Page 651 - Problem-Based Feline Medicine

30 – THE CAT WITH SIGNS OF ACUTE VOMITING 643

The vomiting is easily controlled by changing to
INTUSSUSCEPTION*
another antibiotic, so the prognosis is excellent.
Classical signs
KETOACIDOTIC DIABETES MELLITUS*
● Acute vomiting, anorexia and lethargy,
usually in kittens.
Classical signs
● Abdominal discomfort.
● Vomiting. ● Endotoxemia or shock may ensue if the
● Lethargy or depression. intussusception is complete.
● Anorexia and weight loss.
● Polyuria/polydipsia.
Pathogenesis
See main reference on page 236 for details (The Cat The exact pathophysiology of the development of
With Polyuria and Polydipsia). intussusception is unknown.
Uncoordinated peristalsis resulting in vigorous con-
Clinical signs traction of a segment of bowel into an adjacent quies-
cent segment that occurs due to any variety of causes is
At the time of diagnosis, one third of diabetic cats have
involved, and a common predisposing cause in cats is a
a history of vomiting, and with ketoacidosis, an acute
string foreign body.
onset of vomiting may occur.
The end result is that a segment of intestine telescopes
Vomiting, lethargy or depression, anorexia,
or invaginates into the adjoining, distal segment of
polyuria/polydipsia and weight loss are the classical
bowel, causing an intraluminal obstruction, vascular
signs of ketoacidotic diabetes mellitus in cats.
compromise of the affected bowel segments and ulti-
Diabetic cats may also present without weight loss or mately the development of entoxemia and shock.
depression, and polyphagia and polydipsia are still
Bowel regions that undergo changes in diameter
prominent signs.
(gastroesophageal junction and iliocolic junction) seem
Cats with severe, long-standing ketoacidotic diabetes to be at the greatest risk, but intussusceptions occur at
mellitus may have neurologic signs such as stupor, any location, and are classified according to their loca-
obtundation and coma. tion within the gastrointestinal tract.
Intussusceptions cranial to the jejunum are termed high
Diagnosis intussusceptions and generally are more severe (signs
are more acute and have more rapid clinical deteriora-
Typical hemogram and serum chemistry abnormalities
tion) than distal intussusceptions.
include mild non-regenerative anemia (chronic disease),
leukocytosis, lymphopenia, hyperglycemia, elevated Siamese and Burmese cats appear to have a predilec-
liver enzyme activities, hypokalemia, hypo-magnesemia, tion for development of intussusceptions.
hypophosphatemia, and metabolic acidosis.
Most intussusceptions occur in young animals (< 1
The urinalysis, in conjunction with the presence of year of age).
hyperglycemia, is diagnostic and shows glucosuria
Intussusceptions are rare in cats compared to dogs.
and ketonuria. Cats may be ketonemic and have ace-
tone breath before ketonuria is detected on the dip-
stick. Clinical signs
Many cats will also have concurrent bacteriuria, with An acute onset of vomiting and lethargy, with diarrhea
elevated protein, blood or white cells. occurring occasionally, is typical in kittens.