Page 477 - Problem-Based Feline Medicine

22 – THE CAT WITH ABDOMINAL DISTENTION OR ABDOMINAL FLUID 469

with multiple 1–3 mm spots, thickened pancreas with
TOXOPLASMOSIS*
saponification of peripancreatic fat, lymphadenopa-
thy and focal thickening of the intestines.
Classical signs
Biopsies of abdominal organs may reveal mixed
● Anorexia, fever, dyspnea and signs of
inflammation, tachyzooites, and occasionally cysts.
ocular inflammation in mature cats.
Histology will also reveal multifocal necrosis.
● Fading neonate.
Elevated IgM titer; four-fold rise in IgG titers 3 weeks
See main references on page 375 for details (The apart. Serology gives the most interpretable informa-
Pyrexic Cat ). tion if both acute and convalescent IgM and IgG titers
are obtained.
Clinical signs
Differential diagnosis
Non-specific signs of depression, anorexia, weight
loss and fever are common. Differential diagnoses for cats with hepatopathy, mesen-
Specific clinical signs vary with the various organs teric lymphadenopathy and peritoneal fluid include con-
involved. current inflammatory bowel disease and pancreatitis,
● Common signs include uveitis, dyspnea (pneumo- alimentary lymphoma, FIP, tuberculosis and systemic
nia) and muscle pain. fungal infections. Of these, only the infectious diseases
● All abdominal organs may be infected by are likely to also cause pleural fluid, pneumonia (except
Toxoplasma gondii. Specific clinical signs of for FIP), or uveitis.
abdominal infection are usually due to hepatitis
and hepatic necrosis (icterus), and mesenteric
Treatment
lymphadenopathy (palpable nodes). Vomiting,
diarrhea and pain on abdominal palpation may be Clindamycin 10–25 mg/kg PO, IM, IV bid continuing
present. Peritoneal fluid may also be present, but is at least 2 weeks beyond resolution of clinical signs.
unlikely to cause abdominal distention.
Sulfadiazine (30 mg/kg PO bid) and pyrimethamine
Specific signs may also be due to concurrent disorders (0.5 mg/kg PO bid) may be used if clindamycin is not
causing immunosuppression. available or not tolerated. Folinic acid (5 mg/day) or
brewer’s yeast (100 mg/kg/day) may be required to
correct myelosuppression resulting from folinic acid
Diagnosis
deficiency caused by therapy.
Routine laboratory results are variable. Neutrophilia is
Trimethoprim-sulfonamide 30 mg/kg bid may be con-
common with systemic infection. Hepatitis is common,
sidered if these are the only drugs available.
causing elevations in liver enzymes and bilirubin.
Supportive care.
Abdominal imaging may reveal hepatomegaly, changes
consistent with pancreatitis (see The Cat With Acute
Anorexia, Depression or Dehydration), mesenteric
INTESTINAL TUBERCULOSIS*
lymphadenopathy and peritoneal fluid.
Peritoneal fluid is presumably a transudate or modi- Classical signs
fied transudate, which may contain tachyzooites.
● Chronic weight loss, vomiting, diarrhea,
Abnormalities at exploratory laparatomy include mesenteric lymphadenopathy.
hepatomegaly, reticular pattern to the surface of the liver