Felipedia

This is a relatively rare disease in cats, manifested by increased appetite, often loose stools and sometime bleeding.

Dietary triglycerides are normally digested by pancreatic lipase to monoglycerides and fatty acids. This process is needed for solubilisation and subsequent absorption of fat-soluble vitamins, including vitamin K. In EPI, lipase deficiency can therefore result in vitamin K deficiency. Vitamin K deficiency leads to coagulopathy due to deficiencies of factor II, VII, IX and X.

Vitamin K deficiency is usually mild since there is not complete absence of intestinal lipolysis.

Chronic diarrhoea, weight loss, normal to increased appetite occur. Greasy soiling of the hair coat (especially perianal) may occur. Clinical bleeding is rare and is most likely to be excessive, e.g. following venipuncture, rather than spontaneous. Prevalence of subclinical clotting factor deficiency is not known.

Hemostatic testing in the bleeding cat reveals normal platelet count and BMBT (may re-bleed), and prolonged PT, ACT and aPTT. Cats with EPI and clinically normal haemostasis may have high normal range values or mild prolongation of PT, ACT, and aPTT. A subclinical effect may be better documented by measuring elevated PIVKA time and quantification of factor VII using a technique similar to factor VIII quantification in haemophilia A.

Differential diagnoses for a cat with chronic diarrhoea and coagulopathy include

1) Inflammatory bowel disease. This is differentiated from EPI by normal trypsin-like immunoreactivity and intestinal biopsy showing inflammation

2) Primary intestinal disease and secondary cholangiohepatitis or hepatic lipidosis. These are identified by routine laboratory work-up and biopsy. Appetite is usually reduced with liver disease.

3) Feline leukemia virus and feline immunodeficiency virus infections. Both viral diseases may be associated with chronic diarrhoea, but appetite is usually reduced. Coagulopathies may occur with retroviral infections, but are usually subclinical. Both viruses may cause thrombocytopenia.

Cats with EPI and clinical or laboratory evidence of coagulopathy should be given vitamin K₁, 5mg/kg SQ daily until normalisation of PT. The need for further treatment will depend on response to vitamin K₁ treatment and improvement of diarrhoea with pancreatic enzyme supplementation. Concurrent supplementation with vitamin E (tocopherol) may increase vitamin K₁ requirements. Avoid unnecessary antibiotic therapy that may reduce intestinal bacterial production of vitamin K₂.