Page 481 - Problem-Based Feline Medicine

22 – THE CAT WITH ABDOMINAL DISTENTION OR ABDOMINAL FLUID 473

Biopsy of fat – may be grossly yellow to brown. partial thromboplastin time. If the prothrombin time
is elevated, it may normalize with vitamin K therapy.
Abdominal ultrasound examination may reveal peri-
toneal fluid. Abdominocentesis may reveal a sterile
exudate high in protein and mature neutrophils, Differential diagnosis
similar to that seen with feline infectious peritonitis,
Hemorrhage due to abdominal neoplasia, trauma, or
or a chylous effusion. Associated sclerosing encapsu-
hepatic necrosis, amyloidosis, or peliosis.
lating peritonitis has also been reported.
Treatment
INHERITED AND ACQUIRED
(ANTICOAGULANT RODENTICIDE Transfusion.
POISONING) COAGULATION DEFECTS
Vitamin K for Devon Rex cats, vitamin K antagonist
rodenticide poisoning, and cats with liver disease with
Classical signs
prolonged prothrombin times (see main references on
● Spontaneous bleeding and re-bleeding page 509 for details, The Bleeding Cat).
after trauma.
Environment that minimizes trauma.

Clinical signs
GLOMERULONEPHRITIS
Spontaneous bleeding and re-bleeding may occur at
various sites, including within the abdomen, although Classical signs
thoracic hemorrhage tends to be more common.
● Chronic depression, anorexia, weight loss.
Signs due to acute anemia and abdominal distention ● Polyuria/polydipsia if chronic renal failure.
vary with the severity of blood loss. ● Subcutaneous edema and/or ascites if
nephrotic syndrome.

Diagnosis
Clinical signs
Abdominal ultrasonography will demonstrate peri-
toneal fluid. Abdominocentesis will confirm that the Signs are those of chronic renal failure and/or
fluid is blood. nephrotic syndrome. Concurrent signs may be present
from an underlying disease (FeLV infection, FIP,
Cats bleeding from hemophilia A or hemophilia B
Mycoplasma arthritis and other chronic infections, sys-
will have prolonged activated partial thromboplas-
temic lupus erythematosus and other immune-mediated
tin time. Definitive diagnosis is by quantification of
disorders, mercury intoxication). Dyspnea may occur
factor VIII or factor IX, respectively.
due to pleural effusion or pulmonary thromboembolism.
Devon Rex cats bleeding from inherited vitamin K
responsive coagulopathy will have prolonged pro-
Diagnosis
thrombin time and activated partial thromboplastin
time, which resolve with vitamin K therapy. A serum chemistry profile will reveal azotemia with
chronic renal failure, and severe hypoalbuminemia
Cats bleeding from coagulopathy due to vitamin K
with nephrotic syndrome.
antagonist rodenticide poisoning will have pro-
longed prothrombin time, activated partial throm- Urinalysis will reveal inappropriately low urine spe-
boplastin time, and PIVKA clotting time, which cific gravity with chronic renal failure, and marked
resolve with vitamin K therapy. proteinuria with nephrotic syndrome (note that pro-
teinuria will raise specific gravity).
Cats bleeding from coagulopathy due to liver disease
(e.g. hepatic lipidosis or cholangiohepatitis) will have Abdominal imaging may reveal small kidneys, altered
prolonged prothrombin time and/or activated renal echogenicity or peritoneal fluid.