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The Ascitic Cat
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Ascites is a term used to describe the accumulation of free fluid within the peritoneal cavity. Based on cell counts, total protein, specific gravity, and cellular content, the fluid may be classified as a transudate (pure or modified) or an exudate.
Erin Anderson
VMD, MSc, Dip. ACVIM (cardiology)
Dr. Anderson earned her veterinary degree from the University of Pennsylvania before undertaking a rotating medical/surgical internship at Pittsburgh Veterinary Specialty and Emergency Center in Pittsburgh,Pennsylvania. She completed both her residency in cardiology and her MSc degree at Atlantic Veterinary College in Prince Edward Island, Canada in 2013, and currently undertakes small animal cardiology in private practice in Pennsylvania.
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Key Points
- Ascites can be classified as one of several types of fluid, most commonly pure or modified transudates or exudates. This classification helps narrow a very broad list of differentials for primary etiology.
- Ascitic fluid should be obtained and analyzed for the sake of classification, but this rarely provides a definitive diagnosis without additional, full diagnostic evaluation.
- Congestive heart failure, neoplasia, feline infectious peritonitis, and hepatic disease are among the most common causes of ascites in cats.
- Therapeutic abdominocentesis may be a beneficial option to relieve discomfort in many (but not all) cases of ascites. Specific treatment for the primary cause is recommended.
Introduction
This classification can ultimately be helpful in identifying the etiology of ascites and directing proper treatment (Table 1). Chylous or pseudochylous effusions, hemorrhagic, bilious, neoplastic effusions, and uroabdomen are specific exudates which many clinicians prefer to differentiate from true ascites ( 1 ).
![ascitic cat fig1 ascitic cat fig1](https://www.ivis.org/sites/default/files/styles/free_dimension/public/images/media/image/Schermafbeelding%202021-02-08%20om%2016.59.18.png?itok=i19GS2oJ)
Pathophysiology
Fluid can accumulate within the peritoneal cavity via several mechanisms. These include:
- Increased hydrostatic pressure within the vasculature (as in right-sided congestive heart failure or portal hypertension)
- Decreased colloid osmotic pressure (as in hypoproteinemia secondary to intestinal malabsorption, hepatic failure or protein-losing diseases)
- Increased vascular permeability (as in vasculitis or inflammatory conditions)
- Viscus, vessel or mass rupture, or coagulopathy
- Lymphatic obstruction/rupture or lymphoproliferative disease ( 2 )
While the character of the fluid may shed important diagnostic insight on the source of effusion, a thorough history and physical examination is essential before a fluid sample is obtained to help differentiate these possibilities.
History
An owner of a cat with ascites may describe a primary complaint of abdominal distension or clinical signs commonly associated with ascites. These include lethargy, decreased appetite, or tachypnea (this last sign results from the increased abdominal volume exerting pressure on the diaphragm). The clinician should obtain a full medical history, including any past or current conditions or operations, and all medications. A history of urethral obstruction may indicate a concern for uroabdomen. Known or suspected cardiac disease (i.e., history of a murmur or arrhythmia) may portend a suspicion of right-sided congestive heart failure (CHF). The clinician should also ascertain whether or not the cat has experienced any recent trauma, which would raise suspicion of a visceral rupture or hemoabdomen. An understanding of the cat’s origin, normal environment, and potential exposure to other animals may increase one’s suspicion of a primary infectious pathogen such as feline infectious peritonitis (FIP). This virus has a predilection for younger cats (< 3 years), many of whom live in crowded or stressful environments or have a history of fever that did not resolve with antibiotics ( 3 ).
Physical examination
The physical exam of an ascitic cat often (but not always) reveals abdominal distension (Figure 1); small volumes may not distend the abdominal wall. Ascites can be difficult to definitively differentiate from other causes of abdominal distension on physical exam alone, since organomegaly (including an enlarged urinary bladder), mass effects, pregnancy, and obesity can produce the same appearance. The presence of ascites may allow detection of a palpable fluid wave; this is ascertained by placing a hand flat against one side of the abdominal wall whilst the other hand gently taps the opposite flank to stimulate fluid movement […]
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