Page 664 - Problem-Based Feline Medicine

656 PART 9 CAT WITH SIGNS OF GASTROINTESTINAL TRACT DISEASE

Clinical signs side with peripheral vestibular disease and towards the
affected side with central vestibular disease), circling,
This is a rare clinical problem in cats.
falling, ataxia, and horizontal (more typical for peripheral
Cats with septicemia are severely depressed, may be disease) or rotary (more typical of central disease) nys-
febrile or hypothermic (although this is often a poor tagmus are much more prominent than GI signs.
prognostic sign), and will have systemic signs of shock
Vomiting or anorexia occur due to disequilibrium
(tachycardia, tachypnea, decreased capillary refill).
effects, but are not common clinical signs of cats
Other signs, especially in cats with septic shock, may with vestibular disease. Vomiting is usually only seen
include vomiting or bloody diarrhea and anorexia. in the first 1–2 days after onset and is infrequent (1–2
single episodes in the first 48 hours).
There is no particular age, breed or sex predilection
to development of septicemia or endotoxemia, but Vomiting is more common with peripheral vestibu-
cats with severe infections, immunocompromise (e.g. lar disease or idiopathic vestibular syndrome, and is
FeLV or FIV+) or stress may be prediposed. rarely associated with central vestibular disease.
Altered consciousness, postural deficits or other cranial
Diagnosis nerve deficits are not typically seen.

Hemogram may reveal neutrophilia progressing to Diagnosis
neutropenia and thrombocytopenia. There may be
hyperglycemia early, progressing to hypoglycemia History and physical examination findings are highly
later. Hyperkalemia, elevated liver enzymes and suggestive of vestibular disease.
azotemia are common, and bacteriuria may be present.
Evaluation of cats with vestibular disease should
Blood culture is indicated in patients with suspected include a minimum data base (hematology, serum chem-
bacteremia to confirm the infection exists. Blood cul- istry profile and urinalysis), otoscopic examination, radi-
tures should be obtained in a sterile manner from multi- ographs of the tympanic bulla. CT of the bulla and area
ple venipuncture sites (if possible), and, ideally, samples of the 8th nerve are also important diagnostic tests.
should be obtained over several hours (every 2–4 hours
Major causes of vestibular signs include: idiopathic
collect a new sample) to maximize the opportunity to
vestibular syndrome (diagnosis of exclusion), otitis
obtain a positive sample. Urine culture is also helpful
media/interna (diagnosis by myingotomy, culture, radio-
in cases with renal seeding of the infection.
graphs or CT), middle ear polyps (CT), trauma, neo-
Imaging studies are important in further evaluating the plasia (radiographs or CT), endocrine diseases causing
extent of illness and may help identify a focus of infec- neuropathies (diabetes mellitus and hyperadrenocorti-
tion (radiographs of chest, abdominal ultrasound). cism) and toxic insults (aminoglycoside antibiotics,
topical chlorhexidine or iodophor compounds).
VESTIBULAR DISEASE A minor cause of vomiting is motion sickness from the
vestibular dysfunction during car rides.
Classical signs
PHARMACOLOGIC TOXICITY (NON-
● Head tilt, circling, falling.
STEROIDAL ANTI-INFLAMMATORY DRUG
● Infrequent vomiting and anorexia may
(NSAID) TOXICITY)
occur.
Classical signs
See main reference on page 933 for details.
● Anorexia.
● Vomiting, with or without hematemesis.
Clinical signs
● Abdominal pain.
Occasionally cats with an acute onset of vestibular dis- ● Diarrhea, with or without melena.
ease vomit, but signs of head tilt (away from the affected