Transcript Diseases of Digestive System

Diseases of Digestive System
Chapter 2
Oral Diseases: Periodontal Disease
• Periodontal Disease is plaque-induced inflammation of gums
– Progressive
– Includes gingivitis, gingival hyperplasia, peridontitis with vertical bone
destruction, and peridontitis with horizontal bone destruction
– The end result is loss of tooth
• Periodontal means “around the tooth”
– Etiology
• Food particles, bacteria collect around gum line and form plaque
• Minerals in saliva collect in plaque and harden to form tartar (calculi) which
adheres to teeth
– Called gingivitis
– 3-5 d to harden
– Causes bad breath
Oral Diseases: Periodontal Disease
• Calculus builds up under gums
– Separates teeth from gums to form ‘pockets’, which encourages
more bacteria to accumulate and grow
• Bacteria secrete toxins/enzymes that cause detachment of tooth
from bony socket
• WBC’s invade area and release their enzymes to destroy bacteria
– These enzymes also cause detachment of tooth from bone
• Pockets get deeper and deeper
– Weakens bone
– Can cause pathologic fractures
• Other sequellae
– Bacteria enter blood stream
• Can cause micro-abscesses in liver, kidneys
• Cause endocarditis on heart valves
Oral Diseases: Periodontal Disease
• Periodontitis—irreversible condition:
– Alveolar bone resorption
• Gingivitis—reversible; earliest signs of Periodontal Disease
Mild tartar
Mild gingivitis
No bone loss
more tartar
more gingivitis
min bone loss
severe tartar
gum receding
moderate bone loss
>50% bone loss
tooth is loose
should be pulled
Oral Diseases: Gingivitis
• Gingivitis—earliest signs of Periodontal Disease
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Involves only the soft tissues of the gums
Reversible inflammation of gums
Gingival hyperplasia (may also be breed- or drug-related)
Cause—accumulation of tartar on teeth
• Tartar is conducive to bacterial growth
• Enzymes produced by bacteria damage tooth attachment and
cause inflammation
Oral Diseases: Gingivitis
• Signs
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Halitosis
Reluctance to chew hard food
Pawing at mouth
Oral pain; personality changes
Sneezing; nasal discharge
Increased salivation
Facial swelling; tooth loss
• Dx
– Complete oral exam
– Presence of tartar (plaque) on teeth
Oral Diseases: Gingivitis
• Rx
– Dental scaling
• with ultrasonic scaler
– Root scaling/planing (below gum line)
• with thin ultrasonic tip; curette
– Gingival curettage
• with curette against inner surface of
gums (gingival pocket’s diseased
soft tissue inner surface)
– rationale is to convert chronically
inflamed ulcerated lesions into a clean
surgical wound to promote healing
– Polishing to remove any missed calculi
– Irrigation to remove diseased tissue
and plaque
Oral Diseases: Gingivitis
• Client info
– Good oral hygiene is necessary for all pets
• Brush teeth daily
• Routine dental cleanings performed at veterinarian’s
• Treat gingivitis early before irreversible lesions occur
– Extractions are sometimes necessary to clear up
infections
– Hard, crunchy food may promote better dental health by
removing tartar before it calcifies
• Once it calcifies, tartar must be removed professionally
Oral Diseases: Periodontal Disease
Without intervention, gingivitis progresses to:
• Periodontitis—irreversible condition:
– Loss of gingival root attachment (receding gums)
– Alveolar bone resorption
– Loss of teeth
alveolar bone
Lip-Fold Dermatitis
Often seen in breed with pendulous upper lips (spaniels, setters, St.
Bernard, bulldogs, bassets)
Constant moisture in the folds from saliva causes bacterial growth
Food, hair, moisture cause irritation, erythema, and fetid odor
• Signs
– Halitosis
– Collection of debris in lower lip fold
• Dx
– Clinical signs
• Rx
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Dental cleaning
Clip hair
Clean out folds (food)
Diaper rash cream
Sx is permanent Rx
Lip-Fold Dermatitis
• Client info
– Keep lip folds dry (for the rest of animal’s life!!)
– Flush/clean lip folds with 2.5% benzoyl peroxide
shampoo
– Drying agents like corn starch several times a day
– Good dental hygiene will help prevent it
Oral Trauma
• Causes (many)
– Falls, fights (bites), burns, blunt trauma (HBC)
– “High-rise syndrome” in cats
• Fractured hard palate, mandible
– Tongue injury from biting own tongue, dog
fight, eat from tin can in garbage, FB
– Cats playing with needles, thread; strangulate
tongue
– Electrical, chemical burns
– Gunshot wounds, fish hooks
– Bones lodged in teeth
(Foreign body)
Fx mandible—cat; HBC
Oral Trauma
• Signs
– History or signs of head trauma
– Increased salivation
– Inability to close mouth; due to:
• Pain
• Fracture/dislocation
• FB
– Reluctance to eat (same reasons)
– Presence of foreign object
• Dx
– PE of oral cavity
– X-ray to r/o embedded FB
Oral Trauma
• Rx
– Depends on type of trauma
– Control bleeding
– Provide supportive care
• IV fluids
• pain relief
– Insure adequate airway
– Repair/extract damaged teeth
• Client info
– Like kids, if animals can get into trouble, they will
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Discourage chewing on electric cords
Don’t leave caustic/toxic chemicals out
Keep pets in fenced yard or on leash when outside
Animals still eat well without entire tongue
Salivary Mucocele
Accumulation of excessive amounts of saliva in SQ tissue
Most common lesion of salivary glands in dogs; rarely seen in cats
(following trauma)
Cause is unknown (tight collar, choke chain??)
• Signs
– Slowly enlarging, nonpainful, fluid-filled swelling on
neck or under tongue
– Reluctance to eat
– Difficult swallowing
– Blood-tinged saliva
– Respiratory distress
Salivary Mucocele
• Dx
– Clinical signs
– Paracentesis shows thick, blood-tinged fluid
• Rx
– Aspirate fluid
– Surgical drainage
– Remove salivary gland; insert Penrose drain x 7 d
• Client info
– Cause is unknown; trauma may be involved
– Without removal of gland, excess fluid will continue to
accumulate
– Some cases may resolve spontaneously
Removal of
mandibular
salivary gl
Oral Neoplasia
Relatively common in cats and dogs; malignant melanoma and
squamous cell carcinoma most common
• Signs
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Depend on location and size of growth
Squamous cell
More common in males
carcinoma
(Upper R 3
Abnormal food prehension
incisor)
Increased salivation
Bone loss
Tooth loss
around lesion
Oral pain
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• Dx
– Histology of mass
– X-rays to r/o metastasis
– Biopsy of LN to r/o metastasis
Rostral
maxillectomy
was curative
Oral Neoplasia
• Rx
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Surgical excision
Partial removal of mandible/maxilla if bone is involved
Radiation therapy
Chemotherapy
• Client info
– Px for malignant tumors is guarded even with
aggressive therapy
– Benign lesions have good Px
– Animals (esp cats) with bone removed may need
nutritional support (feeding tube)
Esophageal Disease
• Esophageal obstruction
Ingestion of nondigestible object (bones, play objects)
Degree of damage depends on size, shape, time in esophagus
Surgical removal is least desirable → stricture formation
– Signs
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Exaggerated swallowing movements
Increased salivaiton restlessness
Retching
Anorexia
Hx of chewing on foreign objects
Esophageal endoscopy
Esophageal Obstruction
• Dx
– Endoscopy
– Radiography
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6-mo old St Bernard
What is your diagnosis?
Esophageal Obstruction
• 3 mo kitten
• What is your diagnosis?
Esophageal Obstruction
• 2 yr old cat
• What is your diagnosis?
Esophageal Obstruction
• 8 yr male cat
Interesting stuff
• 7 mo old Pug
Esophageal Obstruction
• Rx
– Prompt removal is important
– NPO x 24 h to allow for healing
– Resume feeding with soft foods
• Client info
– Limit access to bones and small objects
– Strings and needles are hazards for cats
– Px is good if serious damage to esophagus can be
prevented
Stomach Diseases
• Acute Gastritis
– Commonly seen in dogs (cats to lesser degree)
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Spoiled food
Change in diet
Food allergy
Infections (bacterial, viral, parasitic)
Toxins (chemicals, plants, drugs, organ failure)
Foreign objects
– Signs
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Anorexia
Vomiting (maybe dehydration)
Painful abdomen
Hx of diet change, toxin ingestion, infection, parasites
• Dx
Acute Gastritis
– Hx and PE
– CBC, Chem Panel to assess dehydration, metabolic imbalance,
organ failure
• Rx
– NPO until vom stops
• 4-6 sips of water q1h until watered out
• Fluid therapy (SQ or IV)
– Gradually start feeding after watered out
• Bland food (Hill’s I/D, boiled chicken/rice)
– Antiemetics
• Chlorpromazine (Thorazine)
• Metoclopramide
– Coating agents
• Kaopectate
• Pepto-Bismol
– Antibiotics—often prescribed, rarely needed
Acute Gastritis
• Client info
– Avoid abrupt changes in diet
• Gradually mix new food in with old (1 wk)
– If pet vomit 2-3 times, NPO x 24 h; if it continues see
vet
– Dogs and cats do not need variety
– Avoid objects that can be swallowed (treat like a
baby)
Immune-Mediated Inflammatory
Bowel Disease (Enteritis, Colitis)
Seen in cats, less common in dogs
Accumulation of inflammatory cells in lining of stomach, SI, LI
• Signs
– Chronic vomiting, wt loss
– Diarrhea, straining to defecate, mucus in stool
• Dx
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Fecal to r/o parasites; culture to r/o bacterial infection
CBC, Chem panel to r/o metabolic disorder
FeLV, FIV to r/o those diseases
Endoscopy and biopsy for definitive diagnosis
Immune-Mediated Inflammatory
Bowel Disease (Enteritis, Colitis)
• Rx
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What is the Rx for any Immune-mediated Disease?
Azathiaprine—immunosupressant (organ transplants)
Cyclophosphamide—inhibits immune system response
Sulfasalazine—a sulfa drug with anti-inflammatory effects
• Most effective against colitis
– Hypoallergenic diet
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Free from preservative, additives
Highly digestible protein (rabbit, lamb, tofu, chicken)
Homemade diets with rice base
Some commercial diets are available
– Client info
• Life-long condition (special diet, frequent medical monitoring)
• Immunosupressive drugs have side-effects (PU/PD/PP, wt gain,
skin/urinary infections)
• Use lowest dose that provides effect
Gastric Ulceration
Usually a result of long-term NSAIDs
• Signs
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Vary from asymptomatic to vom blood
Anemia, edema
Melana
Anorexia
Abdominal pain
Septicemia if perforation occurs
• Dx
– X-ray using contrast medium (Ba) to show ulceration
in stomach lining
– Endoscopy
Gastric Ulceration
• Rx
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Fluid therapy for dehydration
NPO (as before)
Coating agents/antacids
Cimetidine—H2 antagonist (↓ HCl production)
Omeprazole—↓ HCl production (proton-pump inhibitor)
• Client info
– Do not use NSAIDs without veterinary supervision
– Give NSAIDs with meal
Gastric Dilation/Volvulus
Primarily a disease of large, deep-chested dogs
Dilation—gas filled; Volvulus—twisted along longitudinal axis
• Signs
– Abdominal pain/distension
– Weakness, collapse, depression, nausea, salivation
– Increased HR, RR
• Dx
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PE shows dilation, poor perfusion (↑ cap refill)
X-rays show air filled stomach
ECG may show vent arrhythmia or sinus tachycardia
CBC and Chem panel necessary to assess electrolyte
levels
Gastric Dilation/Volvulus
• Rx
– Goals
• Decompress stomach
– Pass stomach tube
– 18 gauge needle
• Stabilize patient (fluids, electrolytes, ECG)
– Rx for shock
» IV fluids
» Corticosteroids
– Antibiotics
• Prepare for Sx
– Sx—ASAP
– Post-Op
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ECG
Blood pressure
Pain management
Monitor urine output
Antibiotics
Maintain fluids (oral, IV)
Gastric Dilation/Volvulus
• Client info
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Avoid large meals
Limit exercise after meals
Feed high-quality protein diet
Tack-down procedure not 100% preventative
Gastric Neoplasia
Most common malignant neoplasia in dogs is adenocarcinoma; in cats
lymphoma
• Signs
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Wt loss
Vom w/ or w/o blood
Obstruction
Usually seen in older animals
• Dx
– Endoscopy and biopsy for diagnosis
– X-ray with Ba contrast
Gastric Neoplasia
• Rx
– Surgery is TOC
• Many tumors are too far advanced (inoperable)
– Chemotherapy
– Radiation less successful for gastric tumors
• Client info
– Px is poor; gastric neoplasia is a fatal disease
– Supportive care, control of vom, good nutrition are
needed for these animals
Diseases of SI
Often involves impairment of absorptive surface of SI (what is that?)
• Acute Diarrhea—one of the most commonly seen types of diarrhea
– Causes—(often accompanies acute gastritis)
• Diet change
• Stressful situations
• Drug therapy
– Signs (Duh?)
• Acute onset
• ± vomiting
• Normal appearance otherwise
– Dx
• Fecal to r/o parasites
• CBC (dehydration), Chem panel to r/o metabolic diseases
Acute Diarrhea
• Rx
– Fluids for dehydration, electrolyte imbalance (SQ, IV, PO)
– NPO x 24 h; water OK if no vomiting
– Intestinal absorbants/coating agents (Kaopectate,
PeptoBismol)
– Loperamide—opiod receptor inhibitor that slows gut motility
– Antibiotics (?)
– Bland diet after 24 h
• Hills I/D
• Boiled chicken/rice
Parasite Diarrhea
• Signs
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Diarrhea
Wt loss
Poor hair coat
Listlessness
• Dx
– Fecal exam
• Tx
– Anthelmintics for parasites
– Antiprotozoal medication for Giardia, Coccidia
Giardia
Parvovirus
Seen mainly in young, unvaccinated puppies
• Signs
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Diarrhea, usually with blood
Vomiting
Febrile
Anorexia, depression
• Dx—ELISA (enzyme-linked immunosorbent assay) test
• Rx
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IV fluids
Antidiarrheal therapy
Antibiotics (Gram neg)
Keep warm
Parvovirus (coyote)
Parvovirus
• Client info
– Sick animals will infect other unprotected animals
– Parvo can be fatal
– Vaccinate for protection
Diseases of LI
Function is to reabsorb water, electrolytes; store feces
• Inflammatory Bowel Disease (IBD)
– Signs
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Diarrhea with wt loss
↑ frequency of defecations, ↓ volume
Tenesmus
↑ mucus
– Dx
• Fecal to r/o parasites
• Chem panel to r/o metabolic causes
• Biopsy of LI wall
– ↑ lymphocytes and plasma cells
Inflammatory Bowel Disease
• Rx
– Sulfasalazine—a sulfa drug with anti-inflammatory effects
• Most effective against colitis
– Prednisone
– Mesalamine—a metabolite of Sulfasalazine in LI (actions unknown)
– Hypoallergenic diet
• Hill’s d/d, c/d, i/d
• Homemade diets
• Client info
– Treatment is often prolonged
– Goal of Rx is to control symptoms, not cure disease
– Animals with IBD need to be taken outside frequently for BM’s
Intussusception
Cause usually unknown; can result from parasites, FB,
infection, neoplasia
• Signs
– Vom/diarrhea with or without blood
– Anorexia, depression
• Dx
– Palpation of sausage-like mass in cranial abdomen
• Rx
– Surgical reduction/resection of necrotic bowel
– Restore fluid/electrolyte balance
– Restrict solid food x 24 h after Sx; then bland diet x
10-24 d
• Client info
– Recurrence is infrequent
– Px depends on amt of bowel removed
– Puppies should be treated for parasites to prevent
intussusception
Intussuception
Megacolon
Uncommon in dogs, more common in cats
Associated with Obstipation
• Signs
– Straining to defecate
• Must be distinguished from straining to urinate in male cats
– vomiting
– Weakness, dehydration, anorexia
– Small, hard feces or liquid feces
• With or without blood, mucus
Megacolon
• Dx
– Palpation of distended colon filled with hard, dry feces
– Radiographs show colon full of feces
– Rectal palpation assures adequate pelvic opening
• Rx
– Warm water enema
• Animals can become hypothermic
– Manual removal under anesthesia
• Mucosal surface is delicate
– Client info
• Encourage water intake
– Salt food
– Always provide adequate supply
• High-fiber diet
Megacolon
Surgical removal
Suture ends at arrows
Liver Diseases
Liver performs ~1500 functions
High regenerative capacity; damage must
be sever for signs to appear
Vague signs early: anorexia, vom/diar, wt
loss, PU/PD, fever
• Drug/Toxin induced Liver
Disease
– Acute liver failure requires
>70% of liver to be affected
– Susceptible to toxin ingestion
(portal circulation)
– Some drugs have a Hx of liver
toxicity
• Acetaminophen
• Phenobarbital
• Thiacetarsamide (Caparsolate)
Drug/Toxin Induced Liver Disease
• Signs
– Acute onset
– Anorexia
– vomiting/,
diarrhea/constipation
– PU/PD
– Jaundice (maybe)
– Melina, hematuria, or both
– CNS signs (depression,
ataxia, dementia, coma,
seizures)
Drug/Toxin Induced Liver Disease
• Dx
– Hx of drug administration
– Painful liver on palpation
– Chem panel
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↑ ALT (alanine aminotransferase)
↑ Total bilirubin, ↑ blood ammonia
↑ Serum bile acids
Hypoglycemia, coagulopathy
– Radiographs show enlarged liver
– Liver biopsy (unless coagulopathy suspected)
Drug/Toxin Induced Liver Disease
• Rx
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Antidotes—if available (ex: acetaminophen)
Induce vomiting
Activated charcoal
IV fluids
Vit K for clotting
Antibiotics
Special diets (Hill’s k/d or u/d)
Liver Tumors
Primary and metastatic tumors are not uncommon in
dogs and cats
Metastatic tumors are more common than primary
tumors of liver
• Signs
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Anorexia, lethargy, wt loss
PU/PD
Vomiting/diarrhea (?)
Abdominal distension, hepatomegaly
Jaundice
• Dx
– Anemia, usually non-regenerative
– Chem Panel
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↓ serum albumen
↑ serum bilirubin, bile acids
↓ serum glucose
Azotemia (↑ BUN, creatinine; esp in cats)
Liver tumors
• Dx
– X-ray: Heptomegaly, Ascites (?)
– Biopsy of liver
– Abdominocentesis may show tumor cells
• Rx
– Surgical removal is preferred treatment
• Single masses have good Px
• Multiple nodules/Diffuse disease have poor Px
– Chemotherapy doesn’t help primary tumors; better for
metastatic lesions
• Client info
– Guarded to poor Px generally
– Survival time: 6 mo-3 y
Portosystemic Shunts
Shunts form between portal circ and systemic circ allowing blood to
bypass liver; Function of liver—detox blood
Congenital or acquired
• By-passing liver, allows many toxins into systemic
circulation
• CNS is most affected by the circulating toxins
Portosystemic Shunts
Portosystemic Shunts
• Signs
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Dumb/numb, lethargic, depressed
Ataxia, staggering
Head-pressing (against a wall)
Compulsive circling, apparent blindness
Seizures, coma
Bizarre behavior (esp cats)
Signs often more pronounced shortly after a
meal
Portosystemic Shunts
• Dx
– Chem panel
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↓ serum protein, albumen (liver is usually small)
↓ BUN (liver converts ammonia → urea)
↑ ALT (alanine aminotransferase), ALP (alkaline phosphatase)
↑ blood ammonia (from protein)
– X-rays
• Small liver
• Contrast material
– Inject into splenic vein
– By-passes liver
Portosystemic Shunts
• Rx
– Medical management seldom very successful
• Low protein diet
– Sx
• Ligation of shunt
– Total ligation often causes ↑ liver BP
– Partial ligation may be more practical
– A second Sx can be performed after few months to close off
shunt totally
– Client info
• Px often very good following ligation
• For best results, Sx should be performed before 1 y old
• Collateral circulation may develop, with relapse of signs
Pancreatic Dysfunction (Exocrine)
• Main function of Exocrine Pancreas → secretion of dig
enzymes
• Located along duodenum
• Dig enzymes secreted in an inactive form to protect
pancreas tissue
Pancreatic Dysfunction (Exocrine)
• Pancreatitis—Inflammation of pancreas
May be chronic or acute
Develops when dig enzymes are activated within gland → autodigestion
More common in obese animal; high-fat diets may predispose animal to it
Unpredictable results; some recover well, others worsen and die
– Signs
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Older, obese dog or cat with Hx of recent high-fat meal
Depression, anorexia, vomiting
± abdominal pain
Shock, collapse may develop
Often seen post-holiday
– Table scraps of ham, gravy, etc
Pancreatitis
• Dx
– CBC, Chem panel
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Leukocytosis
↑ PCV (means what?)
Hyperlipidemia
↑ serum amylase, lipase
• Rx
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IV fluids, electrolytes
NPO 3-4 d
Antibiotics
Butorphanol for pain
Start back on low fat diet 1-2 d after vom stops
• Client info
– Avoid obesity/overfeeding
– Feed low-fat treats
– Px is difficult to assess
Exocrine Pancreatic Insufficiency
The pancreas stops making dig enzymes
May occur spontaneously (G Shep) or due to chronic pancreatitis (cats)
• Signs
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Wt loss
Polyphagia
Coprophagia, pica
Diarrhea, fatty stool
Flatulence
• Dx
– Normal CBC
– ↓ total lipids
Exocrine Pancreatic Insufficiency
• Rx
– Supplement pancreatic enzymes with each meal
• Pancrezyme
• Viokase-V
– Low fiber diet
• Client info
– EPI is irreversible; life-long treatment
– Pancreatic enzyme replacement is expensive
– With enzyme replacement, dog will regain weight,
diarrhea will stop
– Must be given with every meal
Perineal Hernia
Intact male dogs; atrophy of levator ani muscle; rectum herniates
• Signs
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Reducible perianal swelling
Tenesmus (feeling of full colon)
Dyschezia (difficult defecation)
Urethral obstruction
• If bladder is herniated
• Dx
– Rectal palpation reveals hernia sac
Perineal Hernia
• Rx
– Stool softeners (Colace)
– Enemas
– Surgical repair
• Castration
• Client info
– Keeping stool soft may help reduce straining
• True for all dogs
– Castration recommended testosterone is suspected
as a predisposing factor
Perianal Fistula
Exact etiology unknown; thought to start as an inflammation of sweat
and oil glands around anus
Bacteria grow well in the moist, warm region of these glands
Infection invades into deeper tissues
Most commonly affects G Shep (84% of dogs diagnosed)
• Signs
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Intact male, older (>8 y)
Tenesmus
Dyschezia, pain on exam
Fecal incontinence
Bleeding, foul odor of perianal area
Perianal Fistula
• Dx—PE to r/o anal sac disease/perirectal tumor
• Rx
– Medical—usually not successful
• Clip hair, keep clean
• Flush with saline
• Antibiotics
– Surgical—difficult because of nerves/blood vessels
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Remove infected tissue
Cryosurgery
Laser surgery
Cautery
– Client info
• Painful—be cautious of biting
• many complications of Sx
– Fecal incontinence
– Anal stenosis
Perianal Gland Adenoma
• Signs
– Intact male, older
– Single or multiple masses that may ulcerate
• Not metastatic
– Pruritis in anal area
– Bleeding
– Firm nodules in perianal skin
• Dx—PE, biopsy
• Rx
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Surgical removal
Radiation
Cryosurgery
Castration—causes regression of tumors
• Client info
– Gently cleanse area daily with baby wipes
– Castration at early age helps prevent it
Feline Hepatic Lipidosis
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Idiopathic (IHL) – cause unknown
Most common hepatopathy in cats
Obese cats of any age, sex or breed
Stress may trigger anorexia
– Diet change,
– Boarding
– Illness,
– Environmental change
IHL
• Anorexia prolonged for 2 weeks causes
imbalance between breakdown of
peripheral lipids and lipid clearance within
liver
– Lipids accumulate in liver
• Other mechanisms proposed
• Early diagnosis and aggressive treatment
important
– 60-65% of cases => complete recovery
IHL
IHL
IHL
• Clinical Signs
– Anorexia
– Obesity
– Wt loss (as much as 25% of body weight)
– Depression
– Sporadic vomiting
– Icterus
– Mild hepatomegaly
– +/- coagulopathies
IHL
• Diagnosis
– CBC – nonregeneratiave anemia, stress
neutrophilia, lymphopenia
– Biochem panel – Increased ALP, ALT,
bilirubin, Low albumin, Increase serum bile
acids
– X-rays – mild hepatomegaly
– US liver hyperechoic
– Liver biopsy – severely vacuolized
hepatocytes
IHL
• Treatment
– High protein, calorie dense diet
– Feeding tube usually required
• NG tube for short term liquid
diets
• Gastrostomy tube best
• Esophagostomy tube
– Tubes can remain in place
For up to 3-6 weeks
IHL
• Treatment
– IV fluids
– Metoclopramide SQ 15 min prior to feeding
– Monitor weekly
• CE
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Avoid stress in obese cats
Early intervention is essential
Any cat that stops eating is at risk
Cats do not respond well to frequent diet changes
Osteosarcoma