Testing Testing 1...2...3? (Part 2)
So where were we (continued from part 1)?
Right, the FT4 test. Lo and
behold, it came back elevated. So, the
cat is hyperthyroid. The vitamin B12 and
folic acid level came back normal. If
either the B12 or the folate were low, we could say with good certainty that
the cat has some gastrointestinal illness.
But a normal B12 and/or folate level does not exclude gastrointestinal
disease. So GI disease is still a possibility.
Two days later, ultrasound was performed on the cat, in our
hospital. The ultrasonographer noted that the intestines were diffusely
thickened, suggesting that the intestinal tract was infiltrated with something,
most likely either inflammatory cells or cancer cells. The liver looked a
little more dense than normal, and the pancreas did look a little swollen and
inflamed. The ultrasonographer believes
the cat likely has inflammatory bowel disease, with secondary inflammation of
the liver and pancreas. This is the
so-called “triaditis” that I described in the last post.
In order to prove this, we’ll need to do endoscopy and get
biopsy specimens of the small intestine.
We’ll also need to get a biopsy of the liver, which we can obtain via
ultrasound guidance, at the same time we do endoscopy. We will not get a pancreas biopsy. The pancreas is one organ you don’t mess
around with.
Because the cat is not showing any serious clinical signs relating to the
presume inflammatory bowel disease (other than weight loss), I’ve decided to
postpone the endoscopy and liver biopsy until we get the thyroid under
control. A cat with uncontrolled
hyperthyroidism is a bit of an anesthesia risk. It behooves us to regulate the
thyroid first, and once that’s done, continue our diagnostics.
I prescribed methimazole to control the thyroid. The cat will come back in two weeks for me to
check the thyroid level. If it’s normal,
we’ll proceed with the endoscopy, etc.
Of course, I’ll keep you all informed of the results.
Stay tuned for the conclusion to this interesting case coming soon and remember to keep voting for this blog "Cat Man Do," a finalist in About.com's 2012 Reader's Choice Awards.
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Thickening of the intestines... had me scared! Just went through all of this with my kitty, who was diangosed with lymphoma. This is a great explanation of all things to consider when making a diagnosis. Thank you :)
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