Page 644 - Problem-Based Feline Medicine

636 PART 9 CAT WITH SIGNS OF GASTROINTESTINAL TRACT DISEASE

With gastric or upper small intestinal obstructions,
GASTROINTESTINAL FOREIGN BODIES
(OBSTRUCTION)** acute onset of frequent vomiting or gagging is
common.
Classical signs Dehydration, lethargy and anorexia are common in
these cats, and they may show evidence of abdominal
● Frequent, severe vomiting episodes with
discomfort (either on palpation or by posture).
upper GI obstruction.
● Intermittent vomiting with lower intestinal In cats with a lower intestinal obstruction, diarrhea
obstruction. will probably be more likely, vomiting less frequent
● Anorexia. and severe, and dehydration and abdominal pain more
● Dehydration. variable.
● Diarrhea is more prevalent with lower
If the foreign body is of significant size or if intestinal
intestinal obstructions.
plication from a linear foreign body is present, these
● Abdominal pain.
abnormalities may be palpable.
Cats that develop an intestinal perforation as a result
Pathogenesis
of the foreign body deteriorate rapidly and develop
GI foreign bodies occur more commonly in young depression and fever, hypovolemia/shock.
cats, because of their curious nature, tendency to ingest
non-food substances (string, rubber bands) and prey
(hair, fur, bones). Diagnosis
Linear foreign bodies (e.g. string, yarn, thread, etc.) History and physical examination findings are very
are the most common foreign body in cats and create important in pointing to the diagnosis (always examine
problems from the motility disturbances that are cre- under the tongue of vomiting cats).
ated resulting in intestinal plication or intussuscep-
Hemogram and serum biochemistry profile findings
tion, and from the intestinal perforation due to string
will likely be normal if the condition is acute.
migration through the intestinal wall. Thread, with or
without a needle, and string are the most common Long-standing or severe linear foreign bodies or GI
causes, and in some countries, the string from the end perforation will show an inflammatory response, evi-
of a sausage is a common culprit. dence of dehydration (hemoconcentration or elevated
proteins) and electrolyte abnormalities consistent
Linear foreign bodies may first be caught under the
with vomiting (hypokalemia is most common).
base of the tongue, creating not only an oral lesion, but
also preventing the possible passage of the string The diagnosis is obtained by imaging studies, includ-
through the GI tract. Alternatively, they may become ing radiography (plain or contrast), ultrasonography
trapped at the pylorus, with the rest of the string pass- or upper GI endoscopy. Radiographs may reveal evi-
ing into the small intestine. dence of intestinal plication (wash board appearance)
which is the classic presentation for string foreign
Many foreign objects (especially hair, but including
bodies. In some cases, endoscopy will allow retrieval
string) will pass through the GI tract, so if an obstruc-
of the foreign object, and is a useful means of assess-
tion occurs, it may be due to a disturbance in motility,
ing other damage (e.g. erosions, ulcers, or tears in the
narrowing of lumen or other pathology that prevents
mucosa).
the normal passage of the object.
Clinical signs
Differential diagnosis
The signs depend upon the location of the foreign The acute onset, age of occurrence and history or
object and will help in many cases to localize the physical examination findings usually point to a for-
lesion. eign body.