory laparatomy to address underlying cause of peritoneal fluid, to demonstrate intestinal wall thick-
peritonitis and to lavage abdomen. Post-operative open- ening and to evaluate intestinal motility.
abdomen management or closed-suction drainage sys-
tems are often required to treat severe generalized
Differential diagnosis
peritonitis. With such management, the prognosis for
cats appears to be similar to dogs, with average survival Differential diagnoses for cats with vomiting, diarrhea
rates of 60–80%. and abdominal distention include acute pancreatitis,
cholangiohepatitis, hepatic lipidosis, gastrointestinal
neoplasia and acute renal failure with volume over-
GASTROENTERITIS*
load.
Classical signs
Treatment
● Vomiting and/or diarrhea.
Treatment of the primary disease.
Severe gastrointestinal distention by flatus in
Clinical signs
neonates should be relieved by intubation (stomach
Cats with acute or chronic gastroenteritis will have vom- air) or trans-abdominal enterocentesis (intestinal
iting and/or diarrhea of variable frequency and severity. air).
Other variable clinical signs include depression, Simethicone is not of proven value to reduce flatus
anorexia, dehydration, weight loss, reduced growth rate formation in humans, and is likely of no benefit in
in kittens, abdominal pain, melena and hematochezia. cats.