This a 10 year old cat with a several month history of diarrhea and recent onset of projectile vomting. I see multiple things on U/S and just want to put it together in a single coherent picture. The owner is not allowing biopsies so I am stuck with empiric therapy. Apparently, they have already tried prednisone and metronidazole with no effect. I will check the doses but other suggestions? So far, I have added in cobalamine and cerenia and am discussing Purina HA diet. Does it seem appropriate to assume this may be a triaditis cat?
This a 10 year old cat with a several month history of diarrhea and recent onset of projectile vomting. I see multiple things on U/S and just want to put it together in a single coherent picture. The owner is not allowing biopsies so I am stuck with empiric therapy. Apparently, they have already tried prednisone and metronidazole with no effect. I will check the doses but other suggestions? So far, I have added in cobalamine and cerenia and am discussing Purina HA diet. Does it seem appropriate to assume this may be a triaditis cat?
-bilateral adrenomegaly (0.48 cm)
-hyperechoic pancreas
-bilateral renal cysts and mineralization
-increased colonic wall diameter with normal wall layering
-possible mild splenomegaly (1.11cm), appears normal
-mesenteric lymph nodes quite visible but none enlarged or hypoechoic
For whatever reason, it does not like my clips and is only allowing me to upload still images. I have better clips of the pancreas, but it is clearly visible in several of the stills I took for other reasons.
Thanks!
Suzanne
Comments
Looks like a chronic
Looks like a chronic triad. I am looking at the increased submucosal echogenicity think in chronic ibd like this cat has in your first image. See the thickened echogenic submucosal layer. This is important from a surgical standpoint because its the holding layer…..could dehisc for example in a R&A/ The gb a little echogenic and the fat and panc aornd th eleft limb is remodeled. I dont see an overt inflammatory pattern but today its GI tomorrow its panc next day oits liver…..
In cases I cant get histopath or fna on these and there is weight loss in a money case my shotgun protocol that works most the time is hypoallergeenic diet (different protein source than it has had), b12 2 x wk x 4 weeks, zithromax 50 mg sid x 10-14 days, and prednisolone minimal effective dose…. 2.5 mg sid in minor cases….. obviously disclaimers to the owner re no histopath and so forth but this is usually kitty magic. If you have bartonella or toxopplasma in your area I would screen i see tons of bart + with triad cats in NJ especially adopted indoor cats that were flea ridden when adopted… even old ones that end up being triad indoor cats boom 4_+ at 12 years old…. what it means??? who knows and Im not saying bart is a cause or stimulator but its coincidental in some cases and zithro is easy and effective and liquid sid in a cat… but my protocol works most the time … occasionally dry fip can masquerade as triad in older cats too so wish there were an easier way to get a shopping spree of bx to target and dx better…. but my triad protocol is cheap and mostly effective and therefore accepted by patients and owners.
Thanks so much!! I will give
Thanks so much!! I will give it a try. Much appreciated.
Suzanne
Looks like a chronic
Looks like a chronic triad. I am looking at the increased submucosal echogenicity think in chronic ibd like this cat has in your first image. See the thickened echogenic submucosal layer. This is important from a surgical standpoint because its the holding layer…..could dehisc for example in a R&A/ The gb a little echogenic and the fat and panc aornd th eleft limb is remodeled. I dont see an overt inflammatory pattern but today its GI tomorrow its panc next day oits liver…..
In cases I cant get histopath or fna on these and there is weight loss in a money case my shotgun protocol that works most the time is hypoallergeenic diet (different protein source than it has had), b12 2 x wk x 4 weeks, zithromax 50 mg sid x 10-14 days, and prednisolone minimal effective dose…. 2.5 mg sid in minor cases….. obviously disclaimers to the owner re no histopath and so forth but this is usually kitty magic. If you have bartonella or toxopplasma in your area I would screen i see tons of bart + with triad cats in NJ especially adopted indoor cats that were flea ridden when adopted… even old ones that end up being triad indoor cats boom 4_+ at 12 years old…. what it means??? who knows and Im not saying bart is a cause or stimulator but its coincidental in some cases and zithro is easy and effective and liquid sid in a cat… but my protocol works most the time … occasionally dry fip can masquerade as triad in older cats too so wish there were an easier way to get a shopping spree of bx to target and dx better…. but my triad protocol is cheap and mostly effective and therefore accepted by patients and owners.
Thanks so much!! I will give
Thanks so much!! I will give it a try. Much appreciated.
Suzanne
Let us know how it works out.
Let us know how it works out.
Let us know how it works out.
Let us know how it works out.