Page 635 - Problem-Based Feline Medicine

29 – THE CAT WITH SIGNS OF REGURGITATION 627

Clinical signs 0.5–1.0 mg/kg PO q 24 h), drugs that increase
esophageal sphincter tone (cisapride 5 mg/kg PO q 12
Affected cats have ventroflexion of the head and neck
h), and mucosal cytoprotectants (sucralfate 250–500 mg
because weakness of the dorsal cervical muscles leads
PO q 8–12 h).
to an inability to support the head. Ventroflexion is
accentuated during locomotion, micturition and Other supportive measures include elevated feeding
defecation. of small, liquid meals, or even gastrostomy tube
feeding.
A high-stepping forelimb gait, head bobbing and
progressive dorsal protrusion of the scapulae may
also be seen, particularly following exertion, stress or Prognosis
excitement.
Guarded to poor. Most of these cats suffer from
Cats often have problems prehending and swallowing chronic reflux esophagitis with megaesophagus and
food, partly because of their abnormal head position many die suddenly of laryngospasm after choking on
and partly because of oropharyngeal weakness. food.
Acute upper airway obstruction may develop due to
accumulation of ingesta in the vicinity of the larynx, Prevention
and this may lead to fatal laryngospasm.
Because the condition is associated with an autosomal
recessive gene, the parents of any affected kittens
Diagnosis should no longer be used for breeding.

Diagnosis is made on a combination of history, breed
and clinical signs. DYSAUTONOMIA
Routine bloodwork including serum K+, creatine kinase
Classical signs
and aspartate transaminase shows no abnormalities.
● Regurgitation secondary to
Muscle tone, and spinal reflexes are all within nor-
megaesophagus.
mal limits.
● Constipation.
Sparse fibrillation potentials and positive sharp ● Mydriasis.
waves are present on EMG. ● Dry mucous membranes of mouth and eye.
Muscle biopsy reveals highly variable muscle fiber
See main reference on page 792 for details.
sizes, with increased numbers of nuclei, internal nucle-
ation and split or degenerating fibers.
Pathogenesis
Survey or contrast radiographs may reveal mega-
esophagus with a U-shaped diverticulum at the thoracic Generalized degeneration of the autonomic ganglia
inlet. results in loss of GI tract motility, and loss of auto-
nomic control to the eye and heart.

Differential diagnosis
Clinical signs
Other myopathies such as X-linked muscular dystro-
phy, nemaline myopathy and hypokalaemic polymyopa- Clinical signs usually develop over 48 hours and depres-
thy should be considered, as well as myasthenia gravis. sion and anorexia are present in nearly all cats.
Regurgitation occurs secondary to megaesophagus.
Treatment Vomiting often occurs and regurgitation may be
reported as vomiting.
Symptomatic treatment for reflux esophagitis may be
given, including histamine-2 blockers (famotidine Constipation is commonly reported.