Feline dysautonomia

8 Feline dysautonomia




Initial presentation


Chronic dysphagia, vomiting, constipation, weight loss


Signalment: 2-year-old male neutered domestic shorthaired cat, body weight 3.75 kg



Case history


The cat had a 5-week history of vomiting frothy fluid and partially digested food three to four times a day. He appeared interested in eating, but had difficulty swallowing and was occasionally retching. He had also regurgitated several times recently. His faeces were very dry. He had difficulty passing faeces and sometimes retched when attempting to defecate. His owners felt that the cat was drinking less and he was producing very small amounts of urine. He had also been sneezing and they said he often had a crusty discharge at his nostrils. The owners thought that he had lost about 1 kg in weight during this time.


The owners had owned the cat since he was a kitten. He lived with one other unrelated cat that was healthy and they had both been de-wormed and vaccinated approximately 3 months earlier. His previous diet was a combination of a commercial dry cat food and a commercial canned cat food, but he had recently only been able to swallow small amounts of the canned commercial food. To encourage him to try to eat, the owners had also been giving him small bits of canned tuna.


Previous diagnostic tests had been performed to check for toxoplasmosis, feline immunodeficiency virus and feline leukaemia virus (FeLV); the results of all of these tests were negative.



Physical examination


The cat was quiet but responsive. He had evidence of weight loss, his body condition score was 3/9 and he had poor muscle mass. The mucous membranes of his mouth were dry and pink and capillary refill time was <2 seconds. His heart rate was 120 beats per minute (bpm), respiratory rate was 40 breaths per minute, rectal temperature was 37.9° C and systolic blood pressure was low normal at 140 mmHg. The thorax was normal on auscultation and compression. Palpation of the abdomen revealed a full bladder from which urine was easily expressed.


He had bilaterally dilated pupils which were not responsive to light and his third eyelids were elevated. He did respond to a menace test, although the response was decreased. He had normal postural reactions in all limbs and normal patellar reflexes. A Schirmer tear test showed bilaterally decreased tear production; the right eye was 10 mm and the left was 8 mm (reference range greater than 15 mm in 1 minute).



Problem list and discussion of problems


The cat’s problems included dysphagia, vomiting, constipation with tenesmus and non-responsive dilated pupils with decreased tear production. As he was unable to initiate swallowing, the dysphagia, appeared to be primarily oropharyngeal, although, as he had also regurgitated, a more general acquired neuromuscular disorder was likely.



Differential diagnosis


Differential diagnoses lists for the problems in this cat include the following.



Dysphagia and regurgitation



• Cranial nerve neuropathies, e.g. nerves VII, IX and/or XII

• Inflammation, e.g. caustic agents, infections, immune-mediated disorders

• Pharyngitis/oesophagitis

• Oropharyngeal/oesophageal neoplasia

• Retropharyngeal disorders, e.g. polyps, lymphadenopathy, haematoma, abscess, tumour

• Neuromuscular disorders, e.g. myasthenia gravis, dysautonomia, rabies, botulism

• Oropharyngeal/oesophageal foreign body

• Megaoesophagus (for the regurgitation, not for dysphagia).


Vomiting



• Adverse reactions to food

• Gastrointestinal inflammatory disorder, e.g. inflammatory bowel disease, lymphoma, gastritis, enteritis

• Gastrointestinal obstruction, e.g. foreign body, pyloric stenosis, ileus, tumour

• Constipation

• Intussusception

• Parasites, e.g. Ollulanus triceps, ascarids, Physaloptera

• Systemic disorders and disorders of other organs, e.g. uraemia, liver disease, congestive heart failure, pancreatopathy, metabolic disorders (diabetes mellitus, electrolyte imbalances)


Constipation/tenesmus



• Ingestion of indigestible material, e.g. cloth, hair

• Lack of exercise

• Painful defecation, e.g. trauma, pelvic fracture, inflammatory musculoskeletal disorders

• Obstruction, e.g. tumour, stricture

• Neurological disease, e.g. dysautonomia, idiopathic megacolon, sacral spinal nerve, pudendal nerve or perineal nerve disorder

• Dehydration


Dilated, non-responsive pupils



• Disorder of the visual pathways (likely to cause blindness)

• Disorders of the parasympathetic fibres that innervate the muscle fibres of the iris (oculomotor, CN III)

• Iris atrophy (unlikely in this young cat)

• Fluoroquinolone induced retinal degeneration – causes blindness but loss of pupillary light reflex can be an early sign (no history of its use in this cat)

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  4. Pancreatitis in a cat

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Sep 22, 2016 | Posted by in SMALL ANIMAL | Comments Off on Feline dysautonomia

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