Referring
Veterinarian: Dr. Kimberly Gray		 Clinic Name: VCA Briarcliff Animal Hospital GA
Email: kgray@briarcliffanimal.com


Postal Address:
1850 Johnson Road NE
Atlanta, GA 30306
(404) 874-6393
(404) 881-1517
Client: Howd, Howd    
Patient Name Howd Abilgail Patient ID 122908
Species: Feline Breed: Domestic Mediumhair
Age: 4 years 11 months Sex: Female(Spayed)
Modality/Images : DX/6  Date Of Study: Tue, 27 Jun 2017
Wt.: N/A Temp.: N/A Pulse: N/A Resp.: N/A
Pertinent History*
Pt presented for not eating or drinking over 2 to 3 days.  O reported that pt vomited several times a few days ago - appeared to be bile with a small amount of hair.  O stated that over the last 2 to 3 days, pt seems to be very lethargic, not really moving much from her spot.  O has not noticed any eating or drinking over the last 24 hours.  No diarrhea has been noted and pt seemed to be painful when O picked her up around her abdomen.  O stated that pt has had nasal discharge from right side nostril for the last several years, and right ear seems to need to be cleaned consistently.  O stated that over the last 2 years, pt will urinate small amounts and urine seems very concentrated.  However no blood has been seen.  Pt is completely indoor and has 1 housemate, also a cat.

PE: mm: pink, CRT: ~2s
h/l: auscultated normally
abd: moderately painful on palpation of cranial abdomen
Clinical Question*
Evaluation of abdomen due to history of vomiting.
Findings:
Six orthogonal views of the thorax and abdomen are submitted for assessment.

All bony structures surrounding the thorax are normal. Trachea and main stem bronchi are normal. Cardiac silhouette is normal in size and shape with a vertebral heart score of 7.2.  Pulmonary vasculature is normal. Pleura and mediastinum are normal. Pulmonary parenchyma is normal with no significant infiltrates or focal lesions detected.

Bony structures surrounding the abdomen are normal. Liver is very mildly enlarged with rounded lobar borders. Stomach is mildly distended with air. Small intestinal loops are uniformly air filled and moderately distended and having a diffuse "string of pearls" appearance indicating hyper peristalsis or hypermotility possibly from inflammation. In addition to this diffuse change there is a moderately to severely fluid and air distended loop in the right caudal abdomen that appears to be small intestines that is associated with a tubular accumulation of soft tissue opacity foreign material with lucent linear striations suggestive of cloth. This is not as well visualized on the lateral view but is seen just cranial to the bladder and appears to be causing an obstructive pattern in the distal small intestines. Colon is empty other than a small amount of semi-formed fecal material. Bladder is moderately distended with no mineralization seen. Kidneys are normal and symmetrical. Spleen is normal in size and shape. Serosal detail is normal.
Assessment:
Normal thorax.

Mild hepatomegaly. Differentials include vascular congestion, metabolic hepatopathies (such as vacuolar hepatopathy, endocrine hepatopathy, fatty liver and hepatic lipidosis), infiltrative neoplasias, cholestatic hepatopathy and biliary associated liver disease, and infectious/inflammatory conditions such as hepatitis. Further information may be obtained by laboratory assessment of liver enzymes, potential bile acid stimulation testing and abdominal ultrasound with guided fine needle aspirates.

Mechanical obstruction by a soft tissue opacity piece of foreign material with lucent linear striations suggestive of cloth in the distal small intestines as described. Consider removal.

Uniform moderate distention, small intestines with a "string of pearls" appearance suggestive of hypermotility or spasticity. This could be inflammatory change.

Otherwise normal abdomen.
 
Specialist: Dr. Sue Finn-Bodner, DACVR  
Phone: (480) 258-2584  
Email: Sue.Finn-Bodner@antechimagingservices.com  
Date of Report: Tue, 27 Jun 2017 19:37:48 PDT  
 
 
Thank you for allowing us to be part of your diagnostic team; if you have any questions please contact me directly. Please note AIS will only discuss this report with the referring doctor.
 
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