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"triad syndrome" liver disease, pancreatitis and inflammatory bowel disease
Triad syndrome in cats
Triad syndrome - liver disease, pancreatitis, IBD occurring at same time
Triad syndrome possible
also see Digestive problems
also see Pancreatitis
also see Inflammatory bowel disease
also see Cholagiohepatitis/Hepatitis
Please note: The most recent medical information is at the top of the page to least current at the bottom.
"Triad syndrome" in catsQuestion: I have been a subscriber for several months and am so glad! I would
appreciate it if you could give me some information about the "triad
syndrome" in cats. My cat, Gizmo, was suspected to have this condition
in 1997 when he had a bad case of diarrhea with gas. He was on actigall,
baytril and flagyl for several months. This past May he suddenly
stopped eating and playing (for Gizmo, playing "Kitty tease" is the most
important thing ever, followed closely by food). He was given an injection of
depo medrol as well as a vitamin injection, neither of which seemed to help.
All we could get him to eat was tuna fish. He was then put on
cyproheptadine to stimulate his appitite, which I have to say worked wonders - he
couldn't get enough to eat, but it made him very edgy. He was also given reglan. He
is fine now, we give him laculose about twice a week and he is on Select
Care HiFactor, both canned and dry, which is very high in fiber. He has a
bad habit of eating carpet - he will dig and pull at it until little
strings stick up which he then will chew on. We use tape wherever he's been
working-until he finds a new place. This is something Gizmo has always
done and nothing seems to be able to dissuade him. The triad syndrome was
mentioned when he first got sick and pancreatitis as a possiblility the
second eposide. An x-ray of his lungs showed signs of asthma, possibly
as a result of heart worm years ago. He tested negative for heart worms and
has been on HeartGuard for the past five years.Gizmo is ten now and at his first senior wellness exam, his blood work
was high in blood sugar, but two tests since then have been normal.There's no rush for this information, as he's doing well now. I just
have not been able to find out anything about this condition, other than in
passing mention. I really appreciate the time, caring, and effort you
make allowing people to email you questions and your thoughtful, indepth
answers.
I don't know how you find the time, but I'm glad you do! Also, your
monthly newsletter is really great - I look forward to it each month, and am
learning more every time I get one.Thank's much! Joan
Answer: Joan-
There are a couple of things to think about with Gizmo's history. My
wife and I attended a continuing education seminar this month on infectious
diseases in cats and the speaker (Dr. Lappin from CSU) said that they
were finding that roundworm migration was causing some of the cases of lung
changes and clinical signs resembling asthma in cats. This would
correlate some with our experience that some cats who we deworm with fenbendazole
or ivermectin stop coughing even though we thought their problem was
asthma.
It might be worth trying this, especially since there are both asthma
and gastrointestinal signs in Gizmo's history.Triad syndrome is the name used to describe the occurrence of
pancreatitis, inflammatory bowel disease and cholangiohepatitis at the same time,
which seems to be a fairly common problem in older cats. It has only recently
been recognized as a syndrome and there isn't a lot of information on
why it might occur or on what the relationship is between the three
conditions that causes them to occur concurrently.Pancreatitis is hard to confirm in cats. Just about the only sure way is
to have a biopsy of the pancreas. I don't know of anyone who really pushes
hard for pancreatic biopsies, though. These are more likely to be done
when exploratory surgery to obtain intestinal or liver biopsy samples seems
like it might be helpful in making a diagnosis -- so there is an opportunity
to also get pancreas samples.Inflammatory bowel disease (IBD) is not always easy to confirm, either.
It is best diagnosed with biopsy samples, as well. These can be obtained
during an endoscopic examination or during exploratory surgery of the
abdomen, if that seems necessary. Ultrasound examination sometimes
indicates thickening of the intestinal walls compatible with IBD. The
most consistent clinical sign of IBD in cats is persistent vomiting but
weight loss, decreases in appetite and diarrhea can also occur. Dr. Lappin felt
that some cases of suspected IBD actually were infections with
Cryptosporidium bacteria which can sometimes be identified through
microscopic examination of fecal smears when special staining (acid fast
staining) is used. Most of the time IBD is pretty responsive to
corticosteroids, including methylprednisolone acetate (DepoMedrol Rx)
but not always.Cholangiohepatitis can be acute (early infection) or chronic. If there
is an increase in liver enzymes in lab work, or if a bile acid response
test indicates a problem, cholangiohepatitis is more likely. Sometimes there
are mild elevations in total bilirubin or in gamma-glutamyltransferase (GGT)
levels when other liver values are normal. Confirmation of the diagnosis
is only possible with liver biopsy specimens. These can sometimes be
obtained with a needle guided biopsy without doing more invasive surgery but it
may be necessary to allow a surgical exploration of the abdomen and sampling
of the liver to obtain a diagnosis.The surprising thing about this triad of pancreatitis, IBD and
cholangiohepatitis is that a lot of cats with this syndrome have very
little change in lab values and may not have severe enough clinical
signs to make their owners worried, despite the risk to their health and even
their life if the disease continues unchecked. Usually there will be a
point in the disease when it causes enough changes in the lab values to
be detectable. Slight increases in liver enzymes and mild anemia seem to be
the most common lab findings and it may take several samples over the
course of a few months to a year or so for these changes to show up. We
think that if you find an indication of any combination of two of these
disorders it is probably best to assume that all three are present and
to treat accordingly.I am not sure what the overall experience with this condition is but we
seem to see improvement with low levels of corticosteroids,
administration of ursodiol (Actigal Rx) and antibiotic therapy when it seems
appropriate.Due to the ease of administration and the safety, it seems reasonable to
consider giving fenbendazole (Pancur Rx) orally for three to five days
to try to rule out roundworm irritation as a contributing cause to the
problems seen. It may also be reasonable to think about using an
antibiotic such as metronidazole (Flagyl Rx), tylosin (Tylan Rx) or doxycyline to
try to rule out a bacterial infection of the digestive tract. Your vet can
help you decide if these things are worth a try.Mike Richards,DVM
10/29/2001
"triad syndrome" liver disease, pancreatitis and inflammatory bowel disease occurring at the
same time possible in older SiameseQuestion: Dear Dr. Richards,
Thanks so much for providing this service. I can see that it must be a
terrible drain on your time, and so am doubly appreciative that you are
willing to help people like me.I have been reading about the risks of long-term steroid use, particularly
the effect on the immune system, and intend to discuss the pros and cons of
continuing my cat's prednisone treatment with the vet. But before I do, I
was hoping that you might give me an opinion. I am sorry to write you such
a long and complicated e-mail, but I want to include everything which might
be relevant. The details are as follows.For the past 4 months Spider, my 15-year old, neutered male, Siamese,
indoor cat, has been on Prednisolon, which I presume is the same as
prednisone. Presently I give him 1.25 mg twice a day, orally. He is 3.11
kilos (approx. 6.84 pounds). The vet prescribed Prednisolon to help Spider
gain weight and stop vomiting.Prior to beginning the treatment Spider appeared in relatively good health.
He was active and grooming, etc., but I was concerned about his thinness and
the fact that he eats so little. Blood tests, including for thyroid, done
about 6 months ago were normal. Over the past 4 years Spider's weight has
dropped from 4.5 to 3.11 kilos. Unfortunately I don't know exactly how much
he eats because there is another cat in the house and I am not always home
to see who has eaten what. But when I'm around he eats very little compared
to what he used to eat 10 years ago, and compared to what the other,
overweight cat, 13.5-year old female cat eats. Over the past few years he
has become a very fussy eater...or perhaps I have made him into one with my
anxiety and efforts to find something...anything... he'll eat. Since he
occasionally crunches dry food, I presume he does not have a tooth problem.
I can't tell if he is eating more since he started prednisolon.
Unfortunately I do not have an accurate reading of his weight prior to
starting this treatment. But my guess is that his weight is stable since
beginning the prednisolon. I have just now bought a suitable scale and will
take weekly readings.I should mention that he gets very excited about meal times, so I presume he
is hungry (or is this habit?), but often he just licks his food or has a
bite. Sometimes he nips me, which I believe indicates hunger.Vomiting of undigested food has gradually increased in frequency over the
past 4 years to about 3 times a week. After vomiting, he often heads to the
food bowl. To my surprise, after beginning the prednisone treatment, the
vomiting which had gone on for years stopped. It seemed a miracle.
However, he suffered restlessness, sleeplessness, increased activity, and
became a complainer/yowler. Dose was decreased from 5 mg to 2.5 mg per day
and these side effects decreased but did not disappear. But at least he
sleeps the night now. If I try to decrease the dose anymore, e.g., by
reducing it by 1.25 mg every second day, the vomiting returns.Other info: Spider wants to eat grass which causes him to vomit (although
this is not the cause of the vomiting I am referring to). He has had a hard
stool for the past few years...likely due to the fact that he eats so little
and hence there is nothing to push it out. I give him lactulose and
psyillium when I can. I have read your website and thought that he might
be suffering from inflammatory bowel disease, however he has no diarrhoea,
which I believe is one of the symptoms of this condition. I sometimes think
he sounds congested in his sinuses, but there is no discharge.More history which may be relevant: About 2.5 years ago x-rays showed 5
nodes on his lungs, near the heart. Ultrasound, biopsy, etc. did not reveal
the cause, so the vet in Canada, where I was at the time, recommended
exploratory surgery in Aug. 99. After administration of 2 pre-op drugs
(Torbugesic? and Glycopyrolite?), and while he struggled in fear as they
tried to insert a catheter, he stopped breathing. He then had cardiac
arrest and was resuscitated. While in intensive care on oxygen, IV, etc.,
he then suffered respiratory failure a few days later. By a miracle he
pulled through. During his recovery I had to force feed him with a syringe
for several weeks. He finally started eating again, but his appetite since
then, has always been poor. Re. the scheduled surgery, he never received
anaesthetic and was never operated on for lung nodes. To this day I don't
know what they are. The vet had no satisfactory explanation for his expiry
on the pre-operation table, but I am sick when I think of what this poor
animal went through. And since I wonder if fear had something to do with
what happened, I wish to keep stressful vet visits to a minimum. An X-ray
of approx. 1 year ago revealed that the nodes remain the same and have not
grown. However, they make me nervous and I am aware of his fragility.
Since then, I am told that he has a heart murmur.Despite this, Spider is active and interested in things. He grooms himself,
interacts, etc. He certainly does not look or act like he has any serious
problems.MY QUESTIONS:
* Given his medical history, and his unknown lung problem, is the
predenisone dose he is on a risk for the long term? Particularly re. the
immune system.
* Which is more dangerous for him? Vomiting and being painfully thin
and probably undernourished with regards to essential vitamins and minerals,
or the side-effects of prednisone?
* Based on what I've said, do you know why he might vomit?
* Do you think I could rule out IBD given that he does not have
diarrhoea?This cat means everything to me and I am so worried that I am not doing the
right thing for him...and perhaps am even making his situation worse. I
would appreciate any comments you might have, based on your experience.Many thanks, Monique
Answer: Monique-
Inflammatory bowel disease in cats will often cause vomiting but no
diarrhea. In Spider's case, with the history you have given, I would worry
some about a condition sometimes referred to as "triad syndrome", in which
liver disease, pancreatitis and inflammatory bowel disease occur at the
same time. The reason that this came to mind was that many cats with this
condition seem hungry when they approach food but then won't eat it
consistently. Liver disease sufficient to cause cats to have a variable
appetite sometimes occurs without rises in the liver values that are
commonly tested for (ALT and alkaline phosphatase). Pancreatitis is very
hard to diagnose in cats without making a special effort. It can be
diagnosed in some cats by ultrasound examination, in some cats by
elevations in trypsin-like immunoreactivity (TLI testing) but in many
instances it can only be conclusively diagnosed with biopsy of the
pancreas, which is a surgical procedure. To be honest, we often treat for
this condition without making a diagnosis, because it seems more reasonable
than doing surgery.Older Siamese cats are pretty prone to kidney failure and it can be a good
idea to give potassium as a supplement, as it seems to help with appetite
and may even help prevent the progression of kidney disease to some degree.
If there is normal lab work for kidney values such as blood urea nitrogen
(BUN), creatinine and phosphorous levels, it may be unnecessary to worry
about this possibility, though.When we suspect chronic pancreatitis we try to use a low fat diet. There
are several commercially available low fat diets for cats in the U.S. but I
have no idea what diets are available in Germany. Waltham makes a similar
diet, though. This can be very helpful.When we think that inflammatory bowel disease is more likely, we try three
different dietary approaches. We start with the low fat diet approach
because when it helps, it usually helps quickly, causing a noticeable
difference within a few days. If it hasn't helped by about ten days of use
we try one of the new diets used to control hair ball formation in cats.
These have added essential fatty acids and are really made to treat IBD,
since it is the most common cause of "hairball" formation. Usually we try
these diets for several weeks to guage their effect. Finally, if these
things don't work, we try limited antigen diets. These are diets that have
a protein source that the cat has not been exposed to in the past. There
are diets that contain proteins like rabbit, venison, duck, alligator,
ostrich or other meats that aren't commonly in cat foods and there are
diets that contain hydrolyzed proteins (broken down) that are not capable
of causing allergic responses. Either approach is OK. We try these diets
for 12 weeks before giving up on them. If dietary approaches aren't
helpful, then we use medications long term and prednisone or prednisolone
(these are essentially identical because prednisone is converted to
prednisolone in the body) often work best. Other things that might help are
methimazole (Flagyl Rx), tylosin (Tylan Rx) or sulfasalazine (Azulfidine
Rx). These are antibiotics that seem to help in some cases of IBD.If liver problems seem likely, the addition of ursodiol (Actigal Rx) is
often helpful. If only liver disease is present a moderate to low protein,
but very high quality protein, diet may be helpful. In the U.S. the only
diet that I know of marketed for liver disease is Hill's l/d diet.It seems like you work well with your vet, which is a good thing because it
may take a while to sort through the possible problems and it will take
some teamwork to get to the best possible solution. If you keep working at
this you should be able to keep helping Spider, though.Mike Richards, DVM
7/7/2001
IBD, pancreatitis and cholangiohepatitis "triad syndrome" possible
Question: Dr. Mike,
I have a 14 year old female cat named Beauty. She has really never been sick
before except for a couple of times years ago when she lost some hair on her
back near the base of her tail (no other symptoms). At the time the vet said
it was probably a nervous condition and they gave her what I think was a
cortisone shot and the hair came back. I think these occurences were in the
fallSince the beginning of this year I have noticed that she slowly started to
eat less and she started to look thin. Her coat which is long and silky
started to look sort of ruffled, perhaps from losing weight. I took her to
the vet in April for her yearly check up which included all kinds of blood
work and the vet gave her an A+. All her tests came back normal. At that
time she weighed 8 pounds and even though I didn't think she looked as good
as she use to I figured she was just getting old.Over the summer. I noticed that her stool started to give off an unbelievably
bad odor. The stool was large, soft and sort of a light gray color. I took
her back to the animal hospital in July and this time she was seen by a
different vet who said it may be the type of food I was feeding her. She has
always eaten Fancy Feast wet food and she is very particular in that she will
only eat the fish flavors. I occasionally bought her the store brand version
of Fancy Feast and the vet said that store brands are usually a poor source
of nutrition and that feeding her these inferior brands may be causing the
problem with her stool. I immediatly stopped giving her the store brand and
she did seem to respond. Her stool started to become firmer, darker and the
horrible smell went away. I brought a stool sample to the vet after it had
improved and they said it was ok. Her weight in July was still around 8
pounds even though she looked like she may have lost muscle. The vet said to
keep an eye on her and bring her back if she started to lose weight.The problem with her stool returned a month or so later. She also looked
like she was getting thinner. She spent a lot of time just laying around and
not getting any exercise which is unusual for her. She is an indoor/outdoor
cat but spends most of her time indoor unless it is really nice outside. She
has always been very good about grooming herself and is very spoiled.In September I brought her back to the animal hospital and she was seen by
the vet who gave her a check up in April - Dr. Marge. She did a lot of tests
including blood work to check for a thyroid problem, liver problems,
pancreatic problems, etc. but everything came back normal. I brought in her
awful smelling stool which I believe they test for parasites and that came
back ok too. When Dr. Marge did a physical exam she said she thought she
felt something in her abdomen and so she took x rays which did not show
anything abnormal. The cat is very difficult at the vet, she hisses and
squirms, so they had to sedate her just to get blood as well as take the x-
rays. Dr. Marge wanted her to have an ultrasound. I brought her back a few
days later for the ultrasound at which time they sedated her and shaved her
stomach, and a board certified vet who comes to the animal hospital once a
week from New York did the ultrasound on my cat and found nothing unusual but
a slightly enlarged gall bladder. Dr. Marge said she may have inflammatory
bowel disease. She asked me if the cat was vomiting and I said only the
occassional hairball. We decided at that point to just keep an eye on her
and not do anything unless her symptoms got worse. She still weighed very
close to eight pounds. The only other thing I noticed was that she seemed to
be missing some hair in front of her ears and I thought she might have fleas.
Dr. Marge checked her for fleas by didn't find any and said that her cats
have patches of hair missing in front of their ears and it probably isn't
hair loss.Beauty actually seemed to be getting better. She was eating a little better
and I took her for walks every day. She would even run up trees and race
accross the yard. I did notice that she was scratching as though she had
fleas so I decided to put some Advantage on her especially since we were
going outside so often. I also have a Pomeranian who goes out a lot and may
have picked up some fleas. This was the first time I had ever given her a
flea preparation in her life except for flea collars when she was young which
she use to pull off right away.Since the cat seemed to be doing so well, I decided to go away for the
Columbus Day weekend. My Father came over every day to feed Beauty while I
was away for two nights. When I came back, I noticed that Beauty wasn't
looking very good again. She seemed thin and she walked with her tail down.
After a few days, I noticed that she was always licking herself frantically.
I looked closer and saw that she was licking this large red bald patch on her
stomach. It looked like it might be infected. When I felt the inflamed
area, it felt hard. Her stomach area hangs and sort of swings back and forth
when she runs, I'm guessing that this is what happens when cats get older. I
wasn't sure if the area she was licking was already bald from when she was
shaved for the ultrasound. The first thing I thought of was that the area
was somehow infected from when thay shaved her. I took her to the emergency
clinic beacuse it was a sunday. The technician at the Emergency clinic
pulled Beauty out of her carrier by the scruff of her neck which no one has
ever done before. She hated it so much that the vet could not exam her
thoroughly because she was hissing and growling. They threw a towel over her
head to try to examine her and this further upset the cat. While wrestling
the cat down on the table, the vet caught a quick look at the red area on
Beauty's stomach and said she could not examine her thoroughly without
sedating her but she thought it was either an allergy problem or more
unlikely a skin cancer. I decided not to put the cat through any more trauma
at the clinic, so the vet gave her a shot of amoxicillin and gave me amoxi
drops to give her because she said the area looked infected. When I got the
cat home she would just lay there. She wouldn't eat and she looked like she
was very uncomfortableThe next day I took the cat to the animal hospital I always go to, but Dr.
M was on vacation, so I saw Dr Ct. Dr. C was much gentler
with the cat and so Beauty repsonded much better. Dr. C said the cat
may have eosinophilic granuloma and she gave her an injection of
Methylprednisone, which she said should hopefully clear up the problem. She
also gave the cat another injection of the amoxicillin and gave me IVD
Limited Ingredient Diet food to feed her instead of the Fancy Feast. I told
her that the cat hadn't really eaten or drank much since Saturday (it was now
Monday) so she gave her some fluids under the skin as well.By Tuesday afternoon the cat hadn't eaten anything, not even her Fancy Feast
or tuna fish which is her favorite. She looked very sick and she wouldn't
move. I remember her acting like this when she got a shot of cortisone years
ago and aIso when she gets her vaccinations but to a lesser degree. I
brought the cat back into see Dr. C the next day (Tuesday) she took
some blood to check her liver function which was still ok although she did
say she was slightly anemic. She gave the cat an appetite stimulant in pill
form. She told me not to give her the amoxi since she wasn't eating. When I
got her home, she ate some of her Fancy Feast and an hour later she ate some
more. I also gave her almost an whole jar of chicken baby food. Because she
started eating so soon after I got her home, I don't think it was because of
the appetite stimulant, although that did kick in and she ate more than usual
for the first 24 hours. I think the initial effects of the Prednisone had
worn off and she started to feel more like herself. She is still eating
pretty good but I think it is because of the Prednisone shot. She still
looks very thin and sickly. She weighed about 7lbs 5 oz the last time I took
her to Dr.C last Tuesday. The other thing she is doing is scratching
around her ears, eyes and under her chin. She has taken some of her fur off
doing this and she has a lot of scabbing from making herself bleed. After
her episode of not eating her stool became very hard and small. So I gave
her some hairball medicine because I know it is a laxative. She seemed to
feel bad after eating, so I think she has something else going on.Dr. C had asked me if I thought the red area showed up after the hair
was shaved off her stomach and I said I wasn't sure when it first appeared.
She said that it is possible that she may have picked up a fungus from the
clippers. I asked her for an anti-fungal cream to try and she gave me
Conofite and a collar to put around her neck to keep her from licking off the
medicine. The cat kept stepping on the collar and had trouble walking
especially around corners. I was afraid she might fall of fthe furniture with
the collar on and I knew she wouldn't be able to eat or get into her covered
litter box so I took the collar off her. She licked off some of the medicine
and threw up. Dr. C had suggested doing a skin biopsy so that we know
what we are dealing with. I think we were both hoping that she would show
some improvement after three or four days on the prednidone but she hasn't.
So I want to go ahead with the biopsy. Do you think I should find a
dermatologist to do the biopsy?So far I don't think the area on her stomach looks any better. She is still
licking it all the time and scratching herself around the head. She still
won't eat the special diet food so I have continued to give her the Fancy
Feast. All she wants to do is go outside and sit under the bushes next to my
deck. I live in Connecticut and the temperature is now in the 40's and 50's.
Normally this would be too cold for her but I think it somehow makes her
feel better, maybe less itchy. She will sit outside all day and I have to
pick her up to bring her in. I worry that she is allergic to something
outside but she goes nuts if she is trapped in the house all day.In addition to her skin problem, I still think that Beauty has something
wrong with her digestive tract. Dr. C said she may have IBD or another
possiblity may be lymphoma, but the only way to verify that is through
exploratory surgery. I am very worried that the longer I wait to do something
the more far gone she will get. I have Breast cancer and I know how
important it is to catch things early. On the other hand is the cat too old
to have such surgery? In any case I think Dr. C was hoping to clear up
her skin condition before discussing surgery. Yesterday the cat started to
have the horrible smelling soft stools she was having before. I will be
taking the cat back today to see Dr. Cto try to figure out what to do
next. Any input you can give me would be greatly appreciated. I don't want
to lose Beauty she is my best friend.I apologize for the long message but I didn't want to leave out anything
important.Thank you
A-Answer: Increased odor in the stool sometimes occurs with inflammatory bowel
disease (IBD), is noticed by many cat owners whose cats have
hyperthyroidism and can occur with cholangiohepatitis and pancreatitis.
There is a condition in cats that is sometimes referred to as "triad
syndrome" or "triaditis", in which IBD, pancreatitis and cholangiohepatitis
occur at the same time. Lymphoma, a form of cancer, can also cause symptoms
similar to IBD.Hyperthyroidism can be hard to diagnose in some cats because it is possible
for an older cat to have this condition despite having total thyroxine
(TT4) values in the normal range. A free T4 (FT4) measured by equilibrium
dialysis can be helpful in determining if hyperthyroidism is present in
this case. It would be worth considering running this test.We have some older cats who have very non-specific signs of illness that
are associated with cardiomyopathy (heart muscle weakness). Giving a cat
with cardiomyopathy a long acting corticosteroid injection, such as
methylprednisolone (DepoMedrol Rx) can make them worse for a few days,
apparently due to salt retention induced by the corticosteroid. This isn't
all that likely but it is something to keep in mind.Inflammatory bowel disease, with or without "triad syndrome" is very likely
to be the cause of the problems you are seeing. A limited antigen diet
like the IVD will sometimes help with this problem. Corticosteroids
usually help but sometimes it is necessary to use other medications or
additional medications to gain control of a case of IBD. Lymphoma can be
thought of as a severe form of IBD when it affects the intestines and a
poor response to treatment is one sign that lymphoma might be present.
Differentiating between these conditions requires intestinal biopsy, which
can sometimes be obtained through endoscopic exam, but which often requires
abdominal surgery. If surgery is done, it is best to obtain samples from
the pancreas and liver, as well. Lymphoma can affect the skin and that is
another reason to consider skin biopsies. I do not know how often this
occurs in cats but it is reasonable to pursue a skin biopsy, anyway.It doesn't matter too much who takes the skin biopsy. What matters is who
reads it. It is best if your vet uses a pathologist with a special
interest in skin (a dermatopathologist). There are several pathologists
around the nation with this interest and there is a good chance your vet
does this, but not all vets do. It isn't a bad idea to ask if a
pathologist with an interest in skin disease is going to read the biopsy
samples.Cholangiohepatitis (liver disease) and "triad syndrome" can occur in cats
even though the liver enzyme levels are normal on lab work. This makes it
frustrating to rule in or rule out this condition when trying to make a
diagnosis in a cat that is just not doing well. I have done liver biopsies
and found this when I couldn't find any other reason for a weight loss on
physical exam and tests for things like hyperthyroidism are normal.We do surgery on older feline patients very frequently. We have done
surgery on feline patients as old as twenty-two years of age --- so
fourteen doesn't seem too old to me. Cats usually recover very well from
abdominal surgery and we are comfortable doing surgery to obtain biopsy
samples of abdominal organs. I think I might want to take chest X-rays to
check for heart disease and to do a free T4 test prior to going for
abdominal exploratory surgery, but I wouldn't hesitate to do it if it
seemed like a good idea after doing those tests. We can almost always do
skin biopsies, if you decide to do that first, with sedation and a pain
reliever and then local anesthesia but since your cat is very nervous at
the vets it might not be possible to do that.Hope this helps some.
Mike Richards, DVM
10/31/2000
Last edited 09/17/02
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