FELINE MEDICINE CASE NUMBER 1 Dr. John R.

August Department of Small Animal Clinical Sciences Texas A&M University

Patient An 11-year-old spayed female cat named Kaibab. Presenting complaint Weight loss of two months duration. History According to her owner, Kaibab started losing weight gradually two months prior to presentation at Texas A&M University. Kaibab spends most of her time outdoors, and her owner can not tell if her appetite or water intake have changed. Kaibabs owner has noticed that she will vomit about once a month. During the past year, Kaibab will have occasional episodes of painful urination when she will urinate in the bathtub. Her diet consists of a dry food from the grocery store that is formulated to decrease the risk of bladder disease. She has received all of her vaccinations on schedule. Physical Examination Kaibab weighed 2.7 kg. Her rectal temperature was 39oC. Pulse rate was 156/minute and her respiratory rate was 78 breaths/minute. Her body condition score was 2/5. The capillary refill time of her mucous membranes was less than 2 seconds. Her mucous membranes were pink and dry. Kaibab had several mats in her fur, and there was a brown waxy exudate in both of her ears. On abdominal palpation, both kidneys were palpable and were noted to be smooth and slightly smaller than normal. Her small intestines were found to be thickened on palpation. Kaibabs blood pressure was taken while she was resting quietly with her owner. Her systolic blood pressure was 140 mm Hg (normal - 110-160 mm Hg). Diagnostic Evaluation Kaibabs owner informed us that we could perform whatever diagnostic tests were necessary to identify the cause of her weight loss. Which diagnostic tests would you perform, and in what order would you perform them, with the information that you have been provided in Kaibabs history and physical examination? Diagnostic Test Results Using the diagnostic test results for case #1 that have been distributed to you, please develop a final diagnosis for this patient (I apologize that all of the results are in English). Please answer the questions that I asked for some of the diagnostic tests that we performed on Kaibab. Hematology (Document 1) What abnormalities do you observe on the hematology on this patient? How may these changes be associated with the final diagnosis that you have made?

Chemistry (Document 2) Please evaluate the serum chemistry results at the same time that you evaluate the urinalysis (Document 3). How do you interpret these results? Urinalysis (Document 3) What are the possible causes of proteinuria in this patient? How can you determine if the level of proteinuria is abnormal? Urine Chemistry (Document 5) This test measures the amount of protein and creatinine in a urine sample taken by cystocentesis. What is the diagnostic and prognostic significance of this test? Based on Kaibabs results, is there any evidence of abnormal proteinuria? Radiology Report - Abdominal Ultrasound (Document 8) What is your interpretation of these ultrasound results? Which hematology or chemistry results may be associated with the abnormal findings noted on ultrasound? Which other diagnostic tests could you perform to evaluate the intestinal abnormalities noted on the ultrasound? TAMU G I Lab (Document 9) These tests evaluate intestinal and pancreatic function. Please visit the following website www.cvm.tamu.edu/gilab to review the diagnostic significance of these test results. How do you interpret the pattern of test results in this patient? Biopsy (Document 10) Endoscopic biopsies were taken from the stomach, duodenum, colon, and ileum of this patient. The duodenum appeared pale and friable. Because of this patients small size and the anatomy of her ileocolic sphincter, it was difficult to get diagnostic biopsies of the ileum in Kaibab. Why was it especially important to get biopsies from the ileum? Final Diagnosis and Treatment Based on all of this information, what are your final diagnoses for this patient? What treatment and monitoring would you recommend? Chemistry (Documents 11 and 12) These results were obtained one month after the first visit. What changes do you notice? Why do we perform serum ionized calcium evaluations in some feline patients? TAMU G I Lab (Documents 13 and 14) These gastrointestinal function tests were taken one month and five months after the original visit and after treatment had been initiated. What changes do you notice?