Page 721 - Problem-Based Feline Medicine

32 – THE CAT WITH SIGNS OF ACUTE SMALL BOWEL DIARRHEA 713

intermittent vomiting and weight loss. In many of these After surgical correction, if gastric ulceration is not
cases, the intussusception can be palpated. a complicating factor, oral alimentation should be
instituted in the first 24 hours, to enhance the return
Depending on the location and severity of the obstruction,
of normal motility and reduce the possibility of post-
there may be anorexia or inappetence and vomiting.
operative ileus.
Diagnosis

Hemogram and serum biochemistry profiles are
FOREIGN BODIES*
variable depending on the severity and location of the
intussusception, however, dehydration, electrolyte
Classical signs
abnormalities, anemia and leukocyte changes have
all been observed depending on the cause of the intus- ● Weight loss, anorexia or inappetence
susception. ● Acute onset of vomiting or gagging,
occasionally diarrhea is observed.
Radiographs and/or ultrasound examination of the
gastrointestinal tract are the best means of confirming
See main reference on page 636 for details.
the diagnosis. Contrast studies may be used but should
not be done at the expense of delaying treatment in
severely ill cases.
Clinical signs
Endoscopic examination or colonoscopy can also be
The signs depend upon the location of the foreign
used to obtain a diagnosis, especially with low intus-
object.
susceptions.
With gastric or upper small intestinal obstructions,
acute onset of frequent vomiting or gagging is com-
Differential diagnosis
mon.
Many diseases that can precipitate an intussusception
Dehydration, lethargy and anorexia are common in
(viral enteritis, foreign bodies, gastroenteritis, intestinal
these cats, and they may show evidence of abdominal
parasitism, etc.) also have clinical signs that mimic it.
discomfort (either on palpation or by posture).
Therefore, a thorough physical examination, diagnostic
evaluation, and close patient monitoring are essential. In cats with a lower intestinal obstruction, diarrhea
Mesenteric volvulus is a very difficult condition to dif- will be more prevalent and vomiting less frequent.
ferentiate from intussusception both clinically and radio-
If the foreign body is of significant size or if intestinal
graphically, but fortunately is very rare in the cat.
plication from a linear foreign body is present, these
abnormalities may be palpable.
Treatment
Cats that develop an intestinal perforation as a result
Intussusception must be considered a surgical emer- of the foreign body may be quite ill (depression, fever,
gency. Cats with signs of shock or endotoxemia hypovolemia/shock).
should be prepared for surgery by correcting fluid and
Depending on the location and severity of the obstruc-
electrolyte imbalances, administration of broad-
tion, there may be an acute onset of anorexia or inap-
spectrum, parenteral antibiotics (combinations such
petence.
as ampicillin/amoxicillin or cefazolin and enrofloxain,
amikacin, cefoxitin or imipenam), and use of hista-
mine-2 blockers (ranitidine or famotidine) or protec- Diagnosis
tants if gastric erosions or ulceration is suspected.
History and physical examination findings are very
Motility-enhancing drugs, such as metoclopramide, important. Always examine under the tongue of vom-
are contraindicated in patients with GI obstruction iting cats for evidence of a string or thread foreign
and should not be used. body.