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Predicting the site of histopathological abnormalities of the alimentary tract in cats

Freche V, Faucher MR, German AJ. Can clinical signs, clinicopathological findings and abdominal ultrasonography predict the site of histopathological abnormalities of the alimentary tract in cats? J Feline Med Surg. 2016 Feb;18(2):118-128. 

Because many cats exhibit as they enter their middle to senior years gastrointestinal signs, they often have abnormalities involving the intestine, liver and pancreas and diagnosis of alimentary disorders often is challenging.  This condition is frequently referred to as triaditis or feline inflammatory disease (FID).

The gold standard for diagnosis of FID is histopathological examination of tissue samples – often from biopsies of any and all alimentary organs- making exploratory celiotomy possibly the most appropriate method for tissue collection but also the most invasive. Veterinarians often look to other means that aid in diagnosis before surgery such as clinicopathological tests, diagnostic imaging, and less invasive means of tissue sample collection such as aspiration cytology or endoscopic biopsies. Abdominal ultrasonography as an imaging method can be used to determine specific changes in organs that may be useful in planning where biopsy samples should be collected or whether surgery is needed or a less invasive approach can be pursued. This diagnostic approach has not been critically evaluated.

The authors’ aim with this retrospective study was to assess the performance of preliminary clinical information in predicting the presence of histological abnormalities of the alimentary tract in cats.  The records of 38 cats were examined that had signs compatible with FID (anorexia, lethargy, vomiting, diarrhea, icterus and weight loss) and were considered eligible for inclusion in the study.  All the cats had abdominal ultrasonography, liver enzyme activity, or both performed plus histopathological assessment of at least two alimentary organs.

The results of this study reported a range of histopathological abnormalities was identified in all the alimentary organs. The association of these abnormalities with the presence of clinical signs, clinicopathological abnormalities and abdominal ultranographic findings was poor. The authors question the use of preliminary clinical data in decision-making, especially in determining of the most appropriate sites for sample collection of the alimentary tract. The authors further state the results suggest that, unless all alimentary organs are sampled at exploratory celiotomy, the complete extent of pathological abnormalities might be missed. They also comment that the mean stay for hospitalization after surgery was short, < 2 days, and if any complications were noted, they were mild and transient.

Based on these findings in the study, the authors recommend exploratory celiotomy (with histopathological sampling of all alimentary organs) as the procedure of choice for diagnosis of gastrointestinal disease. (VT)

See also:
Jergens, AE. Feline idiopathic inflammatory bowel disease: what we know and what remains to be unraveled. J Feline Med Surg. 2012 Jul;14(7):445-58.