- 13 year old MN shelter cat with profound weight loss (13lbs to less than 7lbs) and vomiting.
- This cat has lived in the shelter for years as he is too aggressive to adopt out.
- CBC is wnl, chem prof shows ALB=2.4, T4 is normal at 1.0, renal values are normal and usg>1.040.
- Cat had a successful subtotal colectomy 5 years ago for megacolon.
- Echo is wnl except for decreased FS due to sedation (ketamine-medetomidine-telazol)
- 13 year old MN shelter cat with profound weight loss (13lbs to less than 7lbs) and vomiting.
- This cat has lived in the shelter for years as he is too aggressive to adopt out.
- CBC is wnl, chem prof shows ALB=2.4, T4 is normal at 1.0, renal values are normal and usg>1.040.
- Cat had a successful subtotal colectomy 5 years ago for megacolon.
- Echo is wnl except for decreased FS due to sedation (ketamine-medetomidine-telazol)
- Abdominal US shows a thickened gastric muscularis layer, a small section of small intestine with an increased muscularis to mucosal ratio, mildly reactive lymph nodes with normal size and shape, and a hypoechoic left pancreas with no peripancreatic inflammation
- I performed fna’s on the ln’s but they did not exfoliate well (tried 25g, 22g, corkscrew, and syringe aspiration).
- My differential diagnoses are lymphoma, dry FIP, and less likely chronic pancreatitis.
- Any other thoughts? The sonographic changes seem mild compared to the dramatic clinical presentation. I recommended 3 view chest radiographs to look for metastatic disease.
Comments
The LNs are still egg shaped
The LNs are still egg shaped as opposed to rounded and distorted which suggests reactive as opposed to neoplastic. I can make out all the layers of the GI wall and the hyperechoic submucosal layer is a little thick and ragged. I see this with IBD often especially in older cats. I don’t suspect neoplasia but watch that albumin because if there isn t much proteinuria and the liver is ok then PLE is likely. Cats drop albumin in the GI often and especially in GI lymphoma though not likely the case here… yet… as it could transform any time which I have documented as well. In fact I’ve got my sonopath “elves” pulling all my feline lymphoma cases to look at the frequency of hypoalbuminemia in GI lsa. When I see cat serum albumins drop I chase the GI right away. Its a Lindquist thing but its always good to have red flags to chase and albumin is always a good one especially when it drops under 2.2 then the race is on to see where its coming from and it usually takes you to the dx whether in dogs or cats:)
The LNs are still egg shaped
The LNs are still egg shaped as opposed to rounded and distorted which suggests reactive as opposed to neoplastic. I can make out all the layers of the GI wall and the hyperechoic submucosal layer is a little thick and ragged. I see this with IBD often especially in older cats. I don’t suspect neoplasia but watch that albumin because if there isn t much proteinuria and the liver is ok then PLE is likely. Cats drop albumin in the GI often and especially in GI lymphoma though not likely the case here… yet… as it could transform any time which I have documented as well. In fact I’ve got my sonopath “elves” pulling all my feline lymphoma cases to look at the frequency of hypoalbuminemia in GI lsa. When I see cat serum albumins drop I chase the GI right away. Its a Lindquist thing but its always good to have red flags to chase and albumin is always a good one especially when it drops under 2.2 then the race is on to see where its coming from and it usually takes you to the dx whether in dogs or cats:)
Dry FIP (granulomatous
Dry FIP (granulomatous enteritis) unlikley. As Eric says IBD most likley but consider dietary hypersenstivity but never forget GI parasites. Ideally scope is needed else symptomatic therapy – hypoallergenic diet, couse of fenbendazole, and prednisone, and +/- chlorambucil.
Dry FIP (granulomatous
Dry FIP (granulomatous enteritis) unlikley. As Eric says IBD most likley but consider dietary hypersenstivity but never forget GI parasites. Ideally scope is needed else symptomatic therapy – hypoallergenic diet, couse of fenbendazole, and prednisone, and +/- chlorambucil.
Thank you!
Thank you!
Thank you!
Thank you!
In addition to fenbendazole
In addition to fenbendazole as remo mentions here is my blanket triaditis protocol pred used if sampling is not an option or if after sampling IBD is the dx and not neoplasia…. in my experience if this isn’t working in these chronic triad cats there is more going on and you have to get samples to check emerging lsa, mct or even dry FIP pops up on occasion. I have a few in the archive that went to histopath after being a chronic triad cat and dry FIP popped up… red herring but it shows on occasion on these guys.
Here is one of the dry FIP older triad cats that I did intraoperative US on for our IOP study
http://sonopath.com/members/case-studies/cases/dry-fip-16-year-old-mn-dsh-cat
For more FIP cases and similar here is the basic search for FIP
http://sonopath.com/members/case-studies/search?text=FIP&species=All
Triaditis protocol
Recommend pain management when anorexic with Buprenorphine (0.01-0.02 mg/kg IM or SC), clinical trial of Zithromax (50 mg sid/cat x 10 days, 3 weeks if bartonella +), Prednisolone (0.5-2 mg/kg tapering over 1 week to minimal effective dose), and B12 injections if weight loss (Cyanobalamine 250 mcg sub-q once-weekly x six weeks, then every other week for six weeks and then once-monthly, long-term if necessary), novel-protein or hydrolyzed diet or the magical Purina DM (changing protein source is crucial and may need rotation every 6 months if clinical signs recur) Diet trials is a whatever works phenomenon. If vomiting becomes a persistent issue then endoscopy would be warranted and/or recheck sonogram to assess more emerging disease.
In addition to fenbendazole
In addition to fenbendazole as remo mentions here is my blanket triaditis protocol pred used if sampling is not an option or if after sampling IBD is the dx and not neoplasia…. in my experience if this isn’t working in these chronic triad cats there is more going on and you have to get samples to check emerging lsa, mct or even dry FIP pops up on occasion. I have a few in the archive that went to histopath after being a chronic triad cat and dry FIP popped up… red herring but it shows on occasion on these guys.
Here is one of the dry FIP older triad cats that I did intraoperative US on for our IOP study
http://sonopath.com/members/case-studies/cases/dry-fip-16-year-old-mn-dsh-cat
For more FIP cases and similar here is the basic search for FIP
http://sonopath.com/members/case-studies/search?text=FIP&species=All
Triaditis protocol
Recommend pain management when anorexic with Buprenorphine (0.01-0.02 mg/kg IM or SC), clinical trial of Zithromax (50 mg sid/cat x 10 days, 3 weeks if bartonella +), Prednisolone (0.5-2 mg/kg tapering over 1 week to minimal effective dose), and B12 injections if weight loss (Cyanobalamine 250 mcg sub-q once-weekly x six weeks, then every other week for six weeks and then once-monthly, long-term if necessary), novel-protein or hydrolyzed diet or the magical Purina DM (changing protein source is crucial and may need rotation every 6 months if clinical signs recur) Diet trials is a whatever works phenomenon. If vomiting becomes a persistent issue then endoscopy would be warranted and/or recheck sonogram to assess more emerging disease.
I would definitely listen to
I would definitely listen to what the specialists above have said – I have learned a lot from these posts!
However, your case reminds me of two I have seen lately with profound weight loss and minimal, non-specific changes on U/S. Both turned out to have EPI and hypocobalaminemia. All likely secondary to something like IBD or other significant intestinal disease, but both started gaining some weight and feeling better when supplemented with pancreatic enzymes and B12.
Just a thought.
Suzanne
I would definitely listen to
I would definitely listen to what the specialists above have said – I have learned a lot from these posts!
However, your case reminds me of two I have seen lately with profound weight loss and minimal, non-specific changes on U/S. Both turned out to have EPI and hypocobalaminemia. All likely secondary to something like IBD or other significant intestinal disease, but both started gaining some weight and feeling better when supplemented with pancreatic enzymes and B12.
Just a thought.
Suzanne
yes susanne this is usually
yes susanne this is usually the case if no obvious lsa pattern or similar… chronic triad>>>maldigestion/assimilation…
glad we can be of help:)
yes susanne this is usually
yes susanne this is usually the case if no obvious lsa pattern or similar… chronic triad>>>maldigestion/assimilation…
glad we can be of help:)
Thanks for all of the input!
Thanks for all of the input!
Thanks for all of the input!
Thanks for all of the input!