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Tuesday, March 9, 2010

Emergency

A client showed up yesterday morning with her "crashing" six year-old cat. The cat was vocalizing, in severe pain, was markedly hypotensive (low blood pressure), and had pale gums. The elderly owner lives in an apartment, where there was no possibility of having been exposed to toxins, including rat poison, and no toxic plants which the cat could have ingested. She reported that the cat had vomited a few times the day before and that the vomitus contained blood and blood clots.
The cat was evidently in shock. We treated the cat for shock, provided judicious but important pain control for this poor, painful, kitty, and ran a whole slew of tests and x-rays. Nothing, Virtually nothing. The cat didn't have pancreatitis, which was my top differential. The cat passed away peacefully (she was nicely sedated with opiates) last night, which her owner knew was likely.
The owner declined to have a necropsy performed therefore I can only speculate as to the cause of the cat's death.
Obstruction? Intoxication? Intussusception?
I think it was the latter... but I'll never know.
I was not devastated with the outcome, considering the state the cat was in when she presented. Sad, yes, but not disappointed with our efforts.
I wish my condolences to her owner.

This is what I think happened to the poor kitty.

4 comments:

Mondegreen said...

ooh. that is an amazing illustration. i always love such drawings, they're so practical and informative and "real".

Tim

Mel said...

Usually I'd expect to see some evidence of intussusception on rads. What about a possible thrombus? We recently saw a geriatric boston terrier who presented with similar signs. My colleague did a quick post-mortem after the dog was euthanized for deteriorating condition and he turned out to have a segment of infarcted bowel that was on the verge of perforating. It's unusual, yes, but something I'd probably consider.

Valerie said...

So sorry for the poor cat, and for you - these cases are emotionally draining :-(
Was the cat cold? Could be, with sepsis, which would be consistent with your hypothesis. If so, BP is unreliable until they are rewarmed.
Was its abdomen distended, any fluid wave? (I'm thinking FIP as a ruleout, but at his age it would probably be the dry form).
Any Hx of weight loss, change in appetite? I'd expect the cat to be clinically ill from something like FIP or GI neoplasia before presentation. If the signs developed suddenly, I do think your guess is reasonable. Any signs of this on an abdominal rad?
Heart rate/rhythm/murmur? I assume no pulmonary edema/pleural effusion or you would have mentioned it.
More questions than answers; it's a shame the owner didn't want to go for a necropsy.

Steven L said...

Sorry to hear about the cat...

As for the diagnosis, I'm just a bit curious about how blood/blood clots would appear in vomit when the obstruction was in the small intestine? Does everything go back up the stomach and esophagus?