Page 654 - Problem-Based Feline Medicine

646 PART 9 CAT WITH SIGNS OF GASTROINTESTINAL TRACT DISEASE

Differential diagnosis Typically, the hemogram and serum chemistry pro-
file is completely normal, especially since the vomit-
The wide range of clinical signs resulting from various
ing episodes are not frequent enough to cause
renal diseases can mimic many different diseases, and
electrolyte imbalances or dehydration.
so the initial history and physical examination are
extremely important. The most useful diagnostic test is endoscopic exami-
nation and biopsy. The organisms will be visualized
Most of the more common extra-intestinal, systemic
best via histopathologic examination, but cytology or
diseases that can cause vomiting should be considered
culture of the gastric contents has also yielded the
in the initial differentials, but the history, physical
organisms in some cases. However, culture of
exam, minimum database, and urinalysis (with culture
Helicobacter pylori requires special media and cul-
if bacteria or WBC are present) will rule out most of the
ture conditions to be successful, but is the best means
diseases of concern (e.g. diabetes mellitus, hepatopathies,
of finding this pathogenic species.
hyperthyroidism, etc.).
Clo-tests, which are enzymatic tests of the presence of
Imaging studies will help rule in or out the other major
urease used in humans to screen for Helicobacter spp.
differentials: neoplasia, pancreatitis and mechanical
organisms in gastric content, have not been adequately
disturbances.
evaluated in cats; however, because cats have some
Inflammatory bowel disease requires histopathologic Helicobacter spp. as normal flora, this test is not likely
confirmation, which can be obtained by endoscopic to be helpful.
biopsies or via a surgical exploratory.
Treatment PLANT INGESTION/TOXICITY*
The treatment of each individual renal disease is differ-
Classical signs
ent, and the reader is referred to the primary reference
for details. ● Most plants do not cause severe toxicity,
but may cause drooling, vomiting or
diarrhea due to their irritant effects on
HELICOBACTER SPP.* mucous membranes.
● Severe toxicity may result in hepatic or
Classical signs renal failure, with vomiting, diarrhea,
depression, anorexia occurring secondary
● Anorexia.
to these effects.
● Vomiting.
● Usually associated with chronic vomiting,
but may have acute onset of signs. Pathogenesis
Most plants do not cause severe toxicity, but may cause
See main reference on page 682 for details
drooling, vomiting or diarrhea due to their irritant
effects on mucous membranes.
Clinical signs Severe toxicity may result in hepatic or renal failure,
The predominant clinical sign continues to be chronic, with vomiting, diarrhea, depression, anorexia occurring
intermittent vomiting. secondary to these effects.
Plants associated with an acute onset of vomiting fol-
lowing ingestion include mistletoe, azalea, black
Diagnosis
nightshade, Christmas cherry, Christmas rose, daffodil,
The disease mimics so many other causes of vomiting glory lily, jessamines, lantana, larkspur, poinsettia, rhodo-
that a thorough diagnostic evaluation is required to dendron, tulip, wild rosemary, youpon holly (to name a
make the diagnosis. few).