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The Importance of a Proper Diagnosis

History

Phil Zeltzman, DVM, DACVS, CVJ and Scott Fausel, VMD

Ally, a 10 year old female spayed DSH, had been hiding under the bed. She was presented with a 3 day history of vomiting, anorexia and lethargy. Her physical exam was within normal limits (including rectal temperature) except for a tense abdomen. Blood work revealed increased BUN (45; RR 15-32), creatinine (2.1; RR 0.8-1.8) and ALT (316; RR 0-100). The chemistry also showed low potassium (2.7; RR 3.4-5.3) and low chloride (92; RR 107-125). Abdominal radiographs revealed gastric distension.

Phil Zeltzman, DVM, DACVS, CVJ and Scott Fausel, VMD

Ally, a 10 year old female spayed DSH, had been hiding under the bed. She was presented with a 3 day history of vomiting, anorexia and lethargy. Her physical exam was within normal limits (including rectal temperature) except for a tense abdomen. Blood work revealed increased BUN (45; RR 15-32), creatinine (2.1; RR 0.8-1.8) and ALT (316; RR 0-100). The chemistry also showed low potassium (2.7; RR 3.4-5.3) and low chloride (92; RR 107-125). Abdominal radiographs revealed gastric distension.

Comments

This case report illustrates the fact that it is important to keep an open mind and that “age is not a disease.” Not every vomiting cat with Gastric Outflow Obstruction has cancer. It is certainly unusual that an older cat swallows a foreign body, but it happens and should remain on our differential diagnosis list. Update: 2 weeks after surgery, at the time of suture removal, Ally was back to normal, eating and drinking normally.

Clinical Differential Diagnosis

Gastric distension – obstruction (foreign body, neoplasia), hypo-motility, areophagia, bacterial fermentation, dysautonomia
Renal disease – chronic kidney disease, pyelonephritis, renolith, ureterolith, neoplasia

Sampling

Laparotomy was recommended. Surgery confirmed a fluid-distended stomach

Sonographic Differential Diagnosis

First impressions: Hypokaliemia and hypochloremia are typical, although not pathognomonic, for Gastric Outflow Obstruction (GOO). The differential diagnosis for GOO in a 10 year old cat includes pyloric stenosis (aka benign muscular pyloric hypertrophy, mostly described in the Siamese), foreign bodies and certainly tumors. Tumors can be extraluminal (pancreatic, duodenal or hepatic neoplasia) or intraluminal (benign polyp, carcinoma, lymphoma, sarcoma etc).

Image Interpretation

An ultrasound was performed. It showed a markedly fluid-distended stomach with a moderate amount of ingesta. There was a linear echogenicity within the pylorus. Wall architecture and thickness were normal. Differentials for the gastric findings included pyloric obstruction and gastritis (e.g. uremic gastritis).
The next day, a repeat ultrasound showed that the gastric dilatation had gotten worse in spite of supportive care overnight. This included IV fluids, ranitidine and Anzemet* (Dolasetron).

Outcome

Histopathology: Histopathology later revealed a normal liver biopsy and mild mucosal plasmacytosis in the duodenum.

Patient Information

Images

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