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CATS

Cats are now the most popular pets in Britain, far outnumbering dogs. They now live longer than ever before and enjoy better health than they ever have; many cats will live to 15 years of age, a few will exceed 20 years. To keep them healthy and active for as long as possible it is important to ensure proper care, nutrition and observe routine health checks and vaccinations.

Click on a Menu Item to the left in the Table below, for more Information:

	Dental disease in cats becomes a common problem as they get older
	This is the best method of protecting against feline leukaemia, feline infectious enteritis, cat flu and rabies
	Parasites: fleas, other skin parasites, tapeworm and roundworm infections are common problems. We recommend worming cats every 3-4 months and maintaining protection against fleas and ticks with products such as Frontline, Advantage or Stronghold
	Neutering alleviates behaviour problems such as spraying and fighting as well as preventing unwanted kittens

The links below contain information about some of the commoner medical problems encountered in general practice, please use them as an education resource only. Do not try to treat or diagnose problems yourself. Remember the information here is not comprehensive and differing situations may need different solutions to those described here. Always discuss problems with the veterinary surgeon who is dealing with your pet.

	Airway irritation caused by various antigens such as dust and cigarette smoke
	Disorder of the heart, commonly develops as a result of hyperthyroidism
	The deposition of blood clots within the vascular system, associated with heart disease
	High blood pressure
	Upper respiratory infections are extremely common. Vaccination is important

	An allergic type skin disorder
	Fungal infection better known as 'ringworm'
	Ear mites are a common cause of ear irritation and scratching/head shaking
	An abnormal, persistent, inflammatory skin reaction
	Abscesses and cellulitis are frequent sequelae to a cat scrap
	Ubiquitous skin parasite
	An allergy to certain food proteins which manifests as itchy skin
	Allergic reactions to flea bites are common and intensely irritating
	Inflammation of the gums and mouth
	Ear infections can be caused by parasites, bacteria or fungi
	Other than fleas, sarcoptic mange and cheyletiella mites are two common parasites

	Liver and bile duct inflammation/infection
	Common kidney disorder of older cats
	Failure to produce or respond to insulin
	Failure to produce the essential digestive enzymes to break down food
	Many cats are affected by a disorder which causes difficulty passing urine
	A kidney disorder caused by an abnormal immune reaction
	Liver problem associated with a build up of fat within the liver tissue.
	Inflammation of the pancreas
	Cysts in the kidney tissue may compromise kidney function, commoner in long haired breeds of cats
	A congenital disorder which allow blood to bypass the liver.
	Kidney Infection
	Bladder stones and crystals.

Potential serious eye condition usually resulting from trauma or infection.

	Intestinal infection causing vomiting and gastric ulcers.



	Muscular disorder of the lower bowel causing constipation

	Uterine infection causing an accumulation of pus within the uterus
	Infection of red blood cells which results in anaemia
	Overactivity of the thyroid gland is very common in middle aged and older cats. See the following site: www.hyperthroidcat.co.uk
	Neurological dysfunction affecting balance and coordination
	Cancer of the glandular system.

	Traumatic events such as car accidents can rupture the muscular barrier between the chest and abdomen

Cats have 26 deciduous teeth and 30 permanent teeth; 6 upper and 6 lower incisors, 4 canines, 10 premolars and 4 molars. The healthy mouth should have clean unstained teeth with a healthy pink gum margin around the tooth.

The permanent teeth erupt between the ages of 4 and 7 months. Some animals can have a non sequential eruption which results in deciduous teeth being retained within the mouth when the permanent teeth erupt leading to overcrowding. Such teeth are best removed as they later result in a higher incidence of periodontal disease.

Periodontal disease is the major cause of tooth loss in cats. The lifestyle, diet and level of oral hygiene all contribute to the problem. A gingivitis (gum inflammation) develops around the tooth, possibly secondary to tartar formation on the tooth, the bone holding the tooth can weaken leading ultimately to tooth loss. Infection around the tooth socket at this stage leads to a condition called pyorrhoea which further exacerbates the problem. Abscessation is a common sequel of this problem. The treatment is to remove any tartar build up by ultrasonic scaling and polishing, and to extract any diseased or damaged teeth. The indications that the animal is needing dental work are bad breath (halitosis), gingivitis and gum bleeding, gum recession and pain on opening the mouth or while chewing.

In addition to this cats can also suffer from a condition called lymphocytic-plasmacytic-gingivitis which can develop in conjunction with, or as a result of dental disease.

Steps can be taken to prevent or reduce the amount of dental disease. Feeding is important, a diet based purely on soft food (canned meat) allows the build up of tartar. Dried, hard food or treats can aid in breaking tartar off the tooth. Brushing is probably the most effective way of maintaining good oral hygiene. Special cat toothpaste has to be used, human forms are not suitable.

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Vaccination of cats can be carried out against feline leukaemia virus, cat flu, rabies, feline infectious enteritis and Chlamydia.

We recommend routine vaccination of kittens against feline leukaemia, feline infectious enteritis and cat flu from 9 weeks of age, with the second vaccine at 12 weeks and thereafter annual boosters.

Rabies vaccination need only be given if you intend taking your pet abroad.

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The cat flea, Ctenocephalides felis, is the most common ectoparasite of cats. When the female flea lays her eggs, they eventually hatch into larvae. The larvae pupate by spinning a cocoon and may remain in this stage for up to 140 days. Emergence occurs when ideal environmental conditions develop. In humid, warm environments, the life cycle may be completed every 2-4 weeks. When all the life stages of the flea are considered as a single population, the egg comprises 50% of the total, leaving the larvae at 35%, the pupae at 10%, and the adult flea at only 5%. As such, effective flea control programs usually focus on control of juvenile (pre-emergent) fleas, as well as the relatively small population of adults.

In most cases, flea infestation is readily diagnosed by the presence of fleas crawling through the pet's haircoat. Occasionally, owners may first notice the problem when entering the home after the pet has been removed for some time; fleas seeking a food source will bite the pet and, perhaps, humans. Heavily parasitised cats may develop anemia due to blood loss. Flea-allergy dermatitis and tapeworms are other problems associated with flea infestation.

The presence of flea faeces (flea dirt) indicates flea infestation. This may be demonstrated by combing the dark material out of the pet's haircoat and onto a moistened paper towel. The red stain of resuspended digested blood can be easily visualized.

Papulocrusting lesions of miliary dermatitis are often found on the tailhead, and around the neck of flea-allergic cats.

Treatment of this problem involves treating both the environment and the animal. We use Frontline, Advantage, Stronghold and Advocate for treating animals and recommend Acclaim and Indorex for treating the environment. The use of flea collars, combs, and shampoos as the sole agents for treating fleas is not recommended. They do not tend be as effective as the prescription insecticides and owners using these products should not have a high expectation of success.

Successful flea control can be achieved safely with careful attention to the products used. Our clients are welcome to phone for advice if required.

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The main skin parasites of cats are fleas, notoedric mange, and cheyletiella mites

Notoedres

Notoedric mange is caused by the Sarcoptic mite called notoedres cati. It can be spread by direct contact between cats and is highly contagious. Intensely itchy cats with or without additional crusting and dandruff should be suspected of having the mite.

Diagnosis is made by examining skin scrapings microscopically for the presence of mites

Cheyletiella

This is a mite which lives on the skin surface, eggs are attached to the hair shafts and hatch as larvae, develop into nymphs, and then into adults within approximately one month. They are transmitted between animals by contact.

Some animals show little reaction to infection, others develop an itch and have an excessive amount of dandruff in the coat. The diagnosis of the problem is by finding excessive scale and the mites on the skin surface, often by microscopic examination of tape strips applied to the skin.

Treatment can be carried out using various anti-parasitic preparations, solutions such as amitraz, pyrethrums, selenium sulphide, and frontline among others have been proven effective.

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Tapeworms are inte`stinal parasites, 2 types of tapeworm are commonly found in cats in the U.K., Dipylidium caninum and Taenia spp. Dipylidium has a life cycle that infects cats through fleas, Taenia spp are spread to cats through the hunting and ingestion of small mammals such as mice.

The most common sign of tapeworm infection is the finding of small 'rice grain' like segments on the hair beneath the tail and around the perineum.

The control of tapeworm infestation can be carried out with regular worming, we recommend using either Drontal Cat Tablets, or Droncit spot on, or Droncit injection. This should be routinely carried out every 3-4 months unless avid hunters in which case it may be advisable to increase the frequency of treatment. At last a Spot-on, Round and Tapewormer is available. It is called Profendor.

Good flea control will decrease the likelihood of Dipylidium infection.

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Toxocara are small intestinal parasites more commonly known as roundworms. These can infect cats through the ingestion of infected mammals or birds (through hunting activities), or by spread from queen to kittens prior to weaning.

Roundworms have a 2-3 week life cycle and during this cycle the larvae will migrate from the intestine to the lungs and liver before developing to the adult stage in the intestine.

Roundworm infection is generally much more serious in kittens than in adult cats and may cause vomiting, diarrhoea, weight loss, abdominal enlargement, occasionally coughing (from lung migration of larvae) and pneumonia. Many cats with mild infections will show no clinical signs.

Treatment can be easily carried out using effective drugs such as fenbendazole. There are many poorly effective drugs marketed for worming both dogs and cats, please check with your veterinary surgeon that the treatment you intend using is effective.

Kittens should be wormed every 2 weeks until 12 weeks of age and adult cats every 3-4 months throughout life.

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This is an elective procedure carried out to prevent unwanted pregnancy, to reduce the incidence of certain disease problems, and often to resolve aggressive or socially embarrassing behaviour problems.

In the female it involves the removal of the uterus and ovaries (spaying). This is the usual treatment for diseases such as pyometra, ovarian cysts, uterine torsion or prolapse. Neutering early in life will prevent these problems occurring. The usual age for neutering young cats is 6 months old.

In the male it involves the removal of the testicles. It is carried out to reduce wandering and fighting and it can have beneficial effects on the behaviour of an aggressive animal and prevent unwanted breeding. In cats it is often successful in preventing or reducing spraying. The operation can be performed from 6 months of age.

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Asthma is also called chronic bronchitis or allergic bronchitis. Inhaled antigens within airways cause a sudden contraction of the airway smooth muscle, narrowing the air passages. The disease is often progressive. The antigens that initiate the airways are usually not identified, but the common suspects are grass and tree pollens, smoke (cigarette or fireplace), sprays (hair sprays, flea sprays, household deodorizers), dusty cat litter, and flea powder. Food allergy is also a consideration. Cigarette smoke is becoming a greater suspect in smokers' households because the pollutants gravitate to the floor or carpet. The most common sign of asthma is coughing, severe cases have difficulty breathing and wheezing.

X-rays or blood samples may be useful in some cases as an aid to diagnosis.

Treatment for mild asthmatic cases involves administering steroids such as prednisolone possibly in combination with drugs to dilate the air passages. Antibiotics are useful if there is a secondary infectious bronchitis. Weight loss in obese cats is an important part of therapy and if possible avoidance of the allergens that may be causing the asthma such as dusty cat litter and cigarette smoke. If an acute respiratory crisis develops then hospitalisation and oxygen therapy can be used.

The prognosis is good in the short term, however other problems may arise as a sequel to longstanding asthma problems.

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Hypertrophic cardiomyopathy is the most common heart disease of the cat. It is known to occur secondary to hyperthyroidism, high blood pressure and some heart abnormalities. The left hand side of the heart enlarges and the heart becomes stiff and fails to fill with blood in between contractions. The average age of affected cats is 6 years.

These cats are most often examined because a murmur, or other heart abnormality, is detected during routine examination. Although some cases may be first diagnosed only after severe clinical signs become apparent

Many cats present with breathing difficulties. Some develop a paralysis of the hind limbs due to a blood clot (thromboembolism) traveling from the heart to the iliac arteries and cutting off blood supply to the hind limbs. The precise abnormalities found are dependent upon the stage of disease.

In order to assess these animals properly ECGs, ultrasound and X-rays may all be required. Blood pressure monitoring is important.

A variety of drugs can be used to treat heart failure and major therapeutic advances have been achieved over the last few years. The disease process is however irreversible. Animals in heart failure should not be stressed or excited if possible. Any fluid build up within the lungs can be reduced with diuretics and fluid around the lungs may need to be drained off to ease breathing.

The prognosis of affected cats is dependent upon the severity of disease. Those with no clinical signs have an average survival of nearly 5 years. Cats presented with evidence of heart failure have an average survival of 4-5 months. Systemic thromboembolism is a concern and often results in exacerbation of the heart failure. Recurrence is also likely.

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Hyperthyroidism is the most common endocrine disorder of cats. It is caused by excess production of thyroxine by the thyroid gland. In most cases this is the result of a benign tumour of the thyroid gland, about 1-2% of cases however will have the more malignant thyroid carcinomas.

The thyroid gland is not palpable in the normal animal. In hyperthyroidism enlargement may occur. This enlargement is palpable in most affected cats. Hyperthyroidism occurs in older cats but has been recorded at 4 years of age, 95% of affected cats are over 10 years old. Common clinical signs include weight loss, increased appetite, increased thirst, vomiting, increased activity, an diarrhea. Occasionally cats will present with lethargy, depression anorexia, and/or weakness. This is known as apathetic hyperthyroidism and occurs in 5-10% of affected cats. Breathing difficulties and heart failure are also infrequently seen.

The main differential diagnoses for hyperthyroidism include diseases causing increased appetite with simultaneous weight loss (diabetes mellitus, inflammatory bowel disease, alimentary lymphoma, and, uncommonly, chronic renal failure, intestinal parasitism, and exocrine pancreatic insufficiency) and diseases causing increased thirst and urination (diabetes mellitus, chronic kidney failure, and liver disease). Consequences of untreated hyperthyroidism include heart disease and raised blood pressure. Diagnosis and management of raised blood pressure is important hyperthyroid cats; however, high blood pressure generally resolves following successful treatment of hyperthyroidism.

Around 90% of affected cats have an elevation of liver enzymes detectable on blood testing, many also show raised levels of red blood cells. Blood thyroxine levels are elevated in around 90-98% of cats and this is the most commonly used test to diagnose this problem. Concurrent disease may cause normal thyroxine levels in hyperthyroid cats and in these cases further blood testing may be necessary to achieve diagnosis. Blood pressure monitoring should be carried out.

Treatment is with a drug called Felimazole which inhibits the synthesis of thyroxine by the thyroid gland. Other alternatives are surgery to remove one or both of the thyroid glands or the use of radioactive iodine to destroy abnormal thyroid tissue. The decision on which option to use is best discussed with the vet on an individual case basis.

Treatment to reduce blood pressure and control any concurrent cardiac disease should be considered.

Most cats with hyperthyroidism can be successfully treated. Cats with concurrent kidney or heart failure have the poorest prognosis.

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Thromboembolic disease is the dissemination of particles of clotted blood throughout the vascular system. This frequently occurs secondary to heart disease, especially hypertrophic cardiomyopathy since that can create stasis and pooling of blood and it increases its likelihood to clot.

Blood clots can settle anywhere throughout the circulation but by far the most common site is the aortic trifurcation (saddle thrombus). The significance of this site is that the blood supply to the hindlimbs and tail is occluded. This leads to sudden onset paralysis of the hind limbs, which are cold to the touch and have no pulse.

The treatment is based on management of the underlying heart failure and attempting to promote collateral circulation within the affected limbs. The prognosis is guarded, around half of affected cats will survive the initial crisis, thereafter they need to show significant improvement in hind limb function over the next 24-72 hours. If this is not achieved then the prognosis is grave. Those animals which recover are at risk of the condition recurring.

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Hypertension is a prolonged increase in blood pressure beyond normal limits and is common in cats.

The most common causes of raised blood pressure include hypertrophic cardiomyopathy, chronic renal failure and hyperthyroidism. Affected cats tend to be older animals and may present with increased thirst and urination, lethargy, blood in the urine, heart failure, or sudden onset blindness.

Blood pressure monitoring will detect and assess the extent of the problem, more extensive investigation is required to determine the underlying cause including blood tests, eye examination, X-rays and ultrasound.

Several drugs can be used to reduce blood pressure, amlodipine is probably most frequently used, in some circumstances benezapril is invaluable. Other treatment depends on the underlying cause. Prompt treatment is required for cats with sudden onset blindness if sight is to be recovered.

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A number of infectious agents can cause upper respiratory infections, the most serious are feline herpesvirus, feline calcivirus and Chlamydia psittaci.

The herpes virus and calcivirus are responsible for the majority of the cat flu cases seen in general practice. Both viruses are extremely contagious and both can be carried and excreted by apparently healthy cats.

The clinical signs of infection are fever, nasal discharge, sneezing, conjunctivitis, ocular discharge, eye or mouth ulcers and drooling saliva. Affected cats are usually very dull, inappetant and lethargic. Eating or drinking can be painful so many become dehydrated.

Treating these cats can be a very intensive process, intravenous fluids are required to maintain hydration, nutritional support by feeding with a nasogastric tube may be required. Antibiotics should be given to control secondary bacterial infection and topical eye drops should be given if conjunctivitis is a problem. Nasal decongestants are a useful symptomatic treatment.

If the cat responds to nutritional and fluid support within 4-6 days the prognosis is relatively good. Those cats that do not respond well should be tested for FIV and FeLV viruses.

Vaccination is the most effective method of control of feline herpesvirus and feline calcivirus and is strongly recommended.

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Atopy is a skin hypersensitivity (allergy) reaction common in cats. The most common sign is hair loss with or without dermatitis. Diseases of the eosinophilia granuloma complex are thought to be allergic manifestations. Head and neck itching is common. Less common manifestations include self-mutilation, foot chewing, and recurrent ear infections. Because of excessive licking, cats may have an increased number of hairballs or constipation caused by hair ingestion.

Diagnosis of this problem can be carried out buy using intradermal skin testing. However your vet will probably be strongly suspicious of atopy on the basis of clinical examination and may be able to diagnose the problem on the basis of response to treatment.

Hyposensitisation is the treatment of choice but perfectly adequate responses may be seen with corticosteroid therapy. Addition of fatty acid supplements to the diet, and antihistamines may also be of use.

The prognosis is excellent if there is good response to treatment.

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Frequently called ringworm, is a fungal infection affecting the skin and nails. About 95% of feline cases are caused by Microsporum canis. The cat is also infected by Trichophyton species. Direct exposure to a fungus does not necessarily result in an infection, and an infection does not always cause clinical signs. Long-haired cats are more likely to have symptomatic infections. The typical incubation period is 1-4 weeks, but some cats remain asymptomatic carriers for long periods of time. Lesions may have the typical appearance of circular areas of hair loss, but their appearance can be diverse.

Diagnosis is carried out by a Wood's lamp examination which is an ultraviolet light that causes some strains of ringworm to fluoresce. Positive confirmation is by fungal culture from areas affected by the disorder. this may take 7-14 days to perform.

Treatment can be carried out with both topical shampoos or oral medication. It is extremely important to isolate any affected animals and clean and disinfect the environment as thoroughly as possible.

The prognosis is generally good if aggressive therapeutic measures are taken.

This infection can spread easily to other animals and people. The organism can remain in the environment for up to one year.

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Infestation with ear mites (Otodectes cynotis), is common in cats. The mites live on the skin surface; they are non-burrowing but irritate the ear, filling the canal with wax, blood, and mite exudate. Some cats develop intense irritation with the presence of only a few mites. The immune system appears to limit infestations in most mature cats. Infested cats will often shake the head and twitch or rub the ears. Brownish-black debris is usually evident in the external canals. The presence of a brownish ear discharge and evidence of scratching at the ears is highly suggestive of ear mites. Under ear examination the white mites are often seen moving. Although some cats have an extreme response to the presence of ear mites, others are relatively asymptomatic.

Topical ear drops can be used for treatment of ear mites and selamectin can be applied to the skin.

The prognosis is good with appropriate treatment.

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Eosinophilic granulomas is a form of skin reaction that develops in response to underlying allergy (insects, food, atopy) or other immune-mediated factors; bacteria, viruses, and stress are proposed to play a role in some cases. The three forms of the syndrome are eosinophilic plaque, linear (collagenolytic) granuloma, and indolent (rodent) ulcer.

Linear granulomas commonly present as balding, well-circumscribed bands of tissue on the caudal thighs. Related lesions may also occur on the footpads, in the pharynx, and on the tongue. Some cats have a swollen lower chin or lip. Lesions of eosinophilic plaque are well demarcated raised areas of hair loss and ulceration, usually on the ventral abdomen and medial thighs. Associated lesions are extremely itchy and remain moist because of constant licking. Indolent ulcers are usually well, circumscribed areas of ulceration on the upper lip; lesions may be bilateral or unilateral.

Biopsy of the skin offers the most valuable tool for accurate diagnosis.

The most commonly used treatment is corticosteroid therapy, other immunomodulating and hormonal drugs may be used but tend to generate more side effects.

Prognosis

The prognosis is good in most cats, although continuous or repeated therapy may be needed. The prognosis is better if an underlying condition can be identified and treated.

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Cats are very territorial animals, bite and fight wounds are common occurrences. Most bite wounds penetrate to substantial depth within the tissue without leaving large skin wounds. Closure of the skin wound occurs rapidly and the bacteria are trapped in the underlying tissues. The wound then becomes swollen and painful and develops lameness (if on a leg). Abscess formation occurs about 3 to 5 days after the bite. If not lanced, it will usually rupture by 7 days. Some cats develop chronic draining tracts due to resistant bacteria or the presence of foreign bodies within the wound, or immunosuppressive states usually associated with the feline immunodeficiency virus (FIV) or the feline leukemia virus (FeLV).

If a bite wound occurs in a location that does not have loose skin, such as a distal extremity, the infection will dissect through tissues, resulting in diffuse swelling instead of an abscess. Lethargy, inappetance, fever, and lameness are the early signs. Areas of swelling anywhere on the body of a cat showing the appropriate clinical signs should arouse suspicion.

Outdoor cats or cats in multicat households with a history of fighting are at highest risk. Because of the high incidence of this disease, a bite wound infection should be suspected first for draining tracts, especially if fever and a history of fighting are present.

Treatment is with appropriate antibiotic therapy and surgical drainage of abscesses. In intact tom cats castration may help to reduce the incidence of this problem by mollifying aggressive behaviour.

The prognosis for fight wound infections is excellent with proper diagnosis and antibiotic therapy. The FIV and FeLV viruses make the cat susceptible to repeated and resistant infections and should be tested for if there is difficulty in resolving the problem.

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Food hypersensitivity, or food allergy, is an adverse reaction to a component of the diet; protein is the most consistent offender.

Feline food allergy most commonly presents as hair loss and severe non-seasonal skin irritation of the face and neck; classic miliary lesions may be present. Some cats will self-mutilate, leading to ulcerative lesions. Occasionally, generalized skin irritation may be found.

Elimination diet testing remains the only reliable method for confirming food allergy in the cat. Some improvement is noted in most cats after 6 weeks of a food trial.

Skin scraping and fungal culture should be performed to eliminate parasites and ringworm as the cause of irritation.

Intradermal skin testing and blood testing are generally considered unreliable for diagnosis of food allergy. With these tests, a cat may have a positive reaction to foods it has never eaten. Many lamb-based commercial diets contain potentially allergenic substances, including other sources of protein. Lamb is not inherently hypoallergenic. Most cats with food allergy are poorly responsive or non-responsive to corticosteroids. Lack of response should raise one's index of suspicion. Atopy and flea allergy frequently coexist with food allergy

Avoidance of the offending foodstuff is the most appropriate treatment.

The prognosis is good as long as the offending allergen can be identified and avoided.

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The most common allergic skin disease of cats is due to hypersensitivity reactions to flea saliva. These produce clinical signs of itching, excessive licking, and scratching. Some cats are secretive in these activities, so many owners are unaware of their occurrence. Papular, crusty eruptions, known as miliary dermatitis, and varying amounts of hair loss often result. The pattern may be generalized, localized to the head and neck, the back of the rear legs, or to the tailhead region. Flea-allergy dermatitis is one of the causes of eosinophilic plaques and eosinophilic ulcers.

The presence of itching, hair loss, and miliary dermatitis in cats with fleas or flea feces (flea dirt) should cause one to suspect flea allergic dermatitis.

This disease is very common in climates that are warm enough to support a flea population.

Treatment involves good flea control (see Fleas page) and anti-inflammatory drugs such as prednisolone or injectable corticosteroids. If skin damage is severe then antibiotics to control secondary infection may be required. Only a few fleas are required to produce marked clinical signs.

This is not a fatal disease. However, the goal of therapy is to restore quality life to the cat. The prognosis for doing so is good with either good flea control or the use of corticosteroids.

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Lymphocytic-plasmacytic gingivitis is a common disease causing inflammation, ulceration, and proliferation of the soft tissues of the mouth. Middle-aged cats are usually affected. The area of the mouth most commonly affected is the back of the mouth around the entrance to the pharynx. The gums, pharynx, soft palate, lips, and tongue are also commonly affected. The cause is unknown but is felt to be multifactoral with an immune-mediated component, possibly representing a hypersensitivity to oral bacterial antigens. However, it is unlikely that bacterial infection is the primary cause, as antibiotic therapy does not eliminate the disease and immunomodulating therapy is often helpful in improving lesions. Dental disease is also a likely contributing factor.

Clinical signs vary depending on the severity of the lesions. Cats may demonstrate no clinical signs; the disease is noted incidentally at the time of physical examination. Clinical abnormalities present may include drooling saliva, bad breath, pain on opening of the mouth, difficulty eating food, change in food preference from a dry to a soft diet, inappetance, and weight loss.

Diagnosis can be achieved by biopsy of the affected tissue. Affected cats should be tested for FeLV and FIV infection

Treatment involves good dental care since periodontal disease can be a major contributing factor. Antibiotics to clear or prevent secondary bacterial infection and potent antiflammatory drugs such as corticosteroids

Cats with this problem will rarely achieve total resolution of the lesions. Response to therapy is poor, and relapses are common. The goal of therapy should be the best possible control of clinical signs.

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Otitis is inflammation of the ear, otitis externa is inflammation of the outer ear canal, otitis media is inflammation of the middle ear, and otitis interna is inflammation of the inner ear.

Otitis Externa

Inflammation of the external ear canal occurs frequently in response to infection with various forms of bacteria, parasites (mites), and yeast. Foreign bodies such as grass seeds also commonly become lodged in the ear canal. The normal clinical presentation is scratching and head shaking, the ear may have a waxy or purulent discharge.

Treatment can be carried out with topical anti-inflammatories, insecticides, antibiotics or antifungal drugs as required. Most cases will be treated with a product containing a combination of drugs such as 'Surolan' or 'Otomax'.

Those cases which respond poorly to treatment should have the ears swabbed and bacterial and yeast culture carried out to identify the offending organism and allow specific tailored therapy based on the sensitivity of that organism. Sedation and flushing of the ear canal to remove debris may be appropriate in some cases.

Otitis Media and Interna.

Inflammation of the middle or inner ear can produce head shaking and pawing/scratching at the ear, and occasionally a head tilt, with no obvious inflammation or discharge visible in the outer ear canal. The inflammation can also affect some of the adjacent nerves causing drooping of the lip or ear and protrusion of a membrane across the eye called the 3rd eyelid. In cases of inner ear involvement balance and coordination can be affected.

X-rays may be required to diagnose the problem since ear examination may reveal only a normal outer ear canal. Treatment with antibiotics to clear underlying infection should be instituted. Flushing of the middle ear under sedation can be carried out but does involve some risk of damage to the structures within the middle and inner ear.

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The main skin parasites of cats are fleas, notoedric mange, and cheyletiella mites

Notoedres

Diagnosis is made by examining skin scrapings microscopically for the presence of mites

Cheyletiella

Treatment can be carried out using various anti-parasitic preparations, solutions such as amitraz, pyrethrums, selenium sulphide, and frontline among others have been proven effective.

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Cholangitis and cholangiohepatitis are inflammatory and/or infectious diseases affecting the liver and bile ducts. E coli infection can ascend the bile ducts into the liver to cause an infectious cholangiohepatitis, chronic or lymphocytic cholangiohepatitis causes a sterile inflammatory process that may be caused by an abnormal immune response. Cirrhosis is the end-stage of chronic liver disease, resulting in terminal liver failure. It is the least common form because many cats die before the chronic form progresses to cirrhosis. The clinical signs of these disorders are similar. Jaundice, lethargy, inappetance, and vomiting can occur. Fever is common in the acute form. Cats with the chronic form have recurrent episodes of clinical signs interspersed with weeks or months of being apparently healthy.

Blood tests to assess liver function are an important aid to diagnosis. Liver biopsy is diagnostic but the procedure does carry a degree of risk. Ultrasound can non-invasively indicate liver abnormalities but is not specific for acute or chronic cholangiohepatitis, and the study may appear normal. Ultrasound is however very useful in determining the presence of biliary obstruction. X-rays may show an enlarged liver, or in cases or cirrhosis and shrunken and fibrous liver.

Therapy with intravenous fluids and nutritional support is important in stabilising these cases. Antibiotics are required in cases of acute infectious hepatitis, corticosteroids such as prednisolone are helpful in acute cases and form the mainstay of treatment for chronic cases. Symptomatic therapy for vomiting with antacids will be used if necessary.

The prognosis varies with the form of the disease. Most cats with the acute form recover clinically in a few days. The chronic form requires continuous therapy in many cats. Those that respond well have a good prognosis, but those that progress to cirrhosis have a poor prognosis.

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The most common kidney disease in cats is chronic interstitial nephritis. It may be the end result of any chronic renal disease but in most cases the cause is unknown. Because most affected cats are geriatric, it is likely, in part, to be the result of the normal aging process. The most common clinical signs are weight loss, inappetance, lethargy, excessive thirst and urination. Vomiting may also occur. Cats with this disease become dehydrated and emaciated if not treated.

Older cats that are inappetance, lethargy, and have excessive thirst and urination along with significant weight loss should be suspected of having chronic renal disease.

Blood tests will indicate kidney failure, urine may be dilute and a mild anaemia can develop. The cat's kidneys are usually smaller than normal and this may be checked using ultrasound or X-rays.

Cats which develop renal failure frequently also have raised blood pressure. Monitoring this is important since it is thought that high blood pressure and kidney failure may aggravate each other. Drugs to reduce blood pressure may be required in some cases.

Treatment centres around correcting the dehydration and restoration of kidney function. This is best achieved by administering intravenous fluids and proper nutritional support. Electrolyte disturbances in the bloodstream can be corrected via supplementation through the intravenous fluids. Vitamin B administration phosphate binding agents can also be of use. Antacids to treat vomiting, low protein diet, and anabolic steroids, may also be employed in the treatment of these cases.

It is not possible to make a prognosis on the outcome of a case of chronic interstitial nephritis at the beginning of therapy. If therapy for 2-3 days fails to achieve significant improvement, a guarded prognosis is likely. If, however, good response to treatment occurs and proper long-term maintenance therapy is provided, many cats will live 1 to 3 years while maintaining a good quality of life.

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Diabetes is a disease normally resulting from destruction of the insulin producing cells of the pancreas. Secondary diabetes mellitus is due to an underlying condition (often obesity) that causes insulin resistance. Another type develops due to chronic pancreatitis and is probably more common than it is recognized. The clinical signs are increased thirst and urination, excessive appetite, and weight loss. These are brought about by persistently high blood glucose levels.

Diagnosis can be confirmed by measuring urine and blood glucose levels.

Diabetes can produce a condition called ketoacidosis, which also produces the clinical signs of anorexia, vomiting, dehydration, and lethargy. This situation is an emergency and needs to be treated promptly. It develops as a result of untreated or poorly controlled diabetes. Ketonuria can be caused by starvation or anorexia. Pancreatic disorders can complicate, and sometimes be the cause of diabetes mellitus.

A blood test for fructosamine can be used to assess the average glucose level for the last 2 weeks.

Treatment involves administering regular insulin injections and monitoring of blood and/or urine glucose levels. For animals that develop ketoacidosis intravenous fluid and electrolyte supplementation is required. High fibre diets will also help.

Treating a diabetic animal requires a major commitment from the owner.

The prognosis for cats with diabetic ketoacidosis is guarded until they have responded to treatment. However, once the cat is stabilized or if the cat is diagnosed as having uncomplicated diabetes, the prognosis is good. The likelihood of achieving good control varies with the commitment of the owner and several undefined variables with the cat. It is not unusual for owners to elect euthanasia when recurrent regulation problems occur.

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Destruction of pancreatic cells usually occurs secondary to chronic pancreatitis. Another cause of exocrine pancreatic insufficiency may be pancreatic cancer. This disorder produces abnormal intestinal function and impaired absorption of sugars, proteins, and fatty acids. Affected cats typically have soft, pale, voluminous stools with weight loss. Greasy material may collect on the haircoat, especially in the region of the perineum. In cases with pancreatic damage diabetes mellitus may occur concurrently.

The diagnosis is most accurately achieved by the feline trypsin-like immunoreactivity test. We can also measure the fecal proteolytic activity which will identify most affected cats. However, it will give false positive or equivocal results in some cats with small intestinal disease.

Hyperthyroidism and inflammatory bowel disease cause clinical signs similar to EPI. These conditions are much more common, so they should be ruled out before testing for EPI.

Treatment involves administering enzyme replacers with each meal. High protein, low fat diets are ideal. Antibiotics may be required to help restore normal bacterial flora in the intestine.

The prognosis generally is good.

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The term "feline lower urinary tract disease" is used to describe a disorder presenting with difficulty passing urine and blood in the urine that is not caused by bacterial infection, crystals, or bladder tumours. Affected cats often urinate frequently in small amounts and frequently in inappropriate locations, blood is usually present in the urine. Male cats frequently lick the penis. Crystals may be present in the urine. If a large amount of mucoid material combines with this crystalline material, a plug forms that may lodge in the tapering distal urethra, resulting in urethral obstruction. Obstructed cats will die if urine flow is not reestablished quickly. This disease does not appear to be contagious and affects male and female cats, although female cats are extremely unlikely to experience a urethral obstruction.

This disorder causes most cats to empty their bladders when only a small amount of urine is present. Upon presentation, most cats have an empty bladder. Cats with an obstructed urinary tract present with pain in the abdomen and a large, firm urinary bladder. These cats become dehydrated and very depressed with increasing duration.

Treatment involves ensuring there is a patent urinary tract, if obstruction is present then catheterisation and bladder irrigation will be required. If any secondary kidney damage has occurred then intravenous fluids may be necessary. For non obstructed cases anti-spasmodics and anti-inflammatories such as prednisolone, megestrol acetate and amitriptyline are useful to help re-establish urine flow. If concurrent cystitis is suspected then antibiotics should be given. Obesity can contribute to this disease so weight loss is recommended in overweight animals.

Analysis of the urine is important to check for bacterial infection and crystals. If crystals are presents the diet may have to be altered to eliminate their excretion in the urine.

Inappropriate urination is the most common behavior problem of cats and it can be confused with the loss of litterbox training.

If this problem does not respond to treatment then further investigation should be carried out to rule out other urinary problems. Additional tests include X-rays and ultrasound and bacterial culture of the urine.

Prognosis depends on the underlying cause, the prognosis for cats without urinary obstruction is good, although the problem may be recurrent. Those cases that have urethral obstruction and have a more guarded prognosis. Recovery is likely if urine flow occurs normally and kidney function is unimpaired.

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Glomerulonephritis

Glomerulonephritis is an immune-mediated kidney disease. The clinically significant causes of this are diseases due to the feline leukemia virus, the feline immunodeficiency virus, or the feline infectious peritonitis virus; chronic progressive polyarthritis; lupus; pancreatitis; and incompatible insulin (usually of human origin). Affected cats, which are usually young adult males, have two clinical forms of the disease. The first is the nephrotic syndrome. These cats often develop extensive subcutaneous fluid build up and abdominal swelling but are otherwise reasonably healthy. They often have mild weight loss and a depressed appetite. The second form is renal failure. These cats have more pronounced weight loss and appetite depression, increased thirst and urination, and they may be vomiting. Cats with both forms of glomerulonephritis have small, firm kidneys. The nephrotic syndrome is thought to represent an early stage of the disease, and the renal-failure form is believed to be the latter stage.

Signs of the nephrotic syndrome are typical of the first form of this disease. Signs of renal failure occur in the second form but do not differ from renal failure due to other causes.

Blood tests are required to assess renal damage. These cats should be tested for the FeLV, FIV, and feline coronavirus.

Treatment for renal failure can be started and in some cases diuretics and corticosteroids may be of use.

The prognosis depends on the form of the glomerulonephritis, the stage of diagnosis, and the underlying disease. Non-azotaemic cats with the nephrotic syndrome diagnosed early can often be managed for months or years, especially if an underlying disease can be cured.. Cats in end stage renal failure have a poor prognosis.

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Hepatic lipidosis, or fatty liver syndrome is a relatively common liver disorder of cats. It is associated with a build up of fat within the liver tissue and a prolonged period of inappetance. Cats that are obese are especially prone to this disorder. It can develop as a result of another disease process such as cholangiohepatitis, liver tumours and obstruction or inflammation of the bile ducts. The normal clinical presentation involves inappetance, weight loss, jaundice and vomiting.

In order to diagnose this problem your vet will wish to carry out blood tests to check the liver enzyme levels and the blood cell types (there may be a degree of anaemia). Definitive diagnosis is achieved through liver biopsy and histopathology but this procedure does carry some degree of risk. X-rays will reveal any change in the size of the liver and ultrasound is useful in assessing liver architecture.

Treatment involves rehydration and maintenance with intravenous fluids, nutritional support by feeding with a nasogastric tube if necessary, and antibiotics due to the likelihood of infection underlying the disease process. Initial stabilisation can take several days. Over the following weeks the goal is to provide adequate nutritional support and control of vomiting until the cat returns to normal eating habits.

Survival rates vary from 50-90% and the majority of fatalities occur during the first week of illness. Recurrence is possible if a prolonged interruption of food intake occurs.

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Pancreatitis in the cat can present concurrently with cholangiohepatitis or inflammatory bowel disease. Causes also include trauma and infection.

The signs of pancreatitis are non specific, affected cats can be fevered, lethargic and inappetant. Some may have high blood glucose levels (interference with insulin production) and jaundice. The clinical signs are indistinguishable from many liver or gastrointestinal disorders. In order to achieve a diagnosis abdominal X-rays, ultrasound scanning, blood biochemistry and the feline TLI test may all be required. Occasionally the diagnosis is only made when surgical exploration of the abdomen is undertaken.

Supportive nutrition and maintenance of hydration are important, nasogastric tube feeding and intravenous fluid therapy should be undertaken. If abdominal pain is present then painkillers may be administered and drugs to control vomiting can be used if this is a problem. Those cases with raised blood glucose levels will benefit from insulin supplementation and antibiotics should be used if infection is though to be the cause of the disease process.

When the animal resumes feeding small meals should be offered at frequent intervals.

This disease, especially if complicated by hepatic lipidosis, can be difficult to manage, some acute cases can become fatal.

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This disorder is more common in the long haired breeds of cat, particularly Persians. The kidney tissue contains multiple fluid filled cysts of varying size, one or both kidneys can be affected.

The onset of clinical disease does not tend to occur until the cat is a few years old but severely affected kittens with little normal kidney tissue will die at a young age. The clinical signs of disease are increased thirst and urination, vomiting, weight loss, lethargy, and inappetance.

X-rays and ultrasound may show irregular enlarged kidneys with fluid filled cysts. If one cat is diagnosed with this problem then related cats should also be checked because the disease has a genetic basis.

Treatment for chronic renal failure may extend then lifespan of affected cats but the long term prognosis for those individuals in renal failure is poor.

Affected animals should not be used for breeding.

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Portosystemic shunts are abnormal blood vessels that allow blood from the intestine to bypass the liver. The consequence of this is that the blood is not detoxified by the liver. The most common form of this disorder is congenital therefore many cats with this disorder develop illness at a relatively young age, although it has been recorded at ages of 4-5 years.

The common signs produced by this disorder include excess salivation, vomiting, diarrhoea, increased thirst and urination, nervous signs such as tremors or seizures can also develop.

Blood tests can reveal various abnormalities, specifically the bile acid stimulation test is extremely useful in diagnosing this condition. Further work is then required to determine whether or not the condition can be corrected surgically.

The treatment of choice for suitable cases is surgical correction to ligate or occlude the abnormal blood vessels. Not all cases can be considered for surgery and those that cannot will require medical management. In these cases a high quality low protein diet along with lactulose, neomycin and metronidazole will temporarily improve the situation.

Cats which successfully undergo surgery have a good prognosis, medical management normally only provides temporary respite and the prognosis remains guarded.

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Pyelonephritis is the inflammation of the kidney, usually created by bacterial infection. When the infection is active the cat may be fevered, inappetant and lethargic. Some cats will maintain chronic infection within the kidney for a long period of time and eventually develop renal failure as a result.

If the cat is presented with an episode of acute bacterial infection it usually has painful kidneys and blood, protein, or pus detectable within the urine. Culture of the urine to identify the bacterial infection is important. Cases of chronic infection may present in renal failure with specific abnormalities to be found on blood tests. Ultrasound of the kidney is useful.

Treatment depends on the severity of the problem, mild cases may only require lengthy courses of antibiotics, cats in renal failure may require intravenous fluids, electrolyte supplementation, B vitamins, and anabolic steroids. Some acute cases will not have functioning kidneys and may fail to properly produce urine, re-establishing urine flow in these cases is a priority and may require diuretics and intravenous fluids.

Once apparent recovery has been achieved and the antibiotic course is finished the urine should be sent for bacterial culture to ensure the infection is eliminated. Some cats are left with permanent kidney damage which can lead to chronic renal failure later in life.

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Urolithiasis is the formation of stones and crystals within the kidneys and bladder. There are four mains types of urolith which vary in their mineral composition. The most common are struvite uroliths, the others are calcium oxalate, calcium phosphate, and urate.

Formation of uroliths can be induced by chronic bacterial infection within the bladder but more commonly it is dietary related. When the kidneys excrete to much of a certain type of mineral it crystallises in the urine. Uroliths present a problem because they irritate the bladder, provide a focus for persistent infection and, more seriously, can obstruct urine flow. The typical signs include blood in the urine and difficulty or inability to pass urine. Diagnosis of the problem will require urine testing for crystals and possibly X-rays for bladder stones.

If the bladder is blocked the animal should be seen promptly as an emergency case. Cats with blocked bladders are extremely uncomfortable, frequently attempting to urinate, in considerable discomfort and very vocal. Male cats are much more likely to suffer bladder obstruction than females.

Treatment of cases with complete obstruction involves catheterisation of the bladder to re-establish urine flow and surgical removal of any uroliths from the bladder. The prognosis depends on how quickly urine flow can be re-established and whether any renal damage has been suffered, if minimal then the prognosis is good. Cases which are left are likely to result in a ruptured bladder with grave prognosis.

All cats should have their diet modified to reduce the urinary excretion of the offending minerals. Most will require antibiotics to clear bacterial infection. Recurrence of this condition is a problem so strict adherence to a prescribed diet so be ensured. Frequent testing of urine for crystals should be undertaken to monitor the condition.

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The cornea is the clear surface of the eyeball. A corneal ulcer is loss of variable amounts of corneal epithelium and stroma. Feline corneal disease may progress from corneal inflammation to erosion and ulceration within a few hours. Most cases are due to trauma, often from cat fight wounds or foreign bodies; however, some infectious agents can also cause ulcers. Early clinical signs result from pain (excessive tearing, squinting, and rubbing of the eye) and infection (mucopurulent ocular discharge).

Diagnosis is achieved by using a green fluorescein stain to illuminate a corneal erosion or ulcer and is confirmatory. Swabbing the eye and attempting to culture bacteria is useful with deep, progressive, or non-healing corneal ulcers.

Treatment is with topical antibiotic ointments, along with anti-inflammatories for pain relief if required. Atropine drops are also effective in relieving pain. Surgical intervention may be required to debride the ulcer or to cover and protect it until it heals.

The prognosis for uncomplicated erosions and superficial ulcers is good. Deep, refractory ulcers have a guarded prognosis

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Feline infectious peritonitis (FIP) is a progressive, immune-mediated viral disease that is, with few exceptions, fatal within a few weeks. The virus is relatively unstable in the environment but may remain infectious for as long as 7 weeks within dried organic matter or on dry surfaces. It is susceptible to most commonly used veterinary disinfectants. The virus is transmitted via saliva and nasal secretions; prolonged contact with an infected cat is usually required for transmission. The incidence of virus-infected cats in a closed population is typically found to be either zero or 80 to 90%. The outcome of an infection may not be known for months or years, as the virus may remain dormant. The outcome is influenced by the cat's immune response. Antibodies produced against the virus may promote the disease rather than cause immunity.

The wet or effusive form results in lesions within single or multiple organs and the build up of effusive fluid within the chest or abdominal cavity. The dry or non-effusive form causes the same organ lesions, but no fluid build up. The most commonly affected organs are the kidneys, liver, lymph nodes, intestines, lungs, eyes, and brain. The clinical signs are referable to the affected organ or organs, but all cases generally include weight loss, inappetance, and fever. Jaundice and pale mucous membranes are common. Abdominal distention or breathing difficulties occur when abdominal or pleural effusions develop

The clinical signs are not unlike many infectious or inflammatory diseases; however, the presence of persistent fever should raise suspicion for FIP.

Diagnosis is complicated and may involve biopsy of lesions, blood sampling, and sampling any abnormal fluid build up

Dry FIP is one of the most difficult diagnoses to make. It should be considered for any cat with chronic weight loss, poor appetite, and fever. Many cats with FIP are also infected with the FeLV.

The prognosis for cats with FIP is grave. No effective antiviral treatment is available

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Feline leukemia virus (FeLV) is a virus that is transmitted between animals through salivary contact with other cats; known routes of transmission include biting, licking, and grooming. Infected queens can infect kittens prior to birth or will suckling. However, virus contact does not assure infection, and infection does not ensure persistent viraemia or disease. The four possible outcomes of exposure are listed below.

The cat mounts an immune response; some immunity is produced, making the cat resistant to future infections for an undetermined period of time.
The virus survives within the bloodstream leading to persistent infection.
Latency: The cat does not produce immunity, but it does not become persistent viraemia. This is a transient stage that lasts an average of 30 months. Ultimately, it results in virus neutralization or persistent viraemia.
Immune carrier: The whole virus is sequestered in epithelial tissue and is replicating, but it does not leave the cells due to antibody production.

Once introduced into the cat, the virus progresses through various tissues. The ability of the immune system to halt this progression determines the ultimate outcome. The virus produces several proliferative diseases (lymphosarcoma, leukemias), several degenerative diseases (nonregenerative anemias, thymic atrophy, panleukopenia-like syndrome, stillbirths, abortions), and immunosuppression. Clinical signs vary widely depending on the disease type and the organs involved. Test results vary depending on the form of disease present and the target organs involved. For example, over 90% of cats with anterior mediastinal lymphosarcoma are virus positive; less than 50% of cats with alimentary lymphosarcoma are virus positive. Household disinfection to kill the virus is easily accomplished. Without treatment, the virus is gone within a week.

The virus can be removed from a multicat household by a test and removal program. New cats introduced into a household should be tested for FeLV prior to admission.

No effective antiviral treatment is available for FeLV infected cats.

The clinical signs of a cat with an FeLV related illness vary depending on the type of related disease and the organ system infected.

Vaccination is recommended for all cats that have exposure to free-roaming cats or to known FeLV infected cats. Exposure produces solid immunity in 80-90% of vaccinated cats, but the rate is lower when cats are continuously exposed to infected cats.

Because the FeLV causes such a wide variety of diseases, any seriously ill cats should be tested for it. However, its presence does not necessarily mean that it is the cause of the cat's current illness or that the cat is contagious.

Cats that are infected with the FeLV but show no clinical signs may remain asymptomatic for several years. They may be healthy, but they can be contagious to other cats. Cats with any FeLV disease have a guarded prognosis.

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Bite wounds provide the major mode of transmission for feline immunodeficiency virus. Kittens can be infected prior to birth or by suckling an infected Queen. Four stages of infection have been determined:

acute
asymptomatic carrier
persistent generalized lymphadenopathy
feline AIDS-related complex

During the acute phase, signs may consist only of swelling of the glands. As an asymptomatic carrier (stage 2), the cat is usually free of clinical disease. In later stages, signs include weight loss, persistent diarrhoea, gum inflammation, chronic respiratory disease, lymphadenopathy, and chronic skin disease. Profound oral/dental disease is a common finding in the late stages of FIV; in some cats, the gum mucosa and tongue become ulcerated and necrotic. Neurologic dysfunction has been seen in a small percentage of infected cats. Inflammatory eye disease, renal disease, and cancerous disorders are occasionally reported.

Chronic disease states and seemingly minor infections that do not respond well to treatment should alert to the possibility of FIV infection. Antibody tests can be carried out by most practices to confirm infection. Routine blood haematology tests may have changes which will be strongly suspicious of FIV infection

The relative difficulty of recovering virus from blood cells and body fluids varies with the stage of infection. Maternal FIV antibody may cause kittens to have a positive test result for up to 4 months after birth. Positive kittens should be retested after 6 months of age.

No specific antiviral treatment is available for FIV infected cats. Therapy is aimed at symptomatic treatment for complicating factors. Special care should be taken with monitoring infected cats and treating any illnesses early. In the later stages of FIV opportunistic infections are common.

The prognosis is variable and dependent upon clinical stage at diagnosis. In the late stages the longer term prognosis becomes very poor.

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Feline infectious enteritis, or panleukopenia, is caused by a parvovirus. Transmission from faeces to mouth is the most likely route. It has the potential to cause significant disease in unprotected cats of all ages. Kittens and young cats frequently present with fever, acute onset vomiting and dehydration. Liquid diarrhea may not occur initially. The abdomen may be painful. Profound fluid loss may result in death. Kittens infected in the uterus prior to birth may abort or, if they survive, may have problems coordinating movement and a wide based stance. The disease is most prevalent in cats less than 1 year of age, where fatalities may reach 50 to 90%. Routine vaccination has made FIE less prevalent than in the past; it is usually found in unvaccinated cats living in conditions of stress or overcrowding, such as animal shelters.

Kittens and young cats presented with fever and vomiting should be suspected.

Kittens suspected of having infectious enteritis should be tested for FeLV and FIV. The stool should be examined for parasites because heavy parasitism may worsen the prognosis. Because the history, clinical signs, and blood haematology tests are very suggestive of FIE, more elaborate testing, is rarely necessary.

Treatment is supportive to maintain hydration and nutrition and as such will probably involve hospitalisation and intravenous fluids. Antibiotics to prevent secondary infection should be given.

History of recent vaccination in the young kitten does not eliminate the possibility of infectious enteritis because maternal antibodies may interfere with early vaccination efforts.

With appropriate supportive care, most kittens and cats can survive infectious enteritis. Complications that could worsen the prognosis do occasionally occur.

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Helicobacter spp. are spiral-shaped bacteria that inhabit the stomach and have the potential to cause gastritis and gastric ulcer disease in animals. Infections may be asymptomatic or may have mild clinical signs. There is also information in the human literature suggesting that infection may predispose to gastric carcinoma or gastric lymphoma. Clinical findings may include chronic vomiting, weight loss, abdominal pain, and inappetance.

Endoscopy can reveal abnormalities that are suspicious for Helicobacter infection. Diagnosis can be achieved by biopsy of the gastrointestinal tract in which can be found spiral shaped bacteria. Because spiral bacteria are present in normal animals, exclusion of all other diagnoses and confirmation of typical pathologic changes in addition to the organism are necessary before a diagnosis of Helicobacter gastritis can be made.

Treatment with bismuth and 2 antibiotics (usually metronidazole and amoxycillin) is usually effective. The use of antacids can improve the effectiveness of the antibiotics.

Whereas therapy has proven successful in treatment of Helicobacter infection (negative testing and improvement of clinical signs), recurrence is a problem to some degree.

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Tapeworms are intestinal parasites, 2 types of tapeworm are commonly found in cats in the U.K., Dipylidium caninum and Taenia spp. Dipylidium has a life cycle that infects cats through fleas, Taenia spp are spread to cats through the hunting and ingestion of small mammals such as mice.

The most common sign of tapeworm infection is the finding of small 'rice grain' like segments on the hair beneath the tail and around the perineum.

Good flea control will decrease the likelihood of Dipylidium infection.

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Roundworms have a 2-3 week life cycle and during this cycle the larvae will migrate from the intestine to the lungs and liver before developing to the adult stage in the intestine.

Kittens should be wormed every 2 weeks until 12 weeks of age and adult cats every 3-4 months throughout life.

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Inflammatory bowel disease is a disorder created by an abnormal accumulation of inflammatory cells within the lining of the intestine. Various types of this disorder can develop depending on the precise type of cell infiltrating into the gut.

The most common presenting sign is chronic intermittent vomiting but diarrhoea, weight loss, and inappetance can also be seen. The condition is most commonly found in middle aged and older cats.

Many other diseases affecting the bowel can appear similar to inflammatory bowel disease. Diagnosis may require blood tests to rule out other problems such as liver and kidney disease, hyperthyroidism, lymphoma etc. Faecal examination to rule out intestinal parasites and bacterial culture to rule out infectious gastroenteritis. FIV and FeLV tests are useful additions to the diagnostic work up as is a TLI test to assess pancreatic function. Ultimately an intestinal biopsy may be required.

Treatment can require a variety of drug therapies. Prednisolone is the drug of choice for most forms of inflammatory bowel disease. If colitis is part of the clinical syndrome then sulphasalazine is useful. Combining metronidazole, which is thought to inhibit some of the abnormal immune reactions in the gut wall, and immunosuppressive drugs with prednisolone and/or sulphasalazine may provide considerable improvement. The use of immunosuppressive drugs is not, however, without the potential for side effects and blood tests should be carried out to monitor therapy if they are utilised.

A highly digestible, low fat diet, in some cases with a novel protein source can be of benefit. Some cats also prefer a high fibre content in the diet.

Most cats will show some degree of improvement within a week of therapy starting. The disorder is normally controllable but rarely curable.

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Megacolon is a disorder created by a dilation and loss of motility of the colon, the last part of the large intestine. The end result is a loss of muscular function in the colon leading to chronic constipation and colonic dilation. The disorder may be present for months prior to clinical disease becoming apparent.

The cause is not known but it affects cats of all ages with obese individuals at an increased risk. Diagnosis is achieved by using abdominal X-rays to evaluate the degree of colonic distension.

Treatment is primarily by administering enemas and using colonic evacuation to initially deal with constipation, this may need to be performed under anaesthesia or sedation. The use of cisapride can improve colonic motility and in combination with stool softeners, such as lactulose, has proved effective. Easily digestible, low bulk diets with a degree of fiber supplementation are useful in managing megacolon. Too much fiber can, however, lead to excessively bulky faeces which can worsen colonic distension.

Surgery is the last resort for treating this condition and should only be attempted when medical managment has failed.

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Pyometra is a condition that develops when the uterus becomes infected and collects pus within the lumen. This usually occurs in middle aged and older cats. Affected animals have usually been in season in the 8 weeks prior to illness.

Signs of disease include swelling of the abdomen, inappetance, dullness, and a discharge from the vagina. This discharge is not always obvious since many cats are fastidious about cleanliness.

Ultrasound or X-rays may be required to diagnose the problem, blood testing can be useful in doubtful cases.

The treatment of choice is removal of the uterus and ovaries (ovariohysterectomy). A course of antibiotics should be prescribed and intravenous fluids will rehydrate the animal and treat any concurrent toxaemia or azotaemia.

If surgery is successfully performed then the prognosis is good. If the uterus should rupture or if advanced septicaemia has developed then the prognosis becomes guarded.

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Haemobartonellosis is also known as feline infectious anemia. It is caused by the parasite Haemobartonella felis, which attaches to the surface of mature red blood cells. When identified by the immune system as abnormal, affected cells are destroyed by the spleen. Affected cats are generally presented for lethargy and inappetance of 1-2 days duration. Physical examination usually reveals pale and jaundiced mucus membranes, normal body temperature, and rapid breathing. The mode of transmission is not fully understood but is suspected to be via any means of passing blood from one cat to another.

It is thought that this disease may occur secondary to another stress-producing disease or event.

Blood tests will indicate destruction of the red blood cells and the organisms are usually visible microscopically attached to the blood cells.

The presence of the organism on blood cells is cyclic. The absence of H. felis in a cat with a regenerative anemia is not justification for dismissing this disease as a possibility; subsequent blood samples should be examined. Bone marrow disease should also be considered as a potential cause of similar problems.

In severe cases blood transfusions may be required to replaced destroyed red blood cells, in mild cases the combination of the antibiotic doxycycline and the corticosteroid prednisolone are generally effective in inducing remission of the problem. Elimination of the organism is not normally achieved and a carrier states results. Relapse of the problem is a possibility.

The prognosis of hemobartonellosis is generally good if the anemic crisis can be quickly averted, but some cats develop fatal anemias due to very low levels of red blood cells. The carrier state that often occurs leaves the cat susceptible to recurrence. This cat should not be used as a blood donor, but otherwise it is considered noncontagious to other cats, even in the carrier state.

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Treatment to reduce blood pressure and control any concurrent cardiac disease should be considered.

Most cats with hyperthyroidism can be successfully treated. Cats with concurrent kidney or heart failure have the poorest prognosis.

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Idiopathic vestibular syndrome is a disorder which results from abnormal function of either the receptors in the inner ear or the eighth cranial nerve, the cause is not known. Adult cats of a wide age range are affected.

Clinical signs include a sudden onset of falling, staggering, circling, and/or head tilt, flickering of the eyes from side to side may also occur. Other less common accompanying signs include sickness and being very vocal. The affected animal tends to struggle and be extremely disorientated

Treatment involves supportive care, the cat should be kept in a quiet area with no unnecessary noise or lights.

The prognosis for complete or near-complete recovery is good and usually occurs within 2-3 weeks. Most cats show dramatic improvement in 72 hours and continue to gradually improve. The head tilt is often the last problem to resolve.

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Lymphoma, or lymphosarcoma, is the most common form of cancer found in cats. It arises within the glandular lymphoid tissue and may spread to any organ or body system. FeLV and FIV infected cats are at considerable risk of developing this condition. Cats infected with these viruses on average develop the disease 4 years earlier than affected cats who are not infected with either of these viruses.

The cancer frequently arises throughout the gut (alimentary lymphosarcoma) but is also commonly found in the chest cavity (mediastinal lymphosarcoma) and spread throughout the body in a generalised form (multicentric lymphosarcoma). Other sites are less common but do occur (eg kidney).

The diagnosis is frequently made by biopsy of a suspicious growth, although occasionally circulating cancerous cells are found in the blood. The majority of affected cats are IFV or FeLV positive. Ultrasound, X-rays, bone marrow biopsies are all useful in determining the extent of the spread of the disease.

Treatment with chemotherapy is generally well tolerated but most cases will experience some degree of side effects at some point. These can include inappetance, vomiting, diarrhoea, lethargy, and if serious complications from secondary bacterial infection. Supportive nutrition is vital and intravenous fluids may be required in some cases.

The prognosis is guarded, those cats that are not infected with FeLV or FIV and respond well to chemotherapy could survive for 5-7 months. Those that do not respond well are likely to live in the region of 2 months, but this depends on the stage of disease at diagnosis.

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This is the 3rd most common form of cancer in the cat, it normally occurs in older cats aged on average 10 to 12 years. Cats which have not been neutered at an early age are most at risk. Most mammary tumours are malignant and spread to adjacent mammary glands or to the local lymph nodes is a distinct possibility. Further spread to the lungs and/or the liver also frequently occurs.

The other causes of mammary gland enlargement are mammary hyperplasia and mammary adenoma. Mammary hyperplasia is an enlargement of the glands that occurs soon after pregnancy, adenomas are benign, small, usually solitary nodules.

The treatment for mammary cancer is surgical excision at as early a stage as possible. It may well be necessary to remove more than one gland, on some occasions removal of all mammary tissue and the adjacent lymph nodes is appropriate. X-rays to check for spread to other areas of the body and aspiration of cells from lymph nodes to check for local spread should be used.

Chemotherapy can be carried out to increase survival times but side effects are common and the option should be considered carefully.

The average survival time following detection is 1 year. Those cases which are able to undergo surgery do tend to have an improved disease free survival time.

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Diaphragmatic hernia is a tear in the diaphragm through which one or more abdominal organs may pass. The diaphragm is the muscular and fibrous structure which separates the chest from the abdomen. The most common cause of tearing is traumatic, usually associated with vehicle-related injury or a fall from height. Clinical signs normally include breathing difficulty. Without treatment, some mild cases will stabilize in a few days and clinical signs will only be associated with increased activity. This is the chronic form. These cats often become sedentary but may live for many years without surgical correction. The acute traumatic form produces severe respiratory difficulty, which may increase over 1-2 days as more abdominal organs are displaced into the chest.

X-rays will show the abdominal organs in the chest and an empty, small abdomen. The abdomen may feel empty when palpated. Radiographs made immediately after trauma will not be diagnostic for a diaphragmatic hernia if abdominal organs have not migrated into the thorax. If a diaphragmatic hernia is suspected, the cat should be re-radiographed in 12-24 hours. Cats with breathing problems need to be handled very carefully because increased stress may be fatal. It may be necessary to place the cat in an oxygen tent

Treatment first involves stabilisation of the patient and then considering surgery.

The prognosis for all forms of diaphragmatic hernia is good as long as shock and arrhythmias resolve and successful surgical repair can be accomplished. However, cats with traumatic injuries may be poor surgical risks, especially if other traumatic injuries are present.

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