Feline Intestinal Obstruction and Chronic Anemia

Makenzie Wilder, Mizzou

Cases/Abstracts, Honorable Mention

History

 An eight year old spayed feline, who will be named Molly, presented with anorexia of two week duration, lethargy, and lack of bowel movements.  The cat was not current on vaccinations, flea, or heart worm prevention. Molly lived in a home with multiple cats and spent time both inside and outside. 

Presentation

Molly was very lethargic during the exam but purred when palpated. She did not appear tender or agitated upon palpation of the abdomen. Her body conditioning score was one and her temperature was 100.1°F.  Molly was approximately 10% based on the clinical signs:  dry mucous membranes, lack of skin turgor, bilateral weak femoral pulses, and dull eyes which were shrunken in the orbital cavity. Also, her gums were white with a prolonged capillary refill time. Molly was covered in flea feces and fleas especially around the head and tail. 

Differential diagnosis:

 FIV, FeLV, neoplasia, intestinal obstruction, hyperthyroidism, flea bite anemia

Diagnostic tests:

VD and lateral abdominal radiographs were obtained.

Dilated distal jejunal walls measuring about four inches were noted and suggestive of an intestinal mass (pictures 1&2 below). Calcifications in the region were indicative of a neoplasm.  No other abnormalities were discovered. 

Laboratory data:

A blood smear was obtained.

There were no reticulocytes nor nucleated red blood cells present. Mild spherocytes and possible auto-agglutination was observed. Platelet clumps were also seen.

Count: (leukocytosis) neutrophils 83.5%, lymphocytes 4.4%, monocytes 8.1%, eosinophils 3.1%, basophils 0.8%

PCV: 20%

RBC: 4.56 M/uL (5-10)

HGB: 7.5 g/dL ( 9-15.1)

Reticulocyte: 0.5%

Na: 144 mmol/L (150-165)

K:  2.9 mmol/L (3.5-5.8)

Cl: 112 mmol/L (112-129)

FeLV/FIV test= negative

SNAP T4 test= 2.0 ug/dL (normal 1.0-5.0 ug/dL and borderline high 2.5-5.0 ug/dL)

All other values were normal. 

Treatment:

Based on the lab results, hyperthyroidism and FIV/FeLV were ruled out as underlying conditions. Surgery was recommended for the removal of the intestinal mass, but the anemia and dehydration were of first concern. Molly was placed on lactated Ringer’s solution with addition of a B complex (5mL) at a rate of 7mL/hr. She was monitored closely and was given Nitenpyram to kill the living fleas.  She was not eating canned food nor using the litter box. Molly remained stable throughout the afternoon.

Although the anemia persisted, exploratory surgery was performed the following day because the patient was still refusing to eat. Upon incision, the fat appeared pale white likely due to the anemia, but the surrounding organs had no outward signs of neoplasia. The intestines were thoroughly palpated aborally and a marked dilation was discovered in the last third of the jejunum. Fortunately, there was no ischemia of the jejunum. With a longitudinal incision, the mass was revealed to be a trichobezoar composed of not only hair, but multiple bones mostly likely from a small rodent (pictures 3&4 below). The entire mass weighed approximately five ounces.

The day after surgery Molly was stable with pink mucous membranes and was found purring. Her fluids were increased from 7 to 13 mL/hour. Emodepside/praziquantel was given PO for possible intestinal parasites along with a combination of Ampicillin and Sulbactam at 3.3mL IV daily. Two days after surgery she urinated in the litterbox and by day four she was slowly eating canned a/d cat food. Prednisolone 5mg PO was given daily after the onset of eating for any possible auto-immune diseases.

Ten days after being hospitalized, Molly remained stable and the owner was ready to pick up and start home care. She was given selamectin for flea prevention and instructed to get lactulose and Cisapride if there was a lack of bowel movement. Molly continued to be slightly anemic but all other lab values had improved throughout hospitalization. Her owner reported that Molly began to eat normally, go outside often, and use the litter box frequently.

Overview:

Anorexia, lethargy, and dehydration are clinical signs consistent with distal or incomplete intestinal obstructions. The animal gradually loses weight, but may remain alive for up to three week with sufficient water intake. The typical cause of death is either hypovolemia or bacteremia. A barium study can be performed to test for the cause of the obstruction. Trichobezors are typically not visible with a standard radiograph but they retain barium and can be illuminated as long as five and half hours after the barium has passed. As estimated in Molly’s case, the trichobezor either came from eating a small woolen mouse and or excessive grooming due to fleas.

Based on her pale mucous membranes, low PCV, and a prolonged capillary refill time, Molly was diagnosed with chronic anemia. The anemia was purposed to have originated from a combination of fleas, intestinal worms, auto-immune disease, or nutritional deficiency.  From the blood smear, it was determined that she did not have any blood parasites.  Additionally, there was evidence of agglutination and spherocytes, which are both components of immune mediated hemolytic anemia. The anemia was also non-regenerative, which was concluded to be from lack of good nutrition and anorexia of two week duration.  When the owner took Molly home, it was reported that the cat continued to improve eating, become more active, and have more bowel movements.

Reference:

1. Fossum, Theresa  W. Small Animal Surgery: Third Edition. Saint Louis: Mosby Elsevier, 2007. Print.

2. Norsworthy, Gary D. Feline Practice. Philadelphia: J.B. Lippincott Company, 1993. Print.