You know that feeling of too much food, too much booze and, basically, an excess of everything? You just don’t feel yourself. That’s how Lucha, a happy-go-lucky two-year-old male Siamese seemed to be feeling earlier this year. Normally, he makes his presence known to all and sundry but he was feeling a little worse for wear and suffering vomiting and abdominal pain. His owner took Lucha to his local veterinary practice, where a thorough initial search failed to find the problem. Lucha continued to deteriorate and after two days he was referred to Rachel Korman, FAB’s Resident at the Feline Centre at the University of Bristol.
A physical examination did not reveal any obvious abnormalities. Blood tests were also assessed to help identify any other potential causes of vomiting such as kidney or liver disease. These were also normal – where next? Sometimes cats can eat unusual objects (there is no accounting for taste!) and foreign bodies can lodge within the intestines, causing a blockage and subsequent vomiting and abdominal pain results. Abdominal X-rays showed no evidence of this.
Finally, Lucha was sent for an abdominal ultrasound. Specialist ultrasonographers were skilfully able to identify that Lucha’s pancreas was larger and much brighter in appearance than normal, indicating the presence of inflammation. The result of a blood test was also suggestive of pancreatitis.
The pancreas, an organ situated near the stomach and small intestine, is responsible for making many of the enzymes required for digestion of food. The cause of pancreatitis is largely unknown, but can often also be associated with inflammatory bowel disease (inflammation of the intestine) and inflammatory liver disease. In pancreatitis, the pancreas becomes inflamed and very painful. In severe cases this leads to vomiting, diarrhoea, fever, but very frequently in cats it is a low grade inflammation and the only signs may be vague non-specific signs such as mild lethargy and inappetence/anorexia.
Pancreatitis is a relatively common problem in cats, but it is probably under-diagnosed because it can be so challenging to detect. There can be ultrasound abnormalities present but these can be difficult to detect and specialist equipment and a high level of ultrasound expertise is required. In the past few years a new blood test (fPLI) has been developed which can greatly assist in diagnosis.
As soon as Lucha was admitted he was started on intravenous fluid therapy, as he had lost important fluids and electrolytes from both his vomiting and his reluctance to eat. A special feeding tube that runs from the nose down into the oesophagus (naso-oesophageal tube) was placed to make sure that Lucha received adequate food – he felt so poorly that he didn’t want to eat. It is extremely important that cats receive adequate calories during a period of illness, to prevent them having to utilise any fat or muscle stores to obtain energy. If cats do not eat for more than two or three days, particularly if they are also unwell, they are at a high risk of developing a disease called hepatic lipidosis (fatty liver), which is serious and can be fatal. In particular, if pancreatitis and hepatic lipidosis occur together, the prognosis is poor, so prevention by ensuring adequate nutrition is definitely much better than cure.
Intravenous antibiotics, pain relief and drugs to prevent vomiting (metoclopramide) were also given. Metoclopramide is most effective when given as a very slow intravenous injection (constant rate infusion) over 24 hours using a special pump to control the speed.
Dedicated staff and students tried to cheer Lucha up. A special warm bed with his own heating pad was prepared and a number of favourite treats such as fresh white fish and chicken. After two days of intensive nursing care, medication and TLC, Lucha started to feel better. Suddenly, the freshly cooked chicken didn’t look so bad after all and his appetite returned with a vengeance. Soon after came the loud shouts of ‘I feel better now. I’d like to go home please!!’ as only a Siamese can communicate! Lucha got his wish and was discharged home to see his brother. Although cats may suffer repeat episodes of pancreatitis, luckily Lucha is still doing fine, four months later. It must be all the chilling out he does with his brother on the sofa …
See also for further information,
Making Sense of Sensitivity and Specificity by Joanne Lewis BSc BVMS (Hons) MRCVS: http://www.greendale.co.uk/index.php?option=com_content&task=view&id=175&Itemid=34
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