Page 652 - Problem-Based Feline Medicine

644 PART 9 CAT WITH SIGNS OF GASTROINTESTINAL TRACT DISEASE

With high intussusceptions, vomiting, abdominal dis- be prepared for surgery by correcting fluid and elec-
comfort, anorexia, lethargy, dehydration and hypo- trolyte imbalances, administration of broad-
volemia leading to shock are the most common clinical spectrum, parenteral antibiotics (combinations such
signs. as ampicillin/amoxicillin or cefazolin and enrofloxain,
amikacin, cefoxitin or imipenam), and use of hista-
Low intussusceptions (at the iliocolic junction) typi-
mine-2 blockers (ranitidine or famotidine) or protec-
cally present with bloody, mucoid diarrhea, tenesmus,
tants (e.g. sucralfate) if gastric erosions or ulceration is
intermittent vomiting and weight loss. In many of these
suspected.
cases, the intussusception can be palpated.
Motility-enhancing drugs, such as metoclopramide,
are contraindicated in patients with GI obstruction
Diagnosis
and should not be used.
Hemogram and serum biochemistry profiles will be
After surgical correction, which is most commonly
variable depending on the severity and location of
surgical resection and anastomosis, if gastric ulcera-
the intussusception, however, dehydration, electrolyte
tion is not a complicating factor, oral alimentation
abnormalities, anemia and leukocyte changes have all
should be instituted in the first 24 hours, to enhance
been observed depending on the cause of the intussus-
the return of normal motility and reduce the possibility
ception.
of post-operative ileus.
Radiographs and/or ultrasound examination of the
gastrointestinal tract are the best means of confirming
Prognosis and prevention
the diagnosis. A gas- or fluid-filled, dilated loop of
bowel is present immediately cranial to the intussus- The key point is that correction of the intussusception
ception, which may not be visualized without using a does not necessarily alleviate the problem unless the
contrast agent. If there is not too much gas to obstruct underlying cause can be identified and corrected.
adequate images, intestinal intussusceptions are usually Otherwise recurrences are possible and even likely.
readily identified using ultrasound, and are character-
Surgical procedures, such as multiple enteroplexy, are
ized by visualizing the folds of intestine layered on top
recommended to reduce the risk of recurrence.
of one another.
Prognosis is guarded to good if the anesthesia and surgi-
Contrast studies may be used but should not be done at
cal procedure is uncomplicated.
the expense of delaying treatment in severely ill cases.
Endoscopic examination or colonoscopy can also be
PYRETHRINS/PYRETHROIDS/-
used to obtain a diagnosis, especially with low intussus-
PERMETHRINS /ORGANOPHOSPHATES*
ceptions, but this is rarely needed and may be very dif-
ficult in kittens.
Classical signs
Differential diagnosis ● Vomiting, diarrhea.
● Hypersalivation, agitation.
Many diseases that can precipitate an intussuscep-
● Contact dermatitis.
tion (viral enteritis, foreign bodies, gastroenteritis,
● Tremors, ataxia, and possibly seizures.
intestinal parasitism, etc.) also have clinical signs that
mimic it.
See main reference on page 594 for details (The Cat
A thorough physical examination, diagnostic evalua- With Salivation).
tion, and close patient monitoring are essential.
Clinical signs
Treatment
Signs associated with contact exposure or ingestion of
Intussusception must be considered a surgical emer- pyrethrin/pyrethroid-containing pesticides are gener-
gency. Cats with signs of shock or endotoxemia should ally mild.