A 13 lb (6 kg), 9 year old, castrated male American
Domestic Shorthair cat presents to your clinic with a 3 to 4 month
history intermittent vomiting and weight loss. The owner tells you
that the cat has had “hairball-associated” vomiting for the past
year, but during the past 3 to 4 months has been losing weight and
is not eating and drinking very well. Also, the vomiting has been
"projectile", during the past month. The RDVM gave a 10 day course
of metoclopramide, which seemed to help, but now is not working. The
cat has been known to chew plastic and vomited a plastic foreign
body recently. On presentation the cat is lethargic but responsive
to external stimuli, checks out food but doesn’t eat, and vomits
while being examined. The cat’s has a heart rate of 160 bpm, rectal
temperature of 99°F, and respiratory rate of 28 breaths/min.
Abdominal sounds are normal over the stomach and the cat
“hunches-up” when it’s abdomen is being palpated. Ultrasonographic
examination of the abdomen shows diffuse increase echogenicity of
the liver and prominent muscularis layer of the small intestines
with normal thickness of intestinal walls. You perform endoscopy of
the esophagus, stomach and duodenum and you see the above image
(image A, see above) in duodenal lumen. You remove the object via
endoscopy using a snare and are left with image B (see above).
What’s your diagnosis?
What other diagnostic tests would be helpful in
determining the diagnosis?
What treatment(s) would be appropriate?
