Page 802 - Problem-Based Feline Medicine

794 PART 9 CAT WITH SIGNS OF GASTROINTESTINAL TRACT DISEASE

to decrease esophageal dilation and increase gastric Relieve constipation using laxatives and enemas. See
emptying, and hence reduce vomiting and regurgi- page 785 (Constipation (including idiopathic mega-
tation. oesphagus)).
● Cisapride (Propulsid, 2.5–5 mg/cat q 8–12 h) is
Manual emptying of the bladder and colon may be
thought to be more effective than metoclopramide,
required if drug therapy is ineffective. Urine should be
and can be combined with metoclopramide to
monitored for bacterial infection, and infection treated
improve gastric emptying and small intestinal
promptly.
motility. Cisapride is indicated in cats with
esophagitis from vomiting. Cisapride is currently
unavailable in the USA. Nizatadine (2.5–5 mg/kg Prognosis
PO once daily) or ranitidine (1–2 mg/kg PO q
Initial severity of clinical signs is not necessarily corre-
8–12 h) may be used instead as colonic prokinetic
lated with survival, and response to treatment is a bet-
agents.
ter indication of prognosis.
Dysuria, urinary bladder emptying, and gastrointestinal
The prognosis is guarded to poor, especially in cats
motility may be improved with bethanecol (2.5–5.0
with megaesophagus. If cats continue to regurgitate flu-
mg PO q 8–12 h, or 0.0375 mg/kg SC q 8–12 h). Start
ids after 1–2 weeks of treatment, consider euthanasia.
with the lower dose and increase if necessary, but
beware of adverse effects such as bradycardia and The mortality rate is approximately 60%, and surviving
arrhythmias). cats may have residual signs.
RECOMMENDED READING

Firth M, Fondacaro JV, Greco DS. Challenging cases in internal medicine: What’s your diagnosis? Vet Med 2000;
95(8): 606–614.
Grauer GF. Feline lower urinary tract inflammation. In: Nelson RW, Couto CG (eds) Small Animal Internal
Medicine, 3rd edn. Missouri, Mosby, 2003, pp. 642–649.
Washabau RJ, Hasler AH. Constipation, obstipation and megacolon. In: August JR (ed) Consultations in Feline
Internal Medicine, 3rd edn. Philadelphia, PA, W.B. Saunders, 1997, pp. 104–112.
White RN. Surgical management of constipation. J Feline Med Surg 2002; 4(3): 129–138.