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Pet of the Month – August 2017 – Harry

by admin on August 1st, 2017

Category: Pet of the Month, Tags:

Pet of the Month this August is Harry, a handsome 7 year old German Shepherd Dog. We are delighted to report that he has recovered extremely well following recent surgery for Gastric Dilatation.

 

What is gastric-dilatation and volvulus (GDV)? Is my dog at risk?

Gastric dilatation and volvulus, or GDV as it is commonly abbreviated, is a relatively common clinical syndrome seen in large / giant breeds of dog. Dilatation refers to bloating of the stomach with gas, and volvulus refers to twisting of the stomach about its axis. The cause of this syndrome is not completely understood. In fact it is quite controversial which occurs first; the bloat or the volvulus (twisting). Indeed both components do not have to occur together and some patients will develop relatively simple bloat alone. GDV is a potentially life threatening condition and emergency veterinary attention should be sought immediately if it is suspected.

 

Why is GDV potentially life-threatening to dogs?

There are a number of serious and potentially fatal consequences that occur as a result of GDV. Initially the severe distension of the stomach stretches the blood vessels over its surface reducing the blood supply to the stomach walls. This is made worse by the twisting of the stomach which also twists the blood vessels, effectively shutting off blood supply to the stomach. A lack of blood flow means there is a lack of oxygen and nutrients delivered to the stomach and waste products are not removed. As with any organ this will result in parts of it dying. This process happens very quickly and in severe cases could result in part of the stomach wall rupturing and releasing its contents into the abdomen.

The large distended stomach occupies much more space inside the abdominal cavity and compresses surrounding structures. Severe distension puts pressure on the diaphragm and interferes with the patient’s ability to breath. It also applies pressure to a large blood vessel in the abdomen (the vena cava) that normally returns blood from the back half of the body to the heart. Pressure on this vessel obstructs flow therefore reducing the amount of blood returned. If blood can’t be returned to the heart, then it in turn can’t pump it out to the rest of the body. If there is insufficient blood being pumped, the blood pressure falls dramatically making the patient weak and potentially leading to collapse.

To add insult to injury, other organs in the body such as the lungs, kidneys, liver and intestines do not receive a blood supply and begin to fail. The lack of a functional circulation also means that toxic products build up in these organs that further compromise the patient. These changes can happen in a matter of hours, emphasizing the importance of early veterinary attention.

 

What are the symptoms of GDV in dogs?

The symptoms generally include obvious distension or enlargement of the abdomen with unproductive vomiting or retching. The patient may drool excessively and appear restless or agitated. As the condition progresses the patient may become increasingly weak or even develop shock and collapse.

 

What is the treatment for GDV?

The age and breed of the patient coupled with the clinical signs of a severely bloated abdomen will make your vet highly suspicious of this condition. They will immediately place one or more an intra-venous catheters to allow administration of fluids to support the circulation and dilute toxins in the blood. They may also analyse the patient’s blood to assess the severity of organ damage.

The next stage involves attempts to decompress the stomach. This is usually accomplished by passage of a specially designed tube through the mouth down into the stomach. There is a gag that can be used to assist in this process but many patients will require sedation or anaesthesia to complete the task. It can be very challenging or sometimes impossible to perform stomach tubing. This is particularly the case when the stomach is twisted 360 degrees or more. In this instance a cannula (tube) may have to be inserted through the body wall and into the stomach to allow deflation. Deflation is clearly an imperative step because it will relieve pressure on the diaphragm and help restore blood flow back to the heart through the vena cava.

Radiographs of the abdomen are often required to help distinguish between simple dilatation and dilatation with volvulus. In the latter case surgery will be required as soon as the patient is stabilised. The aim of the surgery is to de-rotate the stomach and assess it for areas of devitalisation. If there are areas of the stomach that have undergone necrosis (died), these need to be removed surgically.

It is vital that the stomach is attached to the inside of the body wall. This is called a gastropexy and it will prevent volvulus in the future. This is essential as up to three quarters of the patients that do not have this performed will have another episode in the future. This also applies to those patients suffering with bloat alone as they have the same risk.

 

What are the risk factors for GDV in dogs?

There are several factors that have been clearly demonstrated to increase an individual’s risk of developing this condition. These include:

  • Being a purebred large / giant breed
  • Having a deep and narrow chest conformation
  • Having a history of previous bloat
  • Having a history of bloat or GDV in a first degree relative (parent or sibling)
  • Increasing age
  • Having an aggressive or fearful temperament
  • Eating fewer meals per day
  • Eating rapidly
  • Being fed a food with small particle size
  • Exercising or stress after a meal

 

What breeds are predisposed to this condition?

The breeds most commonly affected are large purebred dogs that have a narrow deep chest confirmation. Those at most risk include:

  • Great Danes
  • Gordon setters
  • Irish setters
  • Weimaraners
  • St. Bernard’s
  • Standard poodles
  • Bassett hounds

Although these are the breeds we typically see GDV in, it is worthy to remember that it can happen in any patient.

What is the prognosis?

With improved understanding of the secondary consequences of GDV and excellent anaesthesia, surgical and post-operative care now available for veterinary patients a good prognosis can be achieved for this condition. Survival rates of 73-90% would be typical. There will always be a range quoted for survival because individual patient’s circumstances in terms of severity, age, general health and treatment received will have an impact on the outcome. One important factor that has been shown to decrease the survival is the presence of clinical signs for greater than six hours. This emphasizes the importance of prompt veterinary attention in all cases.

If you are in any doubt that your dog is suffering from bloat or GDV, please call your vet immediately.

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Pet of the Month – July 2017 – Henry

by admin on July 4th, 2017

Category: Pet of the Month, Tags:

Our pet of the month is Henry who we are pleased to say has recovered fully from a severe bout of pancreatitis, which necessitated a period of hospitalisation.

 

What is pancreatitis?

The pancreas is an organ in the abdomen (tummy) which is responsible for releasing enzymes (types of proteins) to digest food. The pancreas also releases important hormones (such as insulin) into the bloodstream. Pancreatitis occurs when the pancreas becomes inflamed (tender and swollen). In most cases pancreatitis occurs for no apparent underlying reason, although sometimes it can have a particular cause (such as scavenging food). Pancreatitis most commonly affects middle aged to older dogs, but in addition, dogs of certain breeds (e.g. Cocker Spaniels and Terrier breeds) are more prone to developing the condition.

 

What are the signs of pancreatitis?

Pancreatitis can cause a variety of symptoms, ranging from relatively mild signs (e.g. a reduced appetite) to very severe illness (e.g. multiple organ failure). The most common symptoms of pancreatitis include lethargy, loss of appetite, vomiting, abdominal pain (highlighted by restlessness and discomfort) and diarrhoea.

 

How is pancreatitis diagnosed?

The possibility that a dog may be suffering from pancreatitis is generally suspected on the basis of the history (e.g. loss of appetite, vomiting) and the finding of abdominal pain on examination by the veterinary surgeon. Because many other diseases can cause these symptoms, both blood tests and an ultrasound scan of the abdomen are necessary to rule out other conditions and to reach a diagnosis of pancreatitis. Although routine blood tests can lead to a suspicion of pancreatitis, a specific blood test (called ‘canine pancreatic lipase’) needs to be performed to more fully support the diagnosis. An ultrasound scan is very important in making a diagnosis of pancreatitis. In addition, an ultrasound scan can also reveal some potential complications associated with pancreatitis (e.g. blockage of the bile duct from the liver as it runs through the pancreas).

 

How is pancreatitis treated?

There is no specific cure for pancreatitis, but fortunately, most dogs recover with appropriate supportive treatment. Supportive measures include giving an intravenous drip (to provide the body with necessary fluid and salts) and the use of medications which combat nausea and pain. Most dogs with pancreatitis need to be hospitalised to provide treatment and to undertake necessary monitoring, but patients can sometimes be managed with medication at home if the signs are not particularly severe. At the other extreme, dogs that are very severely affected by pancreatitis need to be given intensive care.

One of the most important aspects of treating pancreatitis is to ensure that the patient receives sufficient appropriate nutrition while the condition is brought under control. This can be very difficult because pancreatitis causes a loss of appetite. In this situation, it may be necessary to place a feeding tube which is passed into the stomach, and through which nutrition can be provided (see Information Sheet on Feeding Tubes). If a dog with pancreatitis is not eating and will not tolerate a feeding tube (e.g. due to vomiting), intravenous feeding (using a drip to supply specially formulated nutrients straight into the bloodstream) may be necessary.

 

What is the outcome in pancreatitis?

It may be necessary for dogs with pancreatitis to be hospitalised for several days, but fortunately, most patients with the condition go on to make a complete recovery, provided that appropriate veterinary and nursing care is provided. In some instances, dogs can suffer repeated bouts of the condition (called ‘chronic pancreatitis’) and this may require long term management with dietary manipulation at the forefront.

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Pet of the Month – June 2017 – Louie

by admin on June 1st, 2017

Category: Pet of the Month, Tags:

This June our Pet of the Month is Louie.

Almost 3 years ago he was discovered to have Atrioventricular Insufficiency (AVVI) during a routine investigation for an episode of acute pain, and has been managing very well since that time with appropriate medication.

 

Overview

AVVI is a degenerative disease that damages heart valve leaflets as it progresses. This damage prevents heart valves from closing properly, allowing blood to leak backward into the atrium. This leakage eventually results in a heart murmur detectable via auscultation with a stethoscope. Valve leakage impairs cardiac function and circulation, ultimately leading to congestive heart failure (CHF).

Estimates indicate that 10% of all dogs seen in primary care veterinary practices have heart disease.  As dogs age, the prevalence of heart disease reaches more than 60%.

AVVI, the most frequent cause of CHF in dogs, is a slowly progressing disease. The prevalence of this disease gradually increases with age. AVVI affects:

    • 10% of dogs 5 to 8 years of age
    • 20% to 25% of dogs 9 to 12 years of age
    • 30% to 35% of dogs over age 13 years

This increase is especially dramatic in small breeds, with up to 85% showing evidence of valvular lesions by 13 years of age.

Video: https://www.youtube.com/watch?v=7WsT-iKe5vo

AVVI occurs most often in small- to medium-sized breeds of dogs.  Breeds most susceptible to AVVI include the Boston Terrier, Cavalier King Charles Spaniel, Chihuahua, Miniature Pinscher, Miniature and Toy Poodle, Pekingese, and Pomeranian.  Ultimately, all small breed dogs are at risk for CHF due to AVVI.

 

Management

When it comes to managing canine congestive heart failure (CHF) with the goal of improving and extending life, time matters. Though the early stages of heart disease can progress slowly, once clinical signs appear, immediate treatment is needed.

In fact results of recent longterm studies show that the early administration of appropriate medication to dogs with mitral valve disease who have echocardiographic and radiographic evidence of cardiomegaly (heart enlargement) results in prolongation of the preclinical period (period before any illness is evident) by approximately 15 months, which represents substantial clinical benefit.

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Pet of the Month – May 2017 – Bob

by admin on May 1st, 2017

Category: Pet of the Month, Tags:

Bob is one of many cats we attend who suffers from IBD (Inflammatory Bowel Disease).

IBD is not a single disease but a group of chronic gastrointestinal disorders caused by an infiltration of inflammatory cells into the walls of a cat’s gastrointestinal tract. The infiltration of cells thickens the wall of the gastrointestinal tract and disrupts the intestine’s ability to function properly. IBD occurs most often in middle-aged and older cats.

 

How is IBD diagnosed?

Symptoms of feline IBD are not specific. They may include vomiting, weight loss, diarrhea, lethargy and variable appetite. The symptoms of IBD can vary depending on the area of the digestive tract affected.A definitive diagnosis of feline IBD can only be made based on a microscopical evaluation of tissue collected by means of an intestinal (or gastric) biopsy.

 

How is IBD treated?

The treatment of IBD usually involves a combination of change in diet and the use of various medications. There is no single best treatment for IBD in cats. Your veterinarian may need to try several different combinations to determine the best therapy for your cat.

Hypoallergenic diets are usually tried first. Corticosteroids like prednisolone may be used to reduce inflammation of the gut. Antibiotics such as metronidazole are commonly used.

 

What does the future hold for a cat with IBD?

IBD is a chronic disease. Few cats are actually cured. Symptoms of IBD may wax and wane over time. IBD can often be controlled such that affected cats are healthy and comfortable. Vigilant monitoring by the veterinarian and owner is critical.

We are very pleased to report that Bob has responded well to dietary management and is currently not requiring additional medication. Luckily he is not adept at hunting and so we have no fear that he might upset the illness through illicit snacks!

Bob

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Pet of the Month – April 2017 – Diarmuid

by admin on April 1st, 2017

Category: Pet of the Month, Tags:

Meet Diarmuid a handsome six month old flat coated retriever. Diarmuid has Distichiasis (‘extra eyelashes’).

Distichiasis is a common condition in dogs. It occurs when eyelashes are abnormally positioned and emerge too close to the eyelid margin.

Distichiasis can occur in any breed of dog but is most commonly seen in the American Cocker and Cocker Spaniel, Miniature and Longhaired Dachshund, Bulldog and Weimeraner breeds.

 

What are the signs of distichiasis?

In many dogs the extra eyelashes do not cause a problem, but in some cases they can rub the surface of the eye and cause irritation. The most common signs that you will notice are increased blinking/squinting of the eye, increased watering, and redness of the ‘white’ of the eye.

 

What are the treatment options for distichiasis?

Distichiasis only requires treatment if the hairs are causing irritation, conjunctivitis or corneal ulceration. There are a number of treatment options:

  • Ocular lubricants. In mild cases of distichiasis, daily use of a lubricating gel such as Viscotears, Geltears or Lacrilube may be sufficient to soften the hairs and reduce their irritation. Lifelong treatment will be required.
  • Plucking.   Sometimes the extra eyelashes can be plucked using special epilation forceps. This is particularly useful when there are only a few long hairs present. However, because the hairs will grow back after a few weeks, regular and lifelong treatment will be needed.
  • Electrolysis. Under general anaesthesia, a fine electrode is inserted into each hair follicle and a current is applied to permanently destroy the hair follicle. Once the hair follicle is destroyed the distichia cannot regrow. However, because only those hairs that happen to be present at the time of treatment can be identified and removed, new hairs may emerge at a later date and also cause irritation. The success rate of electrolysis per treatment is around 70-80%. The procedure can be repeated a number of times if necessary. Rarely, electrolysis can cause some scarring and depigmentation of the eyelids, but this is not usually severe.
  • Cryotherapy. This technique may be useful when many hairs are present. Under general anaesthesia, a probe is applied to the inner surface of the eyelid in the region of the hair follicles. Via this probe, the eyelid is frozen to destroy the hair follicles. The technique can cause some scarring and depigmentation of the eyelids. This procedure may also need to be repeated, and has a similar success rate to electolysis.
  • Surgery. Excision of a very small portion of the eyelid margin from which the distichia are growing.

As the few distichia do not appear to be bothering Diarmuid’s eyes excessively, artificial tears are being used alone at present. Should the distichiasis become more of a problem then intervention along one of the lines described above will be necessary

Diarmuid

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Pet of the Month – March 2017 – Prince

by admin on March 1st, 2017

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Our pet of the month this March is a delightful and photogenic Pomeranian puppy called Prince.

Prince had to have his right foot X-rayed after he jumped off a bed and landed awkwardly. Unfortunately, in the process he fractured all the toes of his right paw and was unable to bear weight on it.

Following surgery to stabilise the fractures using small metal pins we are really pleased to report Prince is making good progress and hopefully will be back to normal very soon.

Pet of the month - Prince - March 2017

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Pet of the Month – February 2017 – Hadley

by admin on February 1st, 2017

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Hadley has featured in this column before and his return to this newsletter is to highlight the need for vigilance in respect of skin tumours. Hadley suffers from a very serious form of skin cancer called a Mast Cell Tumour (MCT), and he is recovering very well following surgery to remove yet another recurrence. MCT can be very deceptive as they often start as small bumps which may remain static for many months before growing larger. It can be extremely difficult to contain, frequently recurs and may be life threatening.

MCT is the most common skin tumour in dogs; it can also affect other areas of the body, including the spleen, liver, gastrointestinal tract, and bone marrow. MCT represent a cancer of a type of blood cell normally involved in the body’s response to allergens and inflammation. Certain dogs are predisposed to MCT, including brachycephalic (flat-faced) breeds such as Boston Terriers, Boxers, Pugs, and Bulldogs, as well as retriever breeds, though any breed of dog can develop MCT.

When they occur on the skin, MCT varies widely in appearance. They can be a raised lump or bump on or just under the skin, and may be red, ulcerated, or swollen. In addition, many owners will report a waxing and waning size of the tumour, which can occur spontaneously or can be produced by agitation of the tumour, causing degranulation. Mast cells contain granules filled with substances which can be released into the bloodstream and potentially cause systemic problems, including stomach ulceration and bleeding, swelling and redness at and around the tumour site, and potentially life-threatening complications, such as a dangerous drop in blood pressure and a systemic inflammatory response leading to shock.

When MCT occur on the skin, they can occur anywhere on the body. The biological behaviour of these tumours can vary widely; some may be present for many months without growing much, while others can appear suddenly and grow very quickly. The most common sites of MCT spread (metastasis) are the lymph nodes, spleen and liver.

Diagnosis can be simply achieved via a fine needle aspirate. This requires no anesthesia and only rarely sedation. Early identification and surgical removal are key to the most favourable outcomes however aggressive forms may require radical surgery and necessitate referral to a specialist cancer referral centre.

Hadley initially found the operation sites to be very itchy after surgery, something not uncommon with MCT. After removing a few of his own sutures Hadley was given additional medication, resutured and had to wear a full body suit! We are pleased to report he is making very good progress.

Hadley Pet of the month Feb 2017

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Pet of the Month – January 2017 – Sophia

by admin on January 3rd, 2017

Category: Pet of the Month, Tags:

Sophia Pug Pet of the month for January is Sophia, an 11-year-old Pug. She is seen here in post-op recovery having just had an ovariohysterectomy to treat a condition called pyometra.

Pyometra is an infection of the uterus (womb).  It is a common condition in older female dogs that have not been spayed but can occur in un-spayed dogs of any age.  Occasionally we see cases occurring in cats.

What causes pyometra?

Each time a female dog has a season (usually about twice a year) she undergoes all the hormonal changes associated with pregnancy – whether she becomes pregnant or not. The changes in the uterus that occur during each season making infection more likely with age.  A very common organism called E. coli, found in your dog’s faeces, usually causes the infection.  We most commonly see cases of pyometra in the 4-6week period after a heat.  Injections with some hormones to stop seasons or for the treatment of other conditions can also increase the risk of pyometra developing.

 

What are the signs of pyometra?

Pyometra is of course, only seen in females (since males do not have a uterus). It is more common in older females (above 6 years of age) but can be seen at any age. The signs usually develop around 6 weeks after the female has finished bleeding from her last season, but in some cases, the bitch appears to have a prolonged season.

 

Early signs that you may notice are that your dog is:

  • Licking her back end more than normal
  • Off colour
  • Off her food
  • Drinking more than normal  (and will probably urinate more)

 

These signs will progress and you may see:

  • Pus (yellow/red/brown discharge) from her vulva
  • She may have a swollen abdomen
  • Vomiting
  • Collapse

If left untreated signs will worsen to the point of dehydration, collapse and death from septic shock.

 

Diagnosis

Your vet will probably suspect your dog has a pyometra based on your description of the signs and from their examination of your pet.  They may suggest procedures such as ultrasound and blood tests confirm the diagnosis, rule out other possible causes and to check that your pet is well enough to undergo treatment.

 

Treatment

The treatment of choice for pyometra is surgery to remove the uterus as soon as possible.  The operation is essentially the same as a routine spay, however, there is more risk involved and a higher chance of complications when the operation is being carried out on a sick pet. Your dog will also be given intravenous fluids (a drip), antibiotics and pain relief.

Most dogs will make a full recovery after treatment for a pyometra if the condition is caught early.  Spaying your dog before she develops a pyometra will prevent this condition occurring.

We are delighted to report that Sophia has made a full recovery after surgery.

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Pet of the Month – December 2016 – Smudgey

by admin on December 1st, 2016

Category: Pet of the Month, Tags:

Smudgey is giving us a reproving look from the depths of a buster collar that should prevent him removing his indwelling urinary catheter.

SMUDGEYThe catheter had to be placed under anaesthesia in an emergency procedure to relieve a potentially life-threatening condition called urethral obstruction.

Urethral obstruction is a problem that occurs almost exclusively in male cats. This is because the urethra of a male cat is much longer and much narrower than that of a female cat, and so is more susceptible to becoming blocked.

Urethral blockage is not a common condition, but when it occurs it is painful, the cat will be unable to urinate despite repeated efforts, and it is a life-threatening emergency as it can cause acute kidney failure and death within 2-3 days if not managed appropriately
 

What are the signs of urethral obstruction?

A cat with urethral obstruction will usually show:

  • Repeated attempts to urinate that are unproductive
  • Crying or discomfort when straining to urinate
  • Increased agitation, and there may be some vomiting

Depending on the underlying cause, you may also have noticed some other changes in your cat’s urinating behaviour over the preceding few days such as increased frequency of urination, straining, discomfort or even some blood in the urine.

Contact your vet immediately if you think your cat may have an obstructed urethra, as this is an emergency situation.
 

What causes urethral obstruction?

Several underlying conditions can cause obstruction of the narrow urethra of a male cat, including:

  • A ‘plug’ in the urethra – this is usually an accumulation of proteins, cells, crystals and debris in the bladder that accumulates and lodges in the urethra
  • A small stone (urolith) or an accumulation of very small stones – these form in the bladder but may become lodged in the urethra
  • Swelling and spasm of the urethra – during inflammation of the bladder and urethra, whatever the cause, the inflammation may cause swelling of the wall of the urethra which may contribute to blockage, and in a number of cases the inflammation and irritation causes the muscle around the urethra (the urethral sphincter muscle) to go into spasm – this too can cause obstruction if the cat is not able to relax the muscle.

 

How is urethral blockage managed?

If your cat’s urethra is blocked, the vet will need to relieve the obstruction quickly.

Blood tests may be important to see if there are any significant complications. In particular, cats with a blocked urethra may develop acute kidney failure and may develop very high blood potassium concentrations; these are life-threatening complications that should be checked when possible.

X-rays or ultrasound may be needed to help determine the underlying cause of the obstruction and to help determine the best treatment method.

Under anaesthesia a catheter is passed into the urethra (via the penis) so that fluids can be infused to help flush out the obstruction (or sometimes to push it back into the bladder). These procedures have to be done very carefully to avoid damaging the delicate lining of the urethra.

If the obstruction is caused by spasm of the urethral muscle, simply sedating or anaesthetising the cat may be sufficient to allow easy passage of a catheter into the bladder.
 

What happens after the obstruction is relieved?

Once the obstruction has been relieved, the vet will want to infuse a sterile saline solution into the bladder via the catheter so that all the blood and debris (that will inevitably be present in the bladder) can be washed out. This is usually repeated several times to remove as much debris as possible to reduce the chance of re-obstruction.

Once this has been done, the vet will decide whether the urinary catheter can be removed. If there has been a severe blockage, your vet may want to leave a catheter in for a few days (usually no more than 2-3 days) to ensure urine can be produced while treatment is commenced for the underlying disease and inflammation.
 

What other treatments are given?

Further treatment depends on the underlying cause of the obstruction, the severity of the obstruction, and what (if any) complications have arisen. Any damage to the kidneys may be completely reversible, but cats will often have to receive intravenous fluids for several days if the kidneys have been affected. In addition to intravenous fluids, other drugs commonly used to help manage cats include:

  • Other pain-killing (analgesic) drugs
  • Drugs to help relieve spasm of the urethra (spasmolytics)
  • Anti-inflammatory drugs to relieve the swelling in the urethra

 

Long-term management of the cat with urethral obstruction

In the short-term, while the initial swelling in the urethra settles down, cats may need to be on anti-inflammatory drugs, spasmolytics, and perhaps analgesics for several days and even up to a week or two.

Longer term, management is aimed at the underlying cause of the urethral obstruction. Cases associated with uroliths (stones in the urethra and bladder) will need to be managed with special diets to reduce the risk of their recurrence. Most cats with urethral spasm or urethral plugs are thought to have underlying feline idiopathic cystitis. These cats should be managed with painkillers and the aim of reducing stress.

If repeated episodes of obstruction occur despite appropriate management, in some cases a surgical operation can be performed (called perineal urethrostomy) to help open and widen the narrow end to the urethra. This should not be regarded as a first-line therapy though as it does not deal with the underlying cause, and the surgery can sometimes be associated with complications such as the risk of stricture formation and an increased risk of bacterial urinary tract infections.

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Pet of the Month – November 2016 – Bruce

by admin on November 3rd, 2016

Category: Pet of the Month, Tags:

Poor Bruce! This is not the first time our practice cat has featured in this newsletter. At present Bruce is suffering from pancreatitis and is in our hospital.

Pancreatitis in cats has two forms, acute and chronic, which are usually diagnosed by symptoms and by ruling out other diseases. There are diagnostic tests for pancreatitis, but they are not always accurate, they can be costly, and can be quite invasive for a definitive diagnosis. Pancreatitis can also predispose your cat to other disease processes.

The pancreas is an organ that makes two primary products – digestive enzymes and insulin. Normally the digestive enzymes are released in an inactive form and are not activated until they reach the intestinal tract. This is to prevent the enzymes that are designed to break down food from coming into contact with the delicate pancreatic tissue.

In pancreatitis, for reasons yet unknown to us, these digestive enzymes will become activated while they are still in the pancreas. This results in significant inflammation and irritation to the pancreatic tissue, which can also cascade to other surrounding tissues such as the liver and intestinal tract. This can lead to secondary bacterial infections in the pancreas.

If the activation of the digestive enzymes is significant enough, then your cat can develop acute pancreatitis which can range from mild to severe and life threatening. If the activation of the digestive enzymes remains mild and continues long term, then your cat may develop chronic pancreatitis, which can result in the development of scar tissue in the pancreas, and eventually pancreatic insufficiency and predisposition to diabetes. It has been estimated that 30% or more of cats have chronic pancreatitis, but many may never show symptoms.

 

Acute pancreatitis:

Symptoms - Every cat will have different symptoms, some may have several, and some may have only one.

  • Intense vomiting: Your cat may vomit multiple times over a period of hours or days, and may not be able to keep food down. This needs to be addressed quickly to prevent dehydration.
  • Pain: Your cat may be sitting in a hunched position with their head tucked, or not want to be picked up or touched. Acute pancreatitis is very painful in all mammals.
  • Anorexia:Your cat may be feeling intensely nauseous and painful, so it is unlikely that they will want to eat.
  • Lethargy: Your cat may be extremely tired and lethargic.
  • Diarrhoea: If your cat’s pancreas is so inflamed that it is not secreting digestive enzymes into the small intestine, then any food that your cat does eat may come out as diarrhoea with a very foul odour.

Diagnosis - With acute pancreatitis, we will need to begin treatment immediately. How we treat at this point will be based on the severity of the symptoms and blood sample results.

  • Blood tests: As well as general haematology and biochemistry tests there are pancreas specific tests such as fPLI – this stands for feline pancreatic lipase immunoreactivity which can be elevated in pancreatitis in cats. However, while a positive test can confirm a diagnosis of pancreatitis, a negative test does NOT rule it out. It is possible to have a false positive with this test. The accuracy of this test has been estimated to be between 50-80%. So, while we may use this test to try and confirm a diagnosis of pancreatitis, we will not use it to make an initial diagnosis.
  • Ultrasound: For an experienced ultrasonographer, this can be a good way to diagnose pancreatitis, by finding an enlarged, thickened pancreas on ultrasound. However, this requires a more advanced skill level of ultrasonagraphy than most general practitioners have.
  • Biopsy: This is considered the gold standard for a 99.9% accurate diagnosis. However, this requires exploratory abdominal surgery which is invasive to your already sick cat, and it can take 2-3 days to get the histopathology results, so we do not do this routinely.

Treatment - The goal of treatment for acute pancreatitis is to reduce your cat’s pain and nausea, stabilize any electrolyte abnormalities, treat any secondary infections, and reduce the inflammation until your cat is able to heal.

  • Pain management: This is one of the most important aspects of treating acute pancreatitis. Commonly used drugs are: Buprenorphine. This is a narcotic that has show to have excellent pain control in cats. This is our most common first line pain management for acute pancreatitis.
  • Nausea: We have several anti-nausea medications that we will use in cats with acute pancreatitis. Most commonly used is Cerenia (maropitant). This is a fairly new drug that has quickly become our first line of defense for nausea in cats. This drug not only reduces nausea and vomiting, but it also has anti-inflammatory and anti-pain properties.
  • Reducing gastric acid secretion in the stomach can help an already nauseated cat. We often use omeprazole.
  • Antibiotics: We may use antibiotics to treat any secondary infections.
  • Intravenous fluids: If your cat is having a hard time staying hydrated due to vomiting or not drinking, or if your cat has abnormal electrolytes, then we will start intravenous fluid therapy.
  • Syringe feeding: If is very important that you cat eats. If they are too nauseous to eat, we may syringe feed them a very bland diet or a prescription diet.

Possible long term effects: Acute pancreatitis can lead to destruction of a fair amount of pancreatic tissue. How much tissue is affected can determine what happens next. Some of the more common sequelae are:

  • Scar tissue: After the inflammation subsides, there is a chance of scar tissue developing in the healing process. As long as there is enough healthy tissue remaining, then your cat may never have any additional problems.
  • Chronic pancreatitis: This is what happens when your cat’s pancreas continues to have low grade chronic inflammation. This can result in regular vomiting and anorexia episodes.
  • Pancreatic insufficiency: When too much of your cat’s pancreas that makes digestive enzymes is destroyed, either by severe acute pancreatitis, or by chronic pancreatitis, eventually the pancreas will not be able to make enough enzymes to digest food. Your cat may then have large fluffy diarrhea and an increase in vomiting. This can be treated by giving your cat synthetic digestive enzymes.
  • Type I diabetes: When enough of your cat’s pancreas that makes insulin is destroyed, it will not be able to make enough insulin to counteract the glucose in the body. Your cat may then develop diabetes and will need to be started on insulin injections.

 

Chronic pancreatitis:

The symptoms of chronic pancreatitis are very similar to acute pancreatitis, but on a milder scale. A common pattern we will hear is that your cat will vomit several times a day for a few days, not want to eat, and may act uncomfortable and lethargic, and then a few days later, will be fine until the next episode. These symptoms can also be similar to inflammatory bowel disease, so we may ask you lots of questions about exactly what goes on with each episode, and frequency to try and distinguish between the two.

Diagnosis again is similar to acute pancreatitis, but it can be harder as the blood work will be more likely to look normal, fPLI will only be positive if there is significant inflammation, and ultrasound will be even harder to detect. There is a blood test available that will test for two pancreatic enzymes and two intestinal enzymes to try and differentiate between pancreatitis and inflammatory bowel disease, but if it is negative, it still doesn’t rule either one out for sure.

Treatment most commonly is symptomatic, with pain medications, antibiotics, and anti-nausea medications. For cats who do have routine flare ups of chronic pancreatitis, we may want to treat long term with Cerenia as a preventative. We have a few other preventative treatment options as well if Cerenia is not an option.

While pancreatitis is one of the more painful and potentially nauseating diseases we can see in cats, as you have just read above there are things we can do to decrease its effects and help your cat to feel better.

Bruce Pet of The Month

 

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