Today's Veterinary Practice

NOV-DEC 2017

Today's Veterinary Practice provides comprehensive information to keep every small animal practitioner up to date on companion animal medicine and surgery as well as practice building and management.

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51 NOVEMBER/DECEMBER 2017 ■ TVPJOURNAL.COM CONTINUING EDUCATION A broad-spectrum parasiticide, such as fenbendazole (generally given for 3 days, repeated at 3 weeks and 3 months), should be administered in cases with negative fecal flotation results because of the poor sensitivity of this test. 12 In cases with direct or indirect flea exposure, treatment for Dipylidium species should also be administered. When Physaloptera species are suspected, multiple pyrantel treatments are recommended. 13 Diet Trial Half of cats in a study of chronic enteropathy experienced clinical cure after diet change, with almost immediate cessation of vomiting. 3 Other GI signs, if present, resolved in most cats within 3 days. Because serial diet trials often do not need to exceed 7 to 14 days each, it is reasonable to perform them before pursuing the remaining first-tier diagnostic tests in cats without evidence of systemic disease. Although the phrase "diet trial" is often used interchangeably with the term "novel protein trial"— suggesting that FRD is uniformly triggered by protein sources—grains, feed additives, and nonspecified changes associated with commercial processing can trigger clinical signs in some cats. 3 Thus, over-the- counter and highly digestible diets can be used in addition to novel or hydrolyzed protein diets. During each dietary trial, cats should not receive treats, human food, flavored medications, or vitamins or feast on prey. If clinical cure is noted, rechallenge with the cat's initial diet is important to determine whether long-term dietary modification is necessary to prevent recrudescence. In 1 trial, 40% of cats with FRD remained in clinical remission in the face of rechallenge with their initial diet, while the rest experienced recurrence of signs within 3 to 4 days. 3 Noninvasive Blood Pressure Measurement Hypertension may indicate the presence of systemic disease, such as chronic kidney disease or hyperthyroidism. To avoid misdiagnosis, blood pressure should be measured in a relaxed environment after a 10-minute acclimation period to the environment and personnel. Use of Doppler method is recommended because it has better accuracy and precision in awake cats compared with oscillometry. 14 Additionally, the coccygeal artery should be used in cats with low muscle condition scores because of a confounding influence of sarcopenia on radial artery measurements. 15 Complete Blood Count Normocytic, normochromic, nonregenerative anemia is a nonspecific finding. In contrast, regenerative anemia and microcytic, hypochromic anemia occur secondary to chronic GI bleeding, often without hematochezia or melena. Erythrocytosis in apparently euvolemic patients can result from hyperthyroidism, 16 although subclinical dehydration should be considered. Eosinophilia and basophilia are common in cats with GI disease and/ or parasitism, but they are nonspecific findings. Serum or Plasma Biochemical Profile Abnormalities should be considered in light of magnitude, proportionality of change, and physical examination findings. For example, discordant increases in blood urea nitrogen and creatinine generally suggest GI bleeding but can also occur in cats with cachexia due to chronic kidney disease. Discordant elevation of globulin over albumin might indicate systemic disease, while proportional elevation is more consistent with total body water losses and dehydration. Hypochloremia, hyponatremia, hypokalemia, and hypophosphatemia might occur as sequelae of vomiting, while hypercalcemia and hyperphosphatemia generally reflect underlying systemic disease. Ionized calcium measurement is occasionally necessary to differentiate between hemoconcentration-associated increases in total calcium and true hypercalcemia. Liver enzyme activity increases are more significant in cats than in dogs because of shorter enzyme half- lives and the lack of a glucocorticoid-induced alkaline phosphatase isoform in this species. Discrimination between hepatocellular and cholestatic liver enzyme patterns is a crucial step to guide clinical reasoning. Additional information regarding liver enzyme assessment can be found in McAtee and Lidbury. 17 Urinalysis Urine concentration should be interpreted in light of the water content of the patient's diet, as well as the patient's hydration status. Minimally concentrated urine in a cat eating a dry commercial diet suggests extragastrointestinal disease. Proteinuria should be quantified by urine protein:creatinine ratio in patients with negative urine sediment and culture results, with values 0.2 to 0.4 considered borderline proteinuria and >0.4 considered

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