Page 526 - Problem-Based Feline Medicine

518 PART 7 SICK CAT WITH SPECIFIC SIGNS

● It is produced by intestinal bacteria (especially ● Concurrent use of medium-chain triglyceride sup-
Escherichia coli and Bacteroides spp.) and absorbed plementation, 1–2 ml/kg/day PO will promote vita-
in the ileum and colon. min K absorption and promote weight gain, but the
● If IBD affects predominantly the proximal small product is unpalatable.
intestine, bacterial synthesis provides sufficient ● If oral vitamin K1 therapy is unsuccessful, vitamin
vitamin K2 to prevent coagulopathy. K3 therapy may be considered. Vitamin K3 is a
synthetic vitamin K that is less fat-soluble and is
absorbed in the colon. Unfortunately it causes a
Clinical signs
dose-dependent Heinz-body hemolytic anemia
Chronic diarrhea, chronic intermittent vomiting, and methemoglobinemia, and a safe but effective
weight loss, appetite varying from episodic inappetence dose in the cat has not been determined.
to polyphagia (see The Cat With Signs of Chronic
Avoid unnecessary antibiotic therapy that may reduce
Small Bowel Diarrhea, page 768).
intestinal bacterial production of vitamin K2.
Clinical bleeding is uncommon but spontaneous
bleeding diathesis has occurred.
Prognosis
Based on prolonged PIVKA time, prevalence of sub-
The prognosis for normalization of hemostasis is excel-
clinical factor deficiency in severe IBD is approxi-
lent but ongoing vitamin K1 therapy may be needed
mately 30%.
until the underlying disorder is resolved.
Diagnosis
Hemostatic testing in a bleeding cat reveals normal PANCREATITIS
platelet count and BMBT (may rebleed), and pro-
longed PT, ACT and aPTT. Classical signs
Cats with IBD and clinically normal hemostasis may ● Depression and anorexia.
have high normal range values or mild prolongation of
PT, ACT and aPTT. A sub-clinical effect may be better See main reference on page 272 (The Cat With
documented by measuring elevated PIVKA time and Depression, Anorexia or Dehydration).
quantification of factor VII using a technique similar to
factor VIII quantification in hemophilia A.
Clinical signs

Differential diagnosis The most common signs are non-specific.
Hypothermia, vomiting, abdominal pain and occa-
As for exocrine pancreatic insufficiency.
sionally a palpable cranial abdominal mass may be
present.
Treatment Icterus may be present from concurrent liver disease
or extra-hepatic bile duct obstruction.
Cats with IBD and clinical or laboratory evidence of
coagulopathy should be given vitamin K1, 5 mg/kg SC Hemostatic abnormalities may be present due to DIC of
daily until normalization of PT. The need for further varying severity or due to concurrent liver disease.
treatment will depend on response to vitamin K1 treat- ● Hemostatic abnormalities are usually subclinical.
ment and improvement of diarrhea with corticosteroid Clinical bleeding is unlikely unless there is severe
therapy and dietary manipulations. DIC or concurrent liver disease.
If intestinal malabsorption is not adequately controlled Cats with concurrent liver disease and pancreatitis are
and ongoing vitamin K supplementation is needed, oral more likely to have hemostatic defects and clinical
supplementation with vitamin K1 may be tried. bleeding than with either disease on its own.