Kittens and cats have a natural affinity to using a litter box, but it is important the help your kitten get off to a good start.  The first step to ensure successful house training is to make sure you have the right equipment.  If the kitten was using litter prior to coming in your home, make sure you use the same type of litter.  The litter box should be made of a washable material such as plastic.  The sides must be low enough for the kitten to enter, but high enough to contain the litter. Some commercial litter boxes come with hoods that help control odor as well as keep in litter. The box must be placed in a relatively quiet are of the house in a minimal traffic area.  Be sure the box is easily accessible and not too difficult for your kitten to find. 

To ensure that your kitten uses its litter box every time, keep it within eyesight at all times.  If it stops playing and begins sniffing around, gently carry it to the litter box.  Praise any sniffing or scratching and give it lots of praise or a small food treat for eliminating.  Whenever you are unable to watch your kitten, restrict it to a cat-proofed room with its litter box.  Continue this for at least the first two weeks, until your kitten is using its box regularly. Also, make sure you keep the litter box clean and that the kitten is never frightened when in or around the box.  The box should be scooped daily and washed out weekly.  Many cats do not like to use an excessively dirty litter box and may look for a cleaner spot to use. When an accident does occur, do not scold your kitten as this technique does not work with cats and will only make them afraid of you. Instead, try to determine why your kitten did not use the litter box and work on a solution.

Causes for house-soiling:

• Brand of litter was changed.
• Litter has scented additives or the odor of cleansers/deodorants.
• Litter box is not cleaned frequently enough.
• Kitten was frightened in or near the box.
• Kitten has medical problems.

If soiling persists, make sure that the soiled area has been thoroughly cleaned and treated with a commercial odor neutralizer. Additionally, you should take your kitten to the veterinarian as a medical problem may exist.

Furniture Scratching

Cats scratch on furniture as part of a normal grooming instinct. As they scratch on objects, the outer sheath of their claws are shed off, exposing the newer claw beneath.  There are several different ways of handling this problem.

1. Cat claws can be tipped.  Small plastic caps are glued to the cats claws, preventing them from causing damage when the cat scratches something.  Initially the vet will size the claws and show you how to apply them.   The caps are inexpensive and easy to replace, but will have to be replaced when the outer sheath is shed. This is certainly a humane, inexpensive, and convenient way of remedying the problem.
2. Provide your cat with scratching posts.  Place one post near your cat’s sleeping quarters as they like to scratch upon waking up. You may also smear cat-nip on the post to attract your cat.
3. Place squirt bottles strategically around your house. When you see your cat begin to scratch on the furniture, squirt him with the water. Be careful not to squirt the water in his eyes, however.
4. Do not yell or hit your cat.  This will not teach him anything other than to be fearful of you.  They are not able to associate the fact that you are yelling/hitting them because of the scratching.
5. Repellants for cats are available in pet shops.   Spray the repellant on the corner of furniture that may look appealing for your cat to use as a scratching area.
6. Using double sided sticky tape on the areas where cats scratch is a great way to stop them from even considering scratching the area, even when the tape is removed. Also, cats don’t like the smell of citrus, so spraying some lemon juice or citronella in the targeted area can really help.
7. The option of de-clawing your cat should not be a viable option at all (even though still legal), as it is something that is done for purely selfish, aesthetic reasons on behalf of the owner, rather than in the interests of the cat, for whom scratching is a completely natural behavior.  This is a very controversial procedure that involves amputating a portion of your cats toes.  The procedure does have a painful recovery and renders your cat completely helpless to protect himself should he get out of the house. Your cat will also be compromised is terms of his ability to evade predators such as coyotes or dogs, due to compromising his agility and ability to climb trees.

Play fighting:

Many cats and kittens can play rough.  This can be characterized by attacking and biting your ankles or arms.  Cats can be very energetic and have difficulty finding ways to release their energy.  Their natural instincts involve stalking and biting, and so this behavior characterizes their play.  Several solutions to this include providing more cat toys, allowing him/her to play with another cat, playing with your cat/kitten i.e.: by having him/her chase a string, or allowing your cat to play with another cat. To discourage this behavior, spray him/her using a water filled squirt bottle.  Buy several of them and leave them at strategic points in the house.   Although you may be tempted to hit your cat, do not do so as you may harm your cat or become fearful of you.

Aggression:

In general, cats become aggressive out of defensiveness and self-protection.  Additionally, their sense of self preservation is extremely high.    Incidences of offensive aggression are extremely low as compared to dogs.   Cats may feel threatened with new people around or with the introduction of a new cat.  When introducing cats to each other, more common than not displays of aggression will occur in both cats characterized by hissing, raising the fur along their backs, and arching their backs. In such occurrences, the cats should be allowed to retreat and in time will introduce themselves. Once they have determined that their is not a threat, they will be able to cohabitate peacefully.  It is common for cats to take days or weeks to reach this point.  The same process can occur when a cat meets a new human, although more often the cat will hide until he/she feels there is no more of a threat.

When introducing cats together, it is often a good strategy to separate one of them in another room with it’s own litter pan, food and water.   Ultimately the cats will sniff each other through the door and will be more accustomed to each others presence. After several days of this arrangement, you may open the door and allow the cats to introduce each other on their own.  It is important not to pick them up and place them next to each other.  This in fact may escalate the situation.

Some cats may become aggressive when rubbed vigorously on the belly or at the base of their tail.  Some cats like being petted in these areas and others do not.  Your cat may have an area he/she does not like being petted.  They can respond t this by biting.  Like people, animals vary in their acceptance/enjoyment of physical contact, which should be respected.

If you are concerned that your cat is excessively aggressive, beyond the reasonable scope of most cats, you may consult with your veterinarian.   Cats with thyroid problems can develop aggression. Additionally, remember that hunger and physical stress can elicit agitation and ultimately aggression. If your cat becomes isolative/aggressive and this is out of character, you may be dealing with a physical issue.

Spraying:

Spraying is a form of territory marking that can occur with both males and females.  Un-neutered males by far account for the majority of this behavior, however. When cats spray they are normally in a standing position and spray the urine horizontally.  The exception to this is female cats in heat who will often spray in a squatting position.  Neutering/spaying your cat generally resolves this problem.  If your cat is spayed or neutered, and sprays, it may be because it is having contact with a new cat, such as seeing a cat outside through a window.  In such cases it is best to attempt to eliminate visual contact with the outdoor cat, or to spray the surrounding yard with a cat repellant to keep the cat away from the house.

It is important to differentiate polyphagia caused by a diseased state from that caused by psychological reasons. Psychological polyphagia is often the result of learned behaviors and overfeeding, causing weight gain and obesity. In polyphagia associated with disease states, either weight gain or weight loss might be seen.

Causes

• Psychological or behavioral. Polyphagia can even be associated with aging, as some cats tend to become ravenous with age.
• Poor gastrointestinal absorption of nutrients may cause some animals to be polyphagic while losing weight. Examples of this include inflammatory bowel disorders, certain intestinal cancers, and pancreatic exocrine insufficiency.
• Hyperadrenocorticism (Cushing’s syndrome) is a very common cause of polyphagia in the cat. It is generally also associated with an increase in thirst and urinations.
• Diabetes mellitus may cause polyphagia due to poor utilization of the body’s blood sugar.
• Insulin producing tumors (insulinomas, liver tumors) may cause a lowering of the blood sugar and a corresponding increase in appetite.
• Some drugs may induce an increased appetite (prednisone and phenobarbital).

What to Watch For

Long-term polyphagia can have a profound affect on your pet. Look for these signs:

• Increased appetite associated with weight gain or loss. Weight gain occurs with psychological or behavioral polyphagia. Weight loss may occur with poor gastrointestinal absorption or insulin producing tumors. Weight loss or gain may be associated with diabetes and hyperadrenocorticism.
• A change in behavior. Your pet may become fixated on food.
• A change in body conformation. You may notice fat deposits redistributed around the body, a potbelly and muscle atrophy.
• Vomiting. Some animals will eat so rapidly that they vomit the food back up immediately after eating.

Diagnosis

Your veterinarian will take a good medical history and perform a thorough physical examination. The medical history can be crucial in identifying whether or not polyphagia is behavioral or pathological. Marked weight gain or loss should be noted in the history and physical examination. Your veterinarian may also recommend:

• Complete blood count (CBC) to evaluate for anemia, inflammation, or infection and to evaluate the platelet count. Abnormalities on the CBC would suggest pathological rather than behavioral polyphagia.
• Serum biochemistry tests to evaluate the overall health of your cat and to evaluate the function of vital organs such as the liver and kidneys. These tests are useful for eliminating endocrine disorders such as hyperadrenocorticism and diabetes mellitus. Low blood sugar may be detected in cats with insulin-producing tumors of the pancreas.
• Urinalysis to evaluate kidney function and check for infection or excessive protein loss in the urine. The urinalysis also is a good screening test for the presence of diabetes mellitus as sugar is found in the urine of diabetic cats.

Based on these initial test results, additional diagnostic tests may include:

• Screening tests for hyperadrenocorticism (Cushing’s disease) including low dose dexamethasone suppression test, adrenocorticotropic hormone response test, and urine cortisol-to-creatinine ratio.
• X-rays of the thorax and abdome
• Trypsin-like immunoreactivity, a serologic test for the enzyme trypsin. An extremely low concentration of trypsin is compatible with a diagnosis of pancreatic exocrine insufficiency.
• Endoscopy, a procedure in which a flexible fiberoptic endoscope is passed through the mouth and into the stomach and small intestine while the patient is under anesthesia. Biopsies of the stomach and duodenum (first portion of the small intestine) can be obtained during endoscopy.

Treatment

Your veterinarian will devise a treatment plan based on the underlying cause of the polyphagia.

• Measures to control food intake can be devised if polyphagia is behavioral in nature. Close regulation of food intake, provision of a higher fiber diet and division of the daily food allotment into several small feedings per day may help in appetite control.
• Gastrointestinal conditions such as exocrine pancreatic insufficiency may respond to dietary changes and oral medications.
• Diabetes mellitus often requires daily insulin injections.
•  Hyperadrenocorticism (Cushing’s disease) may be controlled by medication such as o,p-DDD.

Home Care

Feed an appropriate quantity of good quality cat food. Your veterinarian can help you pick a good type of food and determine the appropriate amount to feed. Avoid feeding table scraps and do not reward begging with treats as this behavior encourages behavioral polyphagia.

If pathological polyphagia is present, it should respond to appropriate treatment of the underlying disease process. If polyphagia fails to improve or worsens during treatment, you should schedule re-evaluation of your cat with your veterinarian.

What To Watch For

•   Straining to urinate
•   Frequent attempts at urination
•   Blood in the urine (hematuria)
•   Excessive licking at the urogenital area
•   Passage of only small amounts of urine
•   Vocalization when attempting to urinate
•   Inappropriately urinating (in the house)
•   Unproductive urination (no urine passed)

Causes

Causes of dysuria include a number of different conditions including:

•   Urinary tract infection
•   A stone in the urethra
•   Bladder stones
•   Urethritis (inflammation of the urethra)
•   Masses (tumors) in the bladder or urethra
•   Stricture (narrowed area within the urogenital tract)
•   A neurologic problem resulting in increased urethral tone (dyssynergia) or decreased bladder tone (atony)

Treatment

Treatment will depend upon the underlying cause of the problem. It may require:

•   Antibiotics to treat infections
•   Surgery to treat stones or a stricture
•   An anti-inflammatory dose of steroids to treat inflammation

Home Care

Administer as directed any medications prescribed by your veterinarian. Observe your cat’s urination patterns. Make sure urine is being passed in adequate amounts. Observe your cat’s general activity level, appetite and attitude. Make sure your cat has plenty of water and has frequent opportunities to urinate. Follow dietary recommendations of your veterinarian.

Causes

Dysuria may be the result of a number of different causes. These include:

•   Calculi. Bladder or urethral
•   Infection. Bacterial cystitis (infection of the bladder), urethritis, vaginitis, prostatitis (bacterial) or prostatic abscess
•   Bladder cancer. Transitional cell carcinoma, rhabdomyoma or sarcoma
•   Urethral cancer. Transitional cell carcinoma, transmissible venereal tumor
•   Prostate cancer. Adenocarcinoma, transitional cell carcinoma, squamous cell carcinoma
•   Vaginal or penile cancer. Transmissible venereal tumor, fibromas, sarcomas
•   Trauma. Ruptured bladder or urethra, urethral stricture
•   Inflammation. Feline lower urinary tract disorders (FLUTD) or granulomatous urethritis
•   Neurologic. Detrusor-urethral dyssynergia

Veterinary Care In-depth

Diagnosis In-depth

Diagnostic tests needed to determine the cause of dysuria include:

• Urinalysis to identify crystals, abnormal cells or evidence of inflammation
• Urine culture and sensitivity to identify the presence of infection
• Plain abdominal radiographs to assess for the presence of cystic (bladder) calculi (stones)
• Contrast cystourethrogram. A radiographic dye study to evaluate for the presence of calculi in either the bladder or urethra. This study will also establish the presence of filling defects that may be masses, areas of inflammation or strictures.
• Abdominal ultrasound to assess the kidneys, ureters, bladder and proximal urethra.
• A rectal exam will also be advantageous to assess the size and thickness of the pelvic urethra evaluating for masses, prostatic enlargement, or stones.
• Blood tests such as a complete blood count and serum chemistry profile may be needed to assess for changes suggesting infection or elevations in kidney values.

Treatment In-depth

The course of treatment will be dictated by the underlying cause of the problem.

• Dysuria caused by the presence of a stone in the urethra may require a technique referred to a retrograde urohydropropulsion. This is when a catheter is advanced to meet the stone and sterile water is flushed under pressure to dislodge the stone and either flush it out of the urethra or back into the bladder.
• The presence of stones in the bladder may require either surgery to remove them or in with some types a special diet to dissolve the stones.
  Antibiotics to treat for bacterial infection may be required for a short period of time (2 weeks) with a first infection or up to 3 months with recurrent infections.
• With granulomatous urethritis the use of steroids to decrease the inflammation and perhaps an antispasmotic agent/smooth muscle relaxant such as prazosin will be necessary.
• Some tumors of the bladder or urethra will require surgery to remove and those that are not amenable to surgery will require chemotherapy drugs or nonsteroidal anti-inflammatory drugs.

Follow-up

Follow-up may require long-term medical management. Also subsequent radiographs may need to be taken or repeat ultrasound examinations. Frequent examinations of the urine and repeat cultures will be required to monitor for infections and response to antibiotic management.

Causes

• Heart disease or heart failure
• Lung disease
• Tumors or cancer in the lung or which press on the airway
• Infections such as pneumonia)
• Obstructions that occlude the airway
• Trauma
• Bleeding into the lungs or chest
• Abnormal fluid accumulation in/or around the lungs from various causes including heart and lung disease
• Intact (non-spayed) female cats are predisposed to breast cancer (metastatic mammary carcinoma).
• Younger animals are more likely to develop lung infections.

What to Watch For

•   Coughing
•   Shortness of breath
•   Difficulty breathing
•   Weight loss
•   Fatigue

Diagnosis

Diagnostic tests are needed to determine why your pet is having trouble breathing. Tests that may be performed include:

•   A complete medical history and physical examination with emphasis on stethoscope examination (auscultation) of the heart and lungs
•   A chest radiograph (X-ray)
•   Measurement of blood pressure
•   An electrocardiogram (EKG)
•   Ultrasound examination of the heart (echocardiogram)
•   Laboratory (blood) tests

Treatment

The treatment for dyspnea depends upon the underlying cause. Often, treatment is initiated to help stabilize your pet and allow him to breath easier while tests are being performed to determine the underlying cause. This treatment may include:

•   Hospitalization with administration of oxygen
•   Minimizing stress
•   Thoracentesis, which is drainage of fluid that has accumulated around the lungs (pleural effusion) with a needle
•   Diuretics. A “water-pill” such as the drug furosemide (Lasix®) or spironolactone may be administered or prescribed
•   Combination drug therapy. If heart failure is suspected, treatment with oxygen, a diuretic such as Lasix, and nitroglycerine ointment is often initiated
•   The drug digoxin (Lanoxin, Cardoxin) may be prescribed in some situations

Home Care

Dyspnea is usually an emergency. See your veterinarian immediately. When you first note that your pet is having trouble breathing, note his general activity, exercise capacity and interest in the family activities. Keep a record of your pet’s appetite, ability to breathe comfortably (or not), and note the presence of any symptoms such as coughing or severe tiring.

Optimal treatment for dyspnea requires a combination of home and professional veterinary care. Follow-up can be critical and may include the following:

• Never withhold water, even if your pet urinates more than normal, unless specifically instructed to do so.
• Administer all veterinary prescribed medication as directed and be certain to alert your veterinarian if you are experiencing problems treating your pet.
• Schedule regular examinations with your veterinarian. This will include an interview regarding your pet’s clinical symptoms and quality of life. Be prepared to answer questions about your pet’s activity, appetite, ability to sleep comfortably, breathing rate and effort, coughing, exercise tolerance and overall quality of life.
• Bring your medications with you to show your veterinarian. Dosing is critical for heart medication. If your pet is on digoxin, your veterinarian may want to measure levels of that drug in the blood to make sure that the appropriate amount is being administered.

Causes

The causes of respiratory difficulty can be classified as follows:

• Infections. Pneumonia or infection of the lung can lead to symptoms that are similar to those of dyspnea. Heartworm disease, a parasitic infection of the heart and blood vessels of the lung, must be excluded as a possible diagnosis. This infection can lead to lung injury as well as dyspnea.
• Inflammatory diseases of the lungs and airways such as chronic bronchitis. This is similar to a smoker’s cough. The cause of most feline bronchitis is not known but treatment is different than for other causes of dyspnea.
• Lesions causing airway obstruction or compression
• Trauma
• Diseases of the lung tissue. These include edema, hemorrhage, pneumonia, cancer and fibrosis.
• Tumors of the mediastinum, which is the area between the left and right lungs. These tumors can cause symptoms that resemble those of dyspnea.
• Fluid surrounding the lungs (pleural effusion). When fluid accumulates within the chest cavity, it can cause shortness of breath. Pleural effusion is a common problem in cats.
• Diseases of the heart and blood vessels of the lungs.
• Other causes of altered respiration include: metabolic diseases, neurologic disease, steroid or drug (for example, phenobarbital) administration, ingested toxins and drug reactions.

A detailed list of potential causes of dyspnea include:

Mechanical Disorders Causing Airway Obstruction

• Obstructed nostrils or nasal cavity
• Pharyngeal (throat) disorder, such as post-nasal drip, overlong soft palate, pharyngeal polyps (cysts)
• Hair, hairballs or foreign bodies
• Laryngeal (voice box) diseases, including paralysis; granuloma, polyp or tumor; trauma; edema (abnormal accumulation of fluid in tissues)
• Aspiration of liquid or solid into the lungs
• Tracheal (windpipe) diseases. Collapse or hypoplasia (incomplete development of trachea), foreign body, trauma/hematoma (blood clot), compression from thyroid mass lesion
• Primary bronchial collapse (collapse of airways)
• Bronchial compression from hilar lymphadenopathy
• Bronchial foreign body
• Trauma to the bronchopulmonary tree

Non-infectious Inflammatory Causes

•   Bronchitis. Idiopathic (occurring without known cause), allergic
•   Bronchiectasis, which is chronic dilatation of the bronchi and bronchioles with secondary infection
•   Pulmonary granulomatosis, which is a collection of tumor-like masses in the lungs
•   Pulmonary infiltrates (foreign bodies in the lungs) with eosinophilia (collection of specific white blood cells in the blood)
•   Inhalation of noxious gases or smoke
•   Alveolitis (inflammation of the walls of the alveoli in the lungs) leading to pulmonary fibrosis

Infectious Causes of Respiratory or Thoracic Disease

•   Viral, including infectious tracheobronchitis, viral pneumonia
•   Rickettsial infections, which is a type of parasite
•   Bacterial infections, including pharyngitis (infection of the voice box), tonsillitis (infection of the tonsils), bronchitis (infection of the breathing tubes/airways), pneumonia, lung abscess (growth, cysts and tumors)
•   Mycoplasma pneumonia
•   Toxoplasmosis, which is a contagious disease caused by a parasite
•   Systemic mycosis, which is any disease caused by fungi, including histoplasmosis, blastomycosis and coccidioidomycosis
•   Osleri osleri, including nematodes and traveling parasites
•   Lungworms
•   Larval migrans, which is migration of parasites through the lung
•   Dirofilariasis, which is infection with heartworms

Other Causes

•   Bronchopulmonary dysplasia, which is abnormal development of adult cells
•   Acidosis
•   Anemia, hypoxemia or hemoglobin abnormality
•   Neurologic (brain, spinal cord) lesions that alter ventilation
•   Neuromuscular weakness or disease
•   Rupture or paralysis of the diaphragm, including diaphragmatic hernia
•   Flail chest or rib fractures
•   Severe ascites or abdominal space occupying lesion
•   Drugs, such as steroids that may cause panting, phenobarbital, preservatives in injectables

Lung Disorders

• Pneumonia
• Pulmonary edema from electrocution, airway obstruction, seizures, smoke inhalation, aspiration of gastric contents into the lungs, pulmonary embolism (the sudden blocking of an artery by a clot or foreign material), heartworm thrombus, drug reaction, uremia (an excess of waste products in the blood when the kidneys are not working properly) and DIC (disseminated intravascular coagulation)
• Pulmonary hemorrhage (heavy bleeding into the lung) from trauma; rodenticide coagulopathy, which is a disorder of blood coagulation due to ingestion of rodent poison; DIC; disseminated pulmonary neoplasia (tumor)
• Pulmonary fibrosis (scarring of lung tissue)

Tumors and Mass Lesions

•   Nasal tumor
•   Pharyngeal/tonsillar tumor or polyps
•   Laryngeal tumor or polyp
•   Chondromatous hematoma of the trachea
•   Tracheal adenocarcinoma (cancer)
•   Lymphoma (cancer of lymphoid tissue) in the respiratory tree, lung, mediastinum or lymphatics
•   Thymoma (disease or cancer of the thymus)
•   Primary lung tumors (carcinomas)
•   Cardiac or heartbase tumors
•   Metastatic (pertaining to the transfer of disease from one organ or part to another not directly related to it) lung tumors

Cardiac and Vascular Diseases

•   Left bronchial compression from left atrial dilatation
•   Left-sided congestive heart failure (pulmonary edema and/or pleural effusion)
•   Heartworm disease (canine)
•   Pericardial disease (disease of the sac enclosing the heart and the roots of the great vessels)
•   Heartbase tumors
•   Pulmonary thromboembolism (blood clot in the lungs)
•   Air embolism (e.g. with IV lines or urinary negative contrast studies)

Diseases of the Mediastinum and of the Pleural Space

• Mediastinal mass, which is a mass in the tissues and organs separating the two lungs, including lymphoma, thymoma and teratoma
• Thymic hemorrhage
• Hilar lymphadenopathy (disease of the lymph nodes) with bronchial compression. These include mycosis (any disease caused by fungi), granulomatous lung diseases, lymphoma and other neoplasms.

Diseases Causing Pleural Effusion

•   Congestive heart failure (CHF)
•   Hydrothorax (fluid in the pleural cavity that encases the lungs and thoracic cavity)
•   Chylothorax (milky fluid in the chest)
•   Hemothorax (collection of blood in the chest)
•   Pyothorax (accumulation of pus in the chest)
•   Pneumothorax (entry of air into the chest)
•   Metastatic neoplasia (tumor)
•   Pleuropneumonia (pneumonia accompanied by inflammation of the pleura)
•   Pulmonary embolism
•   Diffuse lymphatic dysplasia
•   Protein losing enteropathy (disease of the intestine)
•   Idiopathic pleuritis
•   Idiopathic pleural effusion

Diagnosis In-depth

A complete medical history and physical examination should be performed by your veterinarian. These diagnostic tests depend on the duration of signs, presence of other abnormalities, and what is found on the physical examination. They may include:

• Complete medical history and physical examination with emphasis on stethoscope examination (auscultation) of the heart and lungs. Identification of abnormal heart sounds such as heart murmurs or irregular heart rhythms (arrhythmia) is extremely important. 
• During physical examination, your veterinarian will pay particular attention to your pet’s breathing, the character of his/her heart and lung sounds, and mucous membrane color. Care must be taken not to stress your cat during the examination. 
• Your cat should also be evaluated for weight loss and any concurrent disease.

Your veterinarian will want to know the following:

•   What medications your cat has been taking?
•   Is there a history of illness and if so, did your pet respond to therapy?
•   Has your cat has been anesthetized recently?
•   Is your cat intact or spayed?
•   Does your cat cough?
•   What circumstances make the breathing worse?
•   Has your cat ever had heartworms and are you giving preventative medication?
•   What is your cat’s home environment and travel history?
•   Has there been any exposure to toxins (such as rat poison)?
•   Has your cat had any trauma?
•   Does your cat vomit or gag?

Diagnostic tests may include:

• A chest radiograph (X-ray) to identify heart enlargement and fluid accumulation in the lung and to exclude some of the previously mentioned conditions that can mimic dyspnea.
• Measurement of blood pressure with the special device that measures blood flow noninvasively. High and low blood pressure values may be identified because either can occur in patients with dyspnea.
• An electrocardiogram (EKG) to identify heart enlargement and determine the electrical activity of the heart. The electrocardiogram is a noninvasive test done by attaching small contact electrodes to the limbs and body.
• Ultrasound examination of the heart (echocardiogram) for a definitive diagnosis. This noninvasive test requires sophisticated equipment that creates high frequency sound waves much like the sonar of a submarine. An image of the heart is created. The echocardiogram is usually the test of choice to establish the final diagnosis of the cause of dyspnea, but this examination may require referral to a specialist.
• Laboratory (blood) tests to evaluate other organ function, such as the kidney, and exclude anemia as a complicating factor. This can be critical to evaluating the effect of dyspnea on other organs and to monitor the effects of treatment.
• A blood test to detect heartworm infection
• A complete blood count (CBC) and serum biochemistry in sick or older animals.

Your veterinarian may recommend additional diagnostic tests to ensure optimal medical care. These are selected on a case-by-case basis if indicated from the examination, prior test results or lack of response. Tests may include:

• Serologic tests for toxoplasmosis and systemic fungi
• Respiratory cytology and culture if clinical signs and prior laboratory test results do not explain dyspnea with abnormal densities in the lungs. Samples for culture and respiratory cytology (characterizing the cells by looking at a sample under a microscope) may be obtained by using one of the five methods listed below; the method of choice depends on your veterinarians experience, availability of supplies and equipment, and nature of the lung disease.
• Tracheal aspiration (removing a fluid sample using suction)
• Bronchoscopy to obtain samples for culture and cytology and to provide a visual examination of the trachea and bronchopulmonary tree
• Bronchoalveolar lavage (BAL), performed through a wedged bronchoscope, if no exudate (fluid high in protein) is observed in the trachea and main bronchi
• A fine needle aspirate (FNA) of the lung is an alternative for assessment of the dyspneic patient with some types of lung disease.
• Endoscopy. This direct visualization of the upper airways, trachea and bronchi is indicted when intraluminal masses, foreign body, Osleri osleri (a type of traveling parasite) nodules or other causes of unexplained airway obstruction or inflammation are suspected.
• Biopsy of the lung (by thoracoscopy or mini-thoracotomy). This test is sometimes the only method for attaining a diagnosis in disseminated pulmonary disease, especially interstitial disorders, unexplained by previous less-invasive test results. When a singular localized lung lesion is evident and either a foreign body or tumor is suspected consider surgical removal of the affected lobe.
• Direct fecal smears and special sedimentation methods (Baerman), along with fecal flotation to screen for lungworms, in pets that have radiographs that are compatible with lungworm infection
• Fluoroscopy or endoscopy to demonstrate dynamic collapse of a major airway when it cannot be shown by routine X-ray films
• Cytologic evaluation of conjunctival membranes (for distemper inclusions), skin ulcers (for systemic fungi) and enlarged lymph nodes (for infection or tumors)
• Esophagoscopy to diagnose esophageal-tracheal fistula or causes of aspiration pneumonia
• Specialized blood tests, such as blood taurine, in cases of dilated cardiomyopathy
• Thyroid tests to exclude abnormal function of the thyroid gland
• Blood cultures in suspected infection of the heart valves
• Consultation with appropriate specialists as needed.

Treatment In-depth

Definitive therapy is always dependent on establishment of a diagnosis. Since there are numerous potential causes of dyspnea, it is necessary to identify a specific cause to provide optimal therapy. Goals in therapy may include improving heart function, preventing fluid accumulation, preventing further deterioration of the heart muscle and antagonizing chemicals and hormones produced in excessive quantities in dyspnea. Rarely is it possible to cure heart disease.

The most important causes of dyspnea in cats are valve degeneration and cardiomyopathy (heart muscle disease). Definitive treatment likely would require valve replacement (which is rarely done in cats) or heart transplantation (not done currently).

Dyspnea caused by fluid accumulation in the sac around the heart (pericardial effusion) is not treated by drugs but instead requires drainage of the fluid or removal of a portion of the pericardial membrane. Congenital (present at birth) heart defects should be referred to a specialist for management. Animals with respiratory distress must be handled with care because struggling can result in respiratory arrest.

Initial treatments may include:

• Minimize stress and handling
• Provide oxygen and cage rest
• Remove fluid or air from the chest cavity (thoracentesis) if present in large quantities
• Perform tracheal intubation and ventilation if life-threatening dyspnea is evident and respiratory arrest is imminent
• Administer furosemide (Lasix®), oxygen and possible vasodilator therapy (Nitroglycerine®) for pulmonary edema
• Treat acute dyspnea of infectious origin with rest, inhalation of humidified air and antibiotics if bacterial infection is suspected . Maintenance of hydration is essential and administration of certain drugs, such as expectorants and bronchodilators, might be useful in bronchitis and pneumonia.

Causes in Males

In males, abnormal preputial discharge can result in excessive licking. Preputial discharge is any substance emanating (flowing) from the prepuce (the fold of skin that covers the penis). Preputial discharge may consist of blood, urine or pus. The normal cat should have no discharge; however a small amount of whitish-yellow “smegma” can accumulate around the preputial opening, and is not considered clinically significant. Causes of excessive discharge include:

• Disorders affecting the prepuce, including neoplasia (cancer), trauma, foreign body or balanoposthitis (inflammation of the penis/prepuce)
• Disorders of the urethra, including neoplasia, trauma, or calculi (stones)
• Disorders of the urinary bladder including infection, calculi, inflammation or neoplasia
• Disorders of the prostate, including prostatitis (infection or inflammation of the prostate), neoplasia, hyperplasia (enlargement), cyst or abscess
• Coagulopathies (bleeding disorders) including thrombocytopenia (decreased platelet count) and ingestion of rat poison
• Urinary incontinence (inability to hold urine) secondary to an ectopic (abnormally placed) ureter or improperly functioning sphincter (tissue that acts like a door, controlling the release of urine)

Causes in Females

In females, abnormal vaginal discharge can result in excessive licking. Vaginal discharge is any substance emanating (flowing) from the vulvar labia (the external female genitals). Vaginal discharge may be a normal in the postpartum (afterbirth) period, sometimes lasting 6 to 8 weeks. Causes of excessive abnormal discharge include:

• Urogenital tract infections (urinary tract infection, pyometra/infected uterus)
• Neoplasia (cancer) of the urogenital tract
• Vaginitis (inflammation of the vagina) or inflammation anywhere in the urogenital tract
• Coagulation (clotting) disorders (associated with rat poison, low platelets)
• Trauma or foreign body of the urogenital tract
• Urinary incontinence (inability to hold urine) secondary to an ectopic (abnormally placed) ureter or problem with the sphincter (the tissue that acts like a door, controlling the release of urine)
• Retained placenta (the organ that unites the fetus with the lining of the uterus) or fetal death

The presence of genital discharge most often suggests an underlying problem, ranging from a mild, relatively benign disorder, to a severe, even life threatening disease.

What To Watch For

• Excessive licking
• Spotting
• Discharge
• Swelling of genital area

Diagnosis

It is important to perform a thorough physical examination, including a thorough genital examination. In addition, your veterinarian may recommend the following diagnostic tests:

• A complete blood count (CBC), biochemical profile and urinalysis are recommended. Although often within normal limits, there may be evidence of infection or inflammation
• A bacterial urine culture to rule out a urinary tract infection
• Cytology (cells obtained from the discharge) and bacterial culture of the discharge
• A coagulation profile in cases of bloody discharge, and/or if a clotting problem is suspected
• Abdominal radiographs (X-ray) assess for the presence of a pyometra (infected uterus) in an intact (not spayed) female and prostate abnormalities in the male
• Abdominal ultrasound is helpful in a more thorough evaluation of the abdominal structures

Treatment

There are several things your veterinarian might recommend to treat the patient with genital discharge and excessive licking.

• Remove or treat any obvious inciting or underlying cause, such as foreign body, tumor or infection
• Daily flushing and cleansing of the vagina or prepuce can be of benefit in many cases

Home Care

Administer all prescribed medication as directed by your veterinarian and observe your pet closely. If the clinical signs are not improving or getting worse, contact your veterinarian at once.

It is first important to understand and treat any underlying diseases that may be causing the foul odor. These include:

• Gingivitis (inflammation of the gums)
• Abscessed tooth or teeth
• Bone or hair stuck in mouth
• Oral ulceration
• Foreign bodies in the mouth (such as plant material or grass awns)
• Oral neoplasia (tumors of the mouth)
• Lung diseases, such as lung cancer
• Severe kidney disease
• Periodontitis (inflammation of the tissue that surrounds the tooth)

What to Watch For

• Oral discharge
• Oral pain
• Bloody oral discharge
• Drooling
• Dysphagia (difficulty swallowing)
• Difficulty eating
• Depression

Diagnosis

Veterinary care should include diagnostic tests to determine the underlying cause of the bad breath and help guide subsequent treatment recommendations. Some tests may include:

• A complete medical history and physical examination
• A complete oral exam, which may require a brief anesthetic
• Full-mouth radiographs (X-rays) with a dental machine
• Periodontal probing (a blunt probe that is used to check the gum/tooth interface) to identify gum and periodontal diseases

Treatment

Optimal therapy of any serious or persistent medical condition depends on establishing the correct diagnosis. There are numerous potential causes of halitosis and before any treatment can be recommended, it is important to identify the underlying cause. Initial therapy should be aimed at the underlying cause. This treatment may include:

• Removal of foreign object if present
• Treatment of any oral tumors as needed
• Periodontal therapy and root planing (cleaning/scraping the teeth under the gums)

Home Care

Home care recommendations will depend on the underlying cause of the problem. Some steps that you can take to help eliminate your cat’s bad breath include:

• Brushing your cat’s teeth daily. Tooth brushes/finger brushes and special toothpastes are available from your veterinarian.
• Spraying 0.12 percent chlorhexidine (prescribed by your veterinarian) into your cat’s mouth once a day for seven to fourteen days.
• Following dietary considerations recommended by your veterinarian. Special diets that may be beneficial include Hill’s Prescription Diet T/D®.
• Evaluation by your veterinarian if the bad breath persists.

• Bacterial infections of the urinary and genital tracts such as cystitis (bladder infection) or vaginitis
• Cancer of the urinary or genital tracts
• Calculi (stones) in the urinary tract
• Congenital urinary tract abnormalities (those present at birth)
• Rare parasites of the urinary tract
• Clotting (bleeding) disorders including anti-coagulant rat poison (warfarin)
• Trauma
• Medication-induced (e.g., cystitis caused by cyclophosphamide, a drug used to treat some types of cancer and immune-mediated diseases)
• Benign idiopathic (“of unknown cause”) hematuria originating from the kidney

The effect of hematuria on the pet may range from no obvious effect to severe. Severe bleeding into the urinary tract may cause the cat to become anemic and may cause weakness or collapse. Other symptoms that commonly accompany hematuria include:

•   Painful or difficult urination
•   Straining to urinate
•   Frequent passage of small amounts of urine
•   Abdominal pain

You should have your pet examined by your veterinarian if you observe hematuria or any of these other symptoms.

Diagnosis

Your veterinarian may recommend one or more of the following tests to evaluate your pet for hematuria:

•   Urinalysis
•   Urine culture and sensitivity
•   Microscopic examination of vaginal smears
•   Complete blood count
•   Serum biochemistry tests
•   Clotting profile including platelet count
•   Plain abdominal X-rays
•   Contrast dye X-ray studies
•   Abdominal ultrasound examination

Treatment

Treatment depends upon the diagnosis. Your veterinarian may prescribe one or more of the following treatments for your cat:

•   Antibiotics for possible bacterial infection of the urinary or genital tracts
•   Dietary changes for certain types of calculi (stones)
•   Fluid therapy for dehydration
•   Vitamin K for consumption of anti-coagulant rat poison

Home Care

The presence of blood in the urine (hematuria) is abnormal. If you observe hematuria, you should take your cat to your veterinarian for evaluation. Observe your cat closely for any of the associated clinical signs such as pain or straining when urinating. If possible, obtain a voided (free-catch) urine sample from your pet and take it with you when you visit your veterinarian.

Administer all prescribed medications as directed by your veterinarian. Promptly bring any unexpected changes in your pet’s condition to the attention of your veterinarian. Evaluate your pet’s environment for the presence of possible toxins. (specifically, anti-coagulant rat poison).

Information In-depth

Hematuria (blood in the urine) can be caused by several different disorders. The most common causes of hematuria are:

•   Bacterial urinary tract infection
•   Stones in the urinary tract especially in the bladder or urethra
•   Cancer of the urogenital (urinary or reproductive) tract, especially cancer of the bladder or urethra
•   Urogenital (urinary or reproductive) disorders such as uterine infection and vaginitis
•   Congenital abnormalities (those present at birth) of the urinary tract, most often an outpouching of the bladder called a urachus

Less common causes of hematuria include:

•   Clotting abnormalities caused by low platelet count (called thrombocytopenia), warfarin (rat poison) ingestion, and disseminated intravascular coagulation (a systemic clotting problem seen in seriously ill animals)
•   Parasites of the urinary tract (the kidney worm Diotophyma renale and the bladder worm Capillaria plica)
•   Trauma to the urinary tract (kidneys or bladder)
•   Some drugs such as cyclophosphamide (a drug used to treat cancer and immune disorders) can cause hematuria by inducing a sterile (non-infectious) hemorrhagic cystitis
•   Bleeding from the kidney of unknown cause (referred to as “benign renal hematuria”) is rare but when present can cause hematuria that is severe enough to lead to anemia

Veterinary Care In-depth

Diagnosis In-depth

The following tests may be needed to diagnose the cause of hematuria:

•   Urinalysis to evaluate for white blood cells, red blood cells, crystals and bacteria.
•   Bacterial culture of urine to identify urinary tract infection and determine the best antibiotic to use to treat the infection.
•   A complete blood count to evaluate for systemic infection, anemia, or low platelet count (thromobocytopenia).
•   Serum biochemistry tests to evaluate kidney and liver function and to identify electrolyte and acid base disturbances.
•   A panel of clotting tests to assess whether the pet’s blood can clot normally.
•   Vaginal cytology in intact female cats that may have vaginitis.
•   Abdominal X-rays to evaluate bladder and kidney size and identify stones dense enough to be visible on plain X-rays.
•   Abdominal ultrasound to evaluate the urinary tract for stones, tumors, obstruction to flow or evidence of infection in the kidneys themselves (pyelonephritis). Ultrasound often is recommended when other diagnostic procedures have been inconclusive. Completion of an ultrasound examination may necessitate referral to a specialty hospital.
•   A contrast dye study to evaluate the urinary tract for stones, tumors or obstruction. A contrast study of the upper urinary tract (kidneys and ureters) is called an excretory urogram or intravenous pyelogram. This study can identify obstruction of the upper urinary tract and signs of kidney infection (dilated kidney pelvis). A contrast study of the lower urinary tract (bladder and urethra) is called a cystourethrogram. This study can help identify bladder tumors or congenital abnormalities such as an outpouching of the bladder wall (urachal diverticulum). These tests may be recommended if other diagnostic tests were inconclusive.
•   Cystoscopy in female cats allows evaluation of the vagina, urethra, and bladder by introducing a rigid scope urethra and bladder. This technique allows the veterinarian to visualize congenital abnormalities of the urogential tract, tumors, stones and other abnormalities. It also allows for small biopsy samples to be obtained through the scope without the need for major abdominal surgery. Cystoscopy usually is done after other diagnostic procedures have been inconclusive. It necessitates general anesthesia and referral to a specialist.

Treatment In-depth

Treatment of hematuria depends on the underlying cause. Treatments for the common causes of hematuria are as follows:

•   Antibiotics are used to treat bacterial urinary tract infection. Ideally, the antibiotic should be chosen based on bacterial sensitivity testing to identify the antibiotic most effective for the particular type of bacteria causing the infection. However your veterinarian may make an educated guess about which antibiotic to use based on knowledge of the types of bacteria that commonly cause urinary tract infection and the ability of several antibiotics to be secreted into urine by the kidney tubules. Treatment generally is recommended for 2 to 3 weeks.
•   Fluid therapy may be recommended for pets that are dehydrated. It also may be recommended to increase urine output (establish a diuresis).
•   Dietary changes may be recommended if stones are present in the urinary tract or if kidney failure is present.
•   Vitamin K is the treatment of choice for hematuria secondary to warfarin (rat poison) ingestion.
•   Surgical intervention may be necessary for the removal of stones or tumors in the urinary tract or to correct congenital abnormalities. Surgery also may be necessary to determine wheter bleeding is coming from the left or right kidney in rare cases of “benign renal hematuria.”
•   Chemotherapy may benefit in some animals with cancer of the urinary tract.

When there is not enough body water, fluid shifts out of the body cells to compensate, leaving the cells deficient in necessary water. This leads to dehydration. The severity of the dehydration is based on the magnitude of these body water shifts. Dehydration is caused by either a lack of food or water intake or an increase in water loss through illness or injury.

What to Watch For

Signs of dehydration include:

•   Loss of skin elasticity
•   Lethargy
•   Depression
•   Sunken eyes
•   Dry gums
•   Increased heart rate
•   Slow capillary refill time

Diagnosis

Physical examination findings can help determine if dehydration is present. A common but inaccurate way to diagnose dehydration is based on skin elasticity. When the skin along the back is gently lifted, it should immediately return to the normal position. In a dehydrated animal, the skin does not return to normal quickly. The speed of return to normal position can help determine the severity of the dehydration.

Blood tests such as a complete blood count and biochemistry profile are important to try to find the underlying cause of the dehydration but may not reveal if dehydration is present.

The most important tests are a packed cell volume and total blood protein test. These tests are done on a blood sample and can help reveal if dehydration is present.

If the packed cell volume and total protein are elevated, dehydration is present. Determining the concentration of the urine can also help determine if the pet is dehydrated and if the kidneys are affected.

Treatment

The treatment for dehydration is to supplement the body with fluids. It is often not possible for an ill pet to ingest sufficient water to correct dehydration. Fluids are typically administered as an injection. The most efficient method of rehydration is through intravenous fluids. This requires hospitalization as well as an intravenous catheter.

Fluid replacement is done slowly to allow the body to compensate and slowly replenish tissues starved of fluid.

Home Care and Prevention

There is no home care for dehydration. If you suspect that your pet is dehydrated, prompt veterinary care is recommended.

Some animals can be treated with subcutaneous fluids at home, after an initial diagnosis and treatment. Ask your veterinarian if this is an option and have him/her show you how to administer injectable fluids at home.

Make sure your cat eats and drinks normally. The best way to prevent dehydration is to have your pet examined and treated early if an illness occurs. For sick pets, preventing dehydration may be difficult but if promptly treated, can result in recovery.

Information In-depth

Dehydration can be caused by numerous illnesses or abnormalities and can be divided into two main categories: reduced fluid intake or increased fluid losses.

Reduced Fluid Intake

The body relies on a steady intake of fluid to maintain hydration. When the ingestion does not meet the body demands, dehydration occurs. If your pet is not eating or drinking adequately because of disease or illness, dehydration is likely to occur. Reduced fluid intake can also occur if there is either accidental or deliberate deprivation of food or water. If you leave your pet unattended for several days and he spills his water bowl, he may be without water for several days.

Increased Fluid Losses

In some diseases or illnesses, your pet may be able to consume enough fluid to meet body demands. The most common cause of this is vomiting and diarrhea or kidney disease. With vomiting and diarrhea, excess fluids are lost. In kidney disease, the kidneys are unable to conserve fluids and they excrete excess fluid in the urine. Other causes of increased fluid losses include fever, large wounds or burns that ooze fluid or severe prolonged drooling.

Veterinary Care In-depth

How To Detect Dehydration

There is no single test that can accurately determine the presence or severity of dehydration. The diagnosis is generally based on history, physical examination findings and laboratory tests.

The recent history is very important and can determine if dehydration is possible and may help determine the underlying cause. Be prepared to answer questions about:

•   Your pet’s eating and drinking habits
•   The presence of vomiting or diarrhea
•   Whether your pet is urinating more frequently
•   The presence of excessive drooling
•   How long the signs have been present

The severity of dehydration is listed as a percentage. This percentage indicates the amount of fluid the body is lacking. The maximum amount of dehydration that can be present in a live animal is 15 percent. Any dehydration beyond that is incompatible with life.

Care must be taken on interpreting these results in obese or very thin patients. In obese pets, underestimating the severity of dehydration can occur easily because the skin returns to normal due to excessive skin fat. In emaciated or extremely thin pets, the skin is not as elastic as a normal pet so the degree of dehydration can be overestimated.

If the pet is less than 5 percent dehydrated, the skin will immediately return to normal. This mild dehydration is rarely detected on physical examination. Pets that are 5 percent dehydrated have a subtle loss of skin elasticity. The skin will return to normal but does so a little slower than a normal pet.

Pets with 6 to 9 percent dehydration have a noticeable delay in the skin returning to normal. The eyes may also appear sunken and the gums dry.

Pets with 10 to 12 percent dehydration have skin that does not return to normal position. It will stay in the tented position until it is physically returned to the normal position. The eyes are significantly sunken, the heart rate is elevated and the pulses are weak.

Pets with 12 to 15 percent dehydration are in a life threatening situation. The pet is typically collapsed, severely depressed and in shock. Death is imminent if aggressive and immediate treatment is not provided.

In addition to physical exam findings, lab tests are needed to determine the presence and severity of dehydration.

• A packed cell volume (PCV) and total protein test are the most important tests. The packed cell volume is the percentage of red blood cells currently in circulation. Normal PCV ranges from 35 to 50 percent. In dehydration, the fluid in the blood is inadequate and the blood becomes more concentrated. This results in an increase in the PCV.
• The total protein is the amount of large protein molecules in the blood. As with red blood cells, in dehydration, the concentration of the protein increases due to a lack of fluid. In a dehydrated animal, both the PCV and total protein are elevated.
• A urinalysis can also help reveal dehydration and may even help determine an underlying cause. In dehydration, the concentration of the urine is higher than normal. If a known dehydrated animal has dilute urine, kidney disease is the suspected underlying cause of the dehydration.
• Complete blood counts and biochemistry profiles can help determine the overall health of the animal as well as determine possible underlying causes for dehydration. Unfortunately, these blood tests do not always diagnose dehydration and can be normal even in a severely dehydrated animal.

Treatment

The treatment for dehydration is to rehydrate with fluids. Since the animal is unable to meet the fluid demands by consuming sufficient food or water, injectable fluids are used. The fluids may be given subcutaneously or intravenously. Intravenous (IV) fluids are preferred since the rehydration is hastened and can be more appropriately monitored.

Once your pet is diagnosed with dehydration, the amount of fluid needed must be determined. The volume of fluid that needs to be replaced is based on the percentage of dehydration and the animal’s body weight. A rough calculation can be made based on one of the following formulas:

• The number of liters of fluid required is equal to percentage of dehydration multiplied body weight in kilograms.
• The number of milliliters of fluid required is equal to 500 multiplied by the percentage of dehydration multiplied by the body weight in pounds.

In addition to rehydrating, fluids are also needed to maintain hydration and meet ongoing fluid needs if the underlying cause of the dehydration has either not been found or has not been treated.

There are multiple different types of injectable fluids. The type of fluid used in based on the concentrations of sodium, chloride and potassium as well as any other patient needs.

Follow-up

After rehydration, the underlying cause of the dehydration must be addressed. Additional testing as well as examinations may be required to find the underlying cause.

Make sure your pet eats and drinks normally. If dehydration is suspected, prompt veterinary assistance is essential to prevent further dehydration.

The presence of hematochezia may be a symptom of either a minor problem, or a potentially more serious problem in the animal. One occurrence of hematochezia may be a minor and transient event. Repeated or persistent hematochezia is more serious and should not be ignored.

General Causes

•   Infectious agents, such as bacteria, protozoa, viruses, and intestinal parasites
•   Dietary intolerance/allergy/indiscretion
•   Cancer (neoplasia) of the lower bowel
•   Polyps (benign masses) in the colon or rectum
•   Inflammatory bowel diseases, such as colitis
•   Trauma to the lower bowel or anal area
•   Clotting disorders (coagulopathy)
•   Intussusception (the telescoping of one part of the bowel into another)
•   Miscellaneous diseases of the anus, rectum and colon

What to Watch For

•   Bright red blood in the feces
•   Straining to defecate
•   Increased number of bowel movements produced
•   Possibly no other clinical signs
•   Possibly other systemic signs of illness, such as excessive drinking, urinating, vomiting and diarrhea, lethargy, poor appetite, weight loss

Diagnostic Tests

•   Rectal examination
•   Complete blood count (CBC)
•   Biochemical profile
•   Urinalysis
•   Fecal examination
•   Coagulation profile
•   Abdominal X-rays (radiographs)
•   Abdominal ultrasound
•   Colonoscopy

Treatment

There are several things your veterinarian might prescribe to treat your pet’ symptoms. These include:

•   Changes in the animal’s diet
•   Fluid therapy
•   Deworming medications for intestinal parasites
•   Antibiotics for bacterial infections
•   Motility modifying drugs that change the rate of movement of food through the intestines

Home Care

At home administer any prescribed medications as directed by your veterinarian and follow any dietary recommendations closely. You should also observe your pet’s general activity and appetite, and watch closely for the presence of blood in the stool, or a worsening of signs. If any changes occur, notify your veterinarian.

Information In-depth

Hematochezia refers to the presence of red or fresh blood in the stools, and must be differentiated from melena, which is the presence of black, tarry stools. The causes, diagnostic tests, and treatment protocols for hematochezia often differ from those for melena.

Hematochezia is often a sign of lower gastrointestinal disease. In some cases it is an indication of a minor, transient problem. In other cases it is indicative of a serious underlying disease that can become an emergency requiring intensive therapy. Hematochezia may be the only clinical sign seen, or it may be accompanied by other signs, especially straining to defecate. Obtaining a detailed history and through physical examination are essential when evaluating these patients.

Causes

There are many potential causes of hematochezia. The most common causes are usually associated with the gastrointestinal tract, although in some cases, the cause is completely unrelated (e.g. clotting disorders or coagulopathies). It is important to determine the cause of hematochezia, as specific treatment is often necessary for these patients.

• Numerous infectious agents may result in hematochezia. These include viral infections such as panleukopenia, bacterial infections such as Salmonella, protozoal agents such as coccidiosis, and intestinal parasites such as hookworms and roundworms.
• Dietary intolerance and indiscretion from eating spoiled food, overeating, ingesting foreign material (especially bones), a sudden change in diet, or eating people food may cause inflammation of the lower bowel and hematochezia.
• Dietary allergy to certain food substances, such as to particular proteins, lactose, high fat content, and certain food additives may also cause colitis with hematochezia.
• Masses of the colon, rectum or anus may cause bleeding and produce hematochezia. Such masses include benign (polyps) and malignant (cancer) tumors.
• Persistent hematochezia is a common sign of inflammation of the colon, sometimes referred to as colitis. Many of the causes of hematochezia listed above also cause colitis. Colitis can also occur for unknown, immune-related, or poorly defined reasons, and may require a colonic biopsy to identify the type of inflammation present.
• Trauma of any sort can cause hematochezia. Examples include bite wounds to the anal area, fractures of the pelvis that disrupt the colon or rectum, the passage of sharp ingested objects (e.g. bones, needles, tacks, etc.), and the insertion of instruments or materials into the rectum (e.g. examination scopes, enema syringes, etc.).
• Bleeding disorders (coagulopathies) of the body may result in bleeding from the lining of the lower bowel. There are numerous types of bleeding disorders that may occur in animals. Examples include ingestion of rat poison that contains anticoagulants, inherited clotting disorders (rare in the cat), decreased numbers of platelets (uncommon in the cat), disseminated intravascular coagulation (DIC) from massive infections or organ failure, and severe liver disorders.
• Intussusception (the telescoping of one part of the bowel into another) secondary to foreign bodies, tumors, or parasites can cause hematochezia.
• Stricture (narrowing) of the anus or colon, secondary to previous trauma, inflammation, cancer or a foreign body may result in bleeding, especially as stools are passed.
• Chronic or intermittent constipation and attempted passages of dry, hard stools may result in hematochezia.
• Anal sacculitis (inflammation of the anal sacs) or anal sac abscessation can change the consistency of the fluid in the anal sacs to a bloody liquid. This liquid may coat the stools as they are defecated. Anal sac diseases are uncommon in the cat.
• Proctitis is inflammation of the rectum and is often associated with colitis.

Veterinary Care In-depth, Diagnosis In-depth

Obtaining a complete medical history, and performing a thorough physical examination are necessary in order to create an appropriate diagnostic plan for the patient with hematochezia. The physical examination often includes a digital rectal examination. In addition, the following tests may be recommended:

• A complete blood count (CBC) to evaluate for the presence of infection, inflammation, anemia, and altered numbers of platelets
• A biochemical profile to assess the overall health and function of various abdominal organs, and to help rule out other disorders
• A urinalysis to evaluate the kidneys, the hydration status of the patient, and the presence of blood in the urin
• Multiple fecal examinations for parasites, bacteria, protozoa, and the presence of occult blood (blood that is not visible with the naked eye)
• A coagulation profile to assess the ability of the blood to clot
• Abdominal radiographs (X-rays) to evaluate the abdominal organs and assess for the presence of a foreign body or tumor

Your veterinarian may recommend additional tests, based on results of the above tests and the clinical signs exhibited by the animal. These ancillary tests are selected on a case-by-case basis:

• An abdominal ultrasound evaluates the size, shape and texture of abdominal organs and helps to determine the presence of tumors. Organs, lymph nodes, and masses can be sampled with a needle or biopsy instrument with the guidance of ultrasound. This test may require referral of your pet to a specialist in veterinary internal medicine or veterinary radiology to perform the procedure.
• Bacterial fecal cultures may be recommended in those cases where a bacterial cause is suspected.
• Colonoscopy (lower GI endoscopy) may be of benefit in the patient with hematochezia. Colonoscopy involves the passage of a viewing scope into the lower bowel to visualize the lining of the colon and to allows biopsy of any abnormal tissue. Colonoscopy is performed under general anesthesia, and may require referral of your pet to a specialist in veterinary internal medicine to perform the procedure.

Therapy In-depth, Supportive Care

Treatment of the symptoms may be necessary while diagnostic testing is underway, especially if the animal is severely ill or blood loss is dramatic. The following supportive measures may be instituted as needed to reduce the severity of symptoms or stabilize the animal.

• Intravenous fluid and electrolyte therapy may be indicated in severe cases of hematochezia, especially if there are concurrent systemic signs of illness like vomiting, dehydration or lack of appetite.
• Treatment for shock may be undertaken in weak or collapsed animals.
• Food and water may be withheld for 24 hours or more.
• Antibiotics may be started via injection.

Symptomatic Care

With mild cases or nonspecific cases of hematochezia, symptomatic therapy may be tried. Such therapy is aimed at reducing inflammation within the lower bowel and decreasing exposure to materials that are difficult to digest or pass in the stools. Symptomatic treatments are not a replacement for specific therapy. With any serious or persistent hematochezia, it is important to perform diagnostic tests that allow a specific cause to be identified, and then specific therapy is instituted. Examples of symptomatic measures include the following:

• Changes in diet may be recommended, and may include a trial of either a high fiber diet or a hypoallergenic diet.
• Thoroughly deworming the pet is often recommended, regardless of whether the fecal examination confirms parasitism. In some cases intestinal parasites are present, but they are difficult to detect on routine fecal screenings.
• Antibiotic therapy with oral Flagyl® (metronidazole) or tylosin may be recommended because these drugs alter the bacterial counts in the lower bowel and may have some mild anti-inflammatory properties.
• Motility modifying drugs that change the rate of movement of food through the intestines may be helpful in some cases.

Specific Treatments

Once a diagnosis is made, then specific therapy may be instituted. Specific treatments are sometimes combined with supportive and symptomatic treatments to ensure the hematochezia resolves. Depending upon the cause, the following may be considered:

• Common treatments used for colitis include dietary changes and oral antibiotic or antibacterial (e.g. sulfadiazine, sulfadimethoxine) medications.
• Corticosteroids may be indicated in some forms of immune-related colitis.
• Treatments for clotting disorders may include Vitamin K therapy, and transfusions of either blood or plasma.
• Masses of the colon or rectum are surgically removed whenever possible.
• Intussusceptions often require correction via require abdominal surgery.
• The presence of colonic foreign bodies, such as bones, metallic materials, etc., may sometimes necessitate cleansing enemas or manual removal with the animal under general anesthesia.
• A variety of treatments exist for rectal strictures and anal sac disease.

What to Watch For

•   Weight loss
•   Loss of body condition
•   Loss of muscle mass
•   Poor hair coat
•   Diarrhea
•   Vomiting
•   Regurgitation
•   Difficulty swallowing

Causes

There are many reasons for loss of weight. Some of these include:

•   Dietary causes
•   Lack of appetite (anorexia)
•   Disorders related to poor absorption of nutrients
•   Disorders related to poor digestion
•   Metabolic disorders
•   Excessive nutrient loss
•   Neuromuscular diseases
•   Excessive use of calories
•   Cancer
•   Heart disease

Confirmation of weight loss is necessary. A review of the animal’s former body weight(s) is essential. Once weight loss has been documented, a thorough history and physical examination, in addition to appropriate diagnostic tests are indicated to determine a cause of the weight loss. Initial diagnostic tests may include:

•   Stool examination
•   Complete blood count (CBC)
•   Biochemical profile
•   Urinalysis
•   Chest and abdominal X-ray

Treatment

Your veterinarian may make several recommendations for the treatment of weight loss prior to instituting a full diagnostic work up. Such treatment is usually administered on an outpatient basis.

•   Sufficient calories in the form of adequate amounts of an appropriate, high-quality diet
•   Force-feeding
•   Appetite stimulants
•   Supplementation with vitamins and minerals for severely malnourished patients
•   Parenteral (intravenous) nutrition for patients who cannot take food orally
•   Comfortable and stress-free environment, especially when eating
•   An appropriate exercise regime

Home Care

Administer prescribed diets and medications precisely as directed. Periodically, weigh and record your pet’s weight. Contact your veterinarian if there is any change in body weight.

Information In-depth

Weight loss is a physical condition that results from a negative caloric balance, as when metabolic utilization and excretion of essential nutrients exceed the caloric intake. Weight loss is considered clinically important when it exceeds 10 percent of the normal body weight and is not associated with fluid loss.

Weight loss can result from many different mechanisms that share the common feature of insufficient caloric intake or availability to meet metabolic needs. Causes vary markedly from intentional restriction of calories in order to reduce weight in an obese patient, to weight loss associated with life threatening illness.

Historical information is very important, especially regarding type of diet, duration and environment of storage of diet, the patient’s daily activity and, environment, the presence of pregnancy, appetite, signs of gastrointestinal disease (vomiting, diarrhea, regurgitation), or signs of any specific illness.

There are several disorders or situations that need to be considered when evaluating patients for weight loss. These include:

Dietary Causes

•   Insufficient quantity of food – not enough calories
•   Poor or inadequate quality of food
•   Decreased palatability (taste) of food
•   Spoiled food
•   Prolonged storage of food with deterioration of nutrients

Anorexia

This is often seen with many disorders and diseases.

Malabsorptive Disorders (poor intestinal absorption)

• Inflammatory bowel disease (IBD) is a microscopic accumulation of inflammatory cells into the intestinal wall. The cause is unknown, although it is thought to have an immune basis. Diarrhea and weight loss are commonly seen with the disorder.
• Lymphangiectasia is a chronic protein-losing intestinal disorder that arises from congestion and dysfunction of lymph carrying structures in the intestines. It is an uncommon disease in the cat.
• Intestinal parasitism is most common in younger animals or animals that are housed in crowded and/or unsanitary conditions. It may involve roundworms, hookworms, coccidiosis.
• Chronic infections of the bowel may lead to malabsorption. Examples include fungal infections and bacterial overgrowth.
• Infiltrative tumors of the intestine may affect the intake of calories.
• Gastrointestinal obstructions can prevent adequate absorption of nutrients and result in nutrient loss from vomiting and diarrhea.
• Surgical resection of large segments of bowel can greatly decrease the overall absorptive surface of the intestines.

Maldigestive Disorders (inadequate break down/processing of food)

• Exocrine pancreatic insufficiency (EPI) is a condition where the pancreas does not produce sufficient enzymes to break down food. It is a rare disease in cats.
• A lack of bile salts due to liver or gall bladder disease affects digestion and absorption.

Metabolic Disorders

•   Various forms of organ failure (e.g. heart, liver, kidney)
•   Diabetes mellitus or sugar diabetes, which decreases the ability of the body to use sugar or glucose in the diet
•   Hyperthyroidism, where increased metabolism occurs secondary to increased out put of thyroid hormone

Excessive Nutrient Loss

• Protein losing enteropathy (PLE), a group of diseases characterized by excessive loss of proteins into the gastrointestinal tract
• Protein losing nephropathies, which involve protein loss through the kidneys
• Chronic hemorrhaging from the skin or intestinal tract, which results in loss of proteins
• Extensive skin lesions or burns that ooze serum and increase the loss of protein from the body

Neuromuscular Diseases

•   Primarily disorders of the central nervous system (brain and spinal cord) that render the animal unable to eat or cause them to loose their appetite
•   Paralysis of the esophagus
•   Neurologic disorders that affect the ability to pick up food or swallow food

Excessive Use of Calories

•   Increased physical activity
•   Prolonged exposure to a cold environment
•   Pregnancy or lactation (nursing)
•   Fever or inflammation
•   Cancer

Chronic Infections

•   Bacterial infections
•   Viral infections
•   Fungal infections
•   Mixed infections

Veterinary Care In-depth, Diagnosis In-depth

Certain diagnostic tests must be performed to reach a definitive diagnosis of an underlying cause of weight loss. A thorough work-up begins with a set of broad tests that assess the overall health of the animal. More specific diagnostics are then performed, depending on the results of the initial tests. The following tests should be considered when working up the patient with weight loss:

•   Multiple fecal studies (flotation, direct smear and zinc sulfate suspension) are important to rule out chronic intestinal parasitism.
•   A complete blood count (CBC) evaluates the presence of infection, inflammation, leukemias, anemia, and other blood disorders.
•   A biochemical profile evaluates kidney, liver, and pancreas function, as well as the status of blood proteins, blood sugar, electrolytes
•   A urinalysis assesses kidney function, helps detect infections of the urinary tract, protein loss from the kidneys and provides information on the hydration status of the patient.
•   Chest and abdominal radiographs (X-rays) evaluate the heart, lungs, and abdominal organs.
•   Measurement of thyroid hormone in older cats.

Your veterinarian may recommend additional diagnostic tests to further investigate the cause of weight loss and to help determine appropriate therapy. These are selected on a case-by-case basis and include the following:

•   Serum trypsin-like immunoreactivity (TLI) is used to diagnose certain disorders of the pancreas that affect digestion and absorption.
•   Abdominal ultrasonography evaluates the abdominal organs and helps detect abnormal structures or masses that may be associated with weight loss.
•   Bile acids are paired blood tests obtained before and after a meal that evaluate liver function.
•   Various hormone assays may be indicated to rule out endocrine disorders.
•   Endoscopic examination and biopsy of the gastrointestinal tract may be recommended to search for diseases such as inflammatory bowel disease, gastrointestinal ulceration, neoplasia (cancer).
•   Exploratory laparotomy (abdominal exploratory surgery) allows close inspection of all abdominal structures. It also allows large biopsy samples to be obtained, and may be indicated in difficult-to-diagnose cases.

Therapy In-depth

Your veterinarian may recommend one or more of the diagnostic tests described above. In the meantime, treatment of the symptoms might be needed, especially if the problem is severe. The following nonspecific treatments may be applicable to some pets with weight loss. These treatments may reduce the severity or provide some relief from the symptoms. Nonspecific therapy is not a substitute, however, for definitive treatment of the underlying disease responsible for your pet’s condition.

•   If an underlying cause has been identified, treat or remove it if possible.
•   Provide sufficient caloric nutrition in the form of adequate amounts of an appropriate, high-quality diet.
•   Force-feeding may be tried in some cases.
•   Parenteral (intravenous) nutrition for patients who cannot take in food orally due to vomiting or regurgitation involves the use of gastric or intestinal feeding tubes, or the administration of liquid nutrients intravenously.
•   Supplementation with vitamins and minerals is necessary for malnourished animals.
•   Appetite stimulants may be useful in some cases.

Follow-up

Optimal treatment for your pet requires a combination of home and professional veterinary care. Follow-up can be critical, especially if your pet does not rapidly improve, and/or continues to lose weight.

The necessity for patient monitoring and the methods required depends on the underlying cause of the weight loss; however, the patient should be weighed regularly and often.

Administer all prescribed medications as directed. Alert your veterinarian if you are experiencing problems treating your pet. If your pet is not responding, also alert your veterinarian.