Lymphocytic inflammatory bowel disease/alimentary lymphoma in a cat

15 Lymphocytic inflammatory bowel disease/alimentary lymphoma in a cat




Initial presentation


2 months of intermittent vomiting, with recent increase in frequency


Signalment: 9-year-old neutered male domestic shorthaired cat; body weight 3.9 kg



Case history


The cat presented with a 2-month history of vomiting and an increasingly poor appetite. The vomiting had been occurring initially two to three times per week, but during the 2 weeks prior to admission was occurring up to four times per day. The vomitus generally consisted of partially digested food, sometimes with bile present. There had been no diarrhoea, although the amount of faeces had decreased as the cat’s appetite decreased.


His previous diet was a commercial dry food supplemented once a day with canned food. During the time his appetite was decreasing the owner had been tempting him with cooked chicken and ham.


His vaccinations were up to date and he had been treated for parasites 3 months prior to presentation. He had not travelled outside of the UK.



Physical examination


On physical examination the cat was bright and alert, but seemed to tire quickly. His body condition score was 3/9. His mucous membranes were pink but slightly dry and capillary refill time was <2.5 seconds. Thoracic auscultation was unremarkable and lymph nodes were within normal limits. On abdominal palpation diffusely thickened loops of bowel were felt. His temperature was 38.7° C, respiratory rate was 30 breaths per minute and his heart rate was 187 beats per minute. His coat was unkempt in appearance.



Problem list



• Chronic vomiting


Differential diagnosis



• Dietary sensitivity (allergy or intolerance)

• Dietary indiscretion

• Stomach
• gastritis

• gastric ulcers

• inflammatory bowel disease

• foreign body

• parasites

• neoplasia

• Small intestinal disease
• infectious, e.g. bacteria, viral, fungal

• gastrointestinal (GI) parasites

• inflammatory bowel disease

• infiltrative neoplasia, e.g. lymphoma, mastocytosis

• high partial obstruction, e.g. intussusception, foreign body

• Systemic disease
• uraemia

• liver failure

• sepsis

• congestive heart failure

• acidosis

• hypoadrenocorticism

• ketoacidotic diabetes mellitus

• hyperparathyroidism

• gastrinoma

• Neurological diseases (no other signs consistent with these in this cat)
• dysautonomia

• vestibular disease

• CNS disease

• Drugs, toxins (no known history of drug or toxin exposure)


Case work-up



Minimum data base


Haematology, serum chemistry, urinalysis and faecal examination were preformed.


Haematology results were within the reference ranges. Serum chemistry showed a mild decrease in albumin to 24 g/l (reference range 28–39 g/l), and mild hyperglycaemia of 6.7 mmol/l (reference range 3.0–5.0 mmol/l), which was thought to be likely due to stress. Serum total thyroxin was within the reference range at 17.5 nmol/l (reference range 13–48 nmol/l).


The serum cobalamin concentration was decreased to 177 ng/l (reference range 251–908 ng/l) and folate was decreased to 6.4 µg/ml (reference range 9.7–21.6 µg/l).



Clinical tip: folate and cobalamin (vitamin B12)


Cobalamin is absorbed in the ileal part of the small intestine. It requires prior binding with intrinsic factor, which comes from the pancreas in cats and the stomach and pancreas in dogs. Deficiency may be caused by poor absorption due to intestinal disease, exocrine pancreatic insufficiency, excessive bacteria in the upper small intestine utilizing the vitamin, or a deficiency in intrinsic factor. In humans who are vegetarians (especially elderly humans), a dietary deficiency is possible; however, this is unlikely in cats as they cannot successfully be vegetarians.


Unlike most other B vitamins, cobalamin is stored in the body. In healthy cats the half life is 11 to 14 days and in cats with GI disease it is only 4.5 to 5.5 days. Clinical signs of cobalamin deficiency in humans include anaemia, thrombocytopenia, neuropathies and digestion abnormalities. In cats (and dogs) the clinical signs are not as well described; however, it has been suggested that response to treatment of intestinal disorders is improved with cobalamin repletion. A high serum concentration of cobalamin does not appear to have clinical significance and may occur with supplementation. The recommended dose for supplementation in humans exceeds the amounts needed to reach serum reference ranges and there is a consideration that there may be positive pharmacological effects.


Folate is absorbed only in the proximal intestine. A deficiency usually indicates small intestinal disease and if it is accompanied by a cobalamin deficiency it likely indicates widespread disease. A high serum folate can be caused by bacterial production, although serum concentrations of this vitamin are sensitive to food intake and a high dietary intake can also increase the serum concentration (Fig 15.1).


image

Fig 15.1 Intestinal absorption of cobalamin and folate

Related posts:

  1. Oesophageal stricture in a cat
  2. Vomiting
  3. Linear foreign body in a cat
  4. Intussusception in a cat

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Sep 22, 2016 | Posted by in SMALL ANIMAL | Comments Off on Lymphocytic inflammatory bowel disease/alimentary lymphoma in a cat

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