Colonic inflammatory bowel disease in a cat

39 Colonic inflammatory bowel disease in a cat




Initial presentation


Diarrhoea, decreased appetite and weight loss


Signalment: 11-year-old, male neutered, domestic shorthaired cat, body weight 3.8 kg



Case history


The cat had a 1-month history of decreased appetite and weight loss, along with increasingly softer faeces. There was some increase in the frequency of defecation and the owner reported that mucus and fresh blood had been present on some occasions. The consistency of the faeces was described as ‘cow-pat’, i.e. soft but formed. He sometimes vomited, although the owners reported that this had been occurring for years.


The cat had been vaccinated within the past year, but had not been de-wormed for several years. His usual diet was a commercial canned cat food, fed two to three times per day. During the past month the owner had also been feeding him cooked ham and canned tuna to encourage his appetite.



Physical examination


Physical examination revealed the cat to be bright, alert and responsive. He was in slightly thin body condition (body condition score 4/9) and appeared well hydrated. His mucous membranes were pink with a capillary refill time of less than 2 seconds. Oral examination showed that most of his teeth were missing but was otherwise unremarkable.


Thoracic auscultation revealed a heart rate of 200 beats per minute with matched pulses. Heart and lung sounds and percussion and compression of the thorax were unremarkable. The respiratory rate was normal at 32 breaths per minute. Abdominal palpation was not resented. There was possible abdominal lymph node enlargement. Rectal temperature was 38.3° C. The remainder of the physical examination was unremarkable.



Problem list and discussion of problems



• Diarrhoea

• Weight loss

• Decreased appetite

The diagnostic approach to diarrhoea usually begins with determining if the cause is large or small intestinal in origin. The diarrhoea in this case appeared to have a large intestine component due to the increased frequency and the presence of fresh blood and mucus. However, concurrent involvement of the small intestine could not be ruled out, especially with the presence of weight loss. The decreased appetite and weight loss were thought to be related to the diarrhoea. Differential diagnoses for decreased appetite include those which cause the animal to be unable to eat (can’t eat) and those in which the animal does not want to eat (won’t eat); in this case the cat was able to eat so the decreased appetite was likely due to illness.



Differential diagnosis



Large intestinal diarrhoea



• Inflammatory conditions
• non-specific colitis

• chronic inflammatory colitis, e.g. plasmacytic/lymphocytic, eosinophilic, granulomatous, suppurative

• Infectious causes
• FIP

• feline leukaemia virus (FeLV)

• Salmonella

• Campylobacter

• Clostridium perfringens

• Parasitic
• whipworms

• hookworms

• Giardia

• Tritrichomonas foetus

• Toxoplasma gondii

• Diet related
• dietary sensitivity (allergy or intolerance)

• fibre responsive diarrhoea

• Neoplasia, e.g lymphoma, adenocarcinoma, others

• Systemic disorders

• Uraemia
• toxicities

• pancreatopathy

• Secretagogues, e.g. unconjugated bile acids, hydroxylated fatty acids secondary to small intestinal disorders


Small intestinal diarrhoea



• Diet related
• dietary sensitivity

• food poisoning

• sudden change of diet

• Small intestinal disease
• inflammatory bowel disease, e.g. plasmacytic/lymphocytic, eosinophilic, other

• infectious (viral, bacterial enterotoxins, fungal – although fungal disorders of the small intestine are unlikely in the UK)

• parasites, e.g. Giardia, cryptosporida, Strongyloides, ascarids, hookworms, Toxoplasma gondii

• neoplasia, e.g. lymphoma, mastocytosis

• lymphangiectasia (uncommon in cats)

• ileus, e.g. hypokalaemia, enteritis, dysautonomia

• antibiotic responsive diarrhoea

• Pancreatic disorders
• pancreatic exocrine insufficiency

• Chronic pancreatitis

• Liver disorders
• liver failure

• intrahepatic cholestasis

• bile duct obstruction

• Kidney disease and uraemia

• Hyperthyroidism

• Congestive heart failure

• Hypoadrenocorticism (uncommon in cats)


Case work-up


A 4- to 6-week dietary trial with a highly digestible restricted novel protein or hydrolyzed diet is appropriate in some cases of diarrhoea. With cases of colitis, the addition of mixed soluble and insoluble fibre sources may also be of benefit. The use of probiotics and prebiotics are also being investigated in intestinal disorders of dogs and cats. In this case, however, as the cat was not eating well and had been losing weight, prompt investigation rather than waiting for the results of a dietary trial was indicated.



Minimum data base


Routine haematology was performed and revealed a moderate mature neutrophilia (21.7 × 109/l; reference range: 2.5–12.8 × 109/l) and a mild monocytosis (1.06 × 109/l; reference range: 0.07–0.85 × 109/l). Blood smear analysis confirmed these findings and showed atypical, reactive appearing lymphocytes, suggestive of antigen stimulation.


Serum biochemistry results revealed a marginal increase in urea (9.9 mmol/l; reference range: 2.8–9.8) and bile acids (7.2 mmol/l; reference range 0–7) and a marginal hypophosphataemia (1.39 mmol/l; reference range: 1.4–2.5). Mild hypoalbuminaemia (24.0 g/l; reference range: 28–39) was also present.



Clinical tip on decreased serum albumin


Decreased serum albumin can be due to decreased production by the liver, increased loss via the intestines or kidneys or a ‘third space shift’ (e.g. into an obstructed loop of intestine, the pleural space or the peritoneal space). Production may also be decreased in inflammatory states, as it is a negative acute phase protein and decreases whereas production of some of the other proteins increases. After checking for urinary loss (a urine protein to creatinine ratio), further diagnostics involve looking for evidence of hepatic or gastrointestinal disorders or inappropriate fluid accumulation.

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Sep 22, 2016 | Posted by in SMALL ANIMAL | Comments Off on Colonic inflammatory bowel disease in a cat

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