Page 646 - Problem-Based Feline Medicine

638 PART 9 CAT WITH SIGNS OF GASTROINTESTINAL TRACT DISEASE

A deep erosion or ulcer may be identified via ultra- chronic renal failure), long-term therapy with histamine
sound, but simple gastritis or superficial mucosal ero- blockade will be necessary to help reduce the develop-
sions will only be diagnosed by endoscopy examination ment of new erosions or ulcers.
or biopsy.
In severe or deep ulcers, surgical intervention may
Endoscopy is the definitive way to diagnose mucosal be necessary but this is unusual. Emergency surgical
erosions and ulcers, and also may help identify a intervention will be necessary in cats that have perfo-
cause via histopathologic examination of the tissue. rating ulcers. Many deep or perforating ulcers are
caused by an invasive neoplasm, or by fungal disease
in geographic areas where systemic fungal infections
Differential diagnosis
are prevalent.
Acute gastritis due to erosions/ulcers will mimic many
Cats with severe disease that are unable or unwilling to
causes of acute vomiting, including dietary indiscre-
eat for more than 3 days should have nutritional sup-
tion, mechanical or obstructive disorders, infectious
port provided, either through placement of a feeding
causes, toxin-induced (especially plant ingestion), pan-
tube for enteral feeding, or by parenteral nutrition.
creatitis, and metabolic or endocrine diseases such as
hepatitis, renal failure or neoplasia.
Prognosis
Treatment The majority of cats will recover completely from the
insult if the cause can be identified and corrected, and
Treatment is aimed at identification and correction of
in most other cases the disease can be successfully
the underlying cause of the primary lesion, reduction
managed. In cats with ulcers due to neoplasia, the
of acid secretion and protection of the gastric
prognosis is guarded to poor.
mucosa to allow it to heal. This is accomplished by:
● Administration of histamine-2 receptor antagonist
(H RA) (e.g. cimetidine 5 mg/kg PO q 8 h, ranitidine Prevention
2
0.5–1.0 mg/kg PO q 12 h, or famotidine 0.5–1.0
Reduce opportunities for ingestion of toxic or irritating
mg/kg PO q 12–24 h).
substances.
– Famotidine is the most potent and only H RA to
2
effectively reduce acid in dogs. No studies have Management of diseases causing hypergastrinemia
been completed in cats. (renal failure, hepatic disease) should always include
– Proton pump inhibiting drugs (omeprazole therapy for gastritis.
1 mg/kg PO q 24 h) are the most effective in
Prevent ischemia and shock-induced gastric erosions
reducing acid secretion but can be difficult to
by rapid replacement of fluids following shock, and
dose.
maintenance of hydration during surgical procedures,
– Sucralfate (250–500 mg PO q 8–12 h) is also a
etc.
useful adjunct therapy for cats with significant
gastric erosions or ulcers, as it will act as a surface
protectant. Sucralfate must be given in an acidic
environment to be effective, so it should be HAPATOPATHIES** (HEPATIC LIPIDOSIS,
administered at least 1 hour prior to giving hista- CHOLANGITIS, DRUG-INDUCED
mine-blocking or proton pump-inhibiting drugs. HEPATOPATHY)
– Feeding nothing per os for the first 24 hours,
then feeding a highly digestible, bland, low- Classical signs
residue diet, either commercial or homemade
● Weight loss, anorexia, vomiting, icterus
(e.g. small amounts of low-fat beef, chicken or
and depression are the most common
turkey), will be beneficial.
signs.
In cases where treatment of the underlying cause is not
possible or where management is the only option (e.g. See main reference on page 421 for details.