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Kitten with bloated belly

post #1 of 16
Thread Starter 
Ok, this one has both me and two of our vets stumped. I'll give a run down of what has been done so far...

Milo is a 5/6-ish week old kitten. We got him, along with 4 litter(?) mates on Saturday. He weighed just 15 ounces. Had fleas and an URI (Calicivirus...he has ulcers in his mouth.)

All kittens were combo tested (negative), had fecal (negative), dewormed (Strongid), given dawn baths and Milo was started on Amoxicillin and Terramycin.

The bloated belly was noted, but we all thought roundworms. The size of the belly has not decreased and is not related to eating.

Appetite is good, and he is urinating and producing stool. Stool quality was formed, but almost had a soft play-dough consistency. Just in the last 12 hrs he has had looser stool, but I attribute this to a diet change yesterday. (Vet wanted him on a simple, easily digestible, high protein diet as there was concern about a protein absorption issue and wanted to try a baby food diet for a few days.)

We sent out another fecal (outside lab...basic panel) and did radiographs (being read by a radiologist.)

The x-rays did not look normal and there doesn't appear to be much if any fluid in the belly. Liver was suggestively larger than normal. But, again, waiting on the official report, which should be in later today.

Milo is getting over the URI and, with that, his energy level is increasing, though he does tire easily.

Any thoughts?

I will add. Milo weighed 15 ounces on Saturday and was 1 lb 3 ounces yesterday. I'm honestly not sure if this is a good thing or not as his belly is proportionally larger than it was on Saturday. Also, the belly is form/hard not soft/squishy.

Pictures coming.
post #2 of 16
Thread Starter 
Two additional pieces of info:
Before we got the kittens they were being fed dry Kit n Kaboodle and the litter being used was Arm&Hammer Clump and Seal litter...and, yes, we are taking into consideration that litter may have been ingested, though he is not blocked.
post #3 of 16
Thread Starter 






post #4 of 16

Love all those belleh spots!  I wish I had words of wisdom for you, but I don't.  Sorry!

post #5 of 16
Thread Starter 
Yes, and he's a cutie too!

Fecal came back negative, which I expected. Radiologist report came back stating that both the heart and liver were "borderline" enlarged. Unfortunately, Milo is too little to do further testing. We'll have to wait for him to grow a bit more (ideally when he is 12-16 weeks old). At that point, depending on symptoms, we'll look into an ultrasound and an echo.

I switched his diet to Instinct LID turkey as it is higher in protein than the canned kitten he was on. This does seem to be helping his stool consistency improve.

Ultimately, the plan for now is to watch, wait and let him grow. Unfortunately for me, I'm not good at the waiting part.
post #6 of 16
Thread Starter 
Wanted to give an update. I took Milo in for some blood work and repeat x-rays yesterday. Blood work all came back completely normal (yea!)

I contacted the cardiology department at one of the vet schools that is "close" by (both are 2 1/2 hrs away, so not a horrible drive) to see at what age they could do an echo. I was told 4 weeks (not the 12 wks the local cardiologist..not board-certified). I was told that they would be more than happy to do a free consult and take a look at the radiographs to see if they suspected a heart issue.

Just heard back from one of the cardio residence and Milo does definitely have an enlarged heart. I will be headed down for a consult either tomorrow or Friday. I am really hoping that this is something than can either be fixed or managed! He is a SUPER sweet baby and, unfortunately, our history with babies with this disposition isn't great.

Please send us lots of prayers and good vibes as we make this journey with him! (And that we have adequate funds to do whatever is needed for him!)
post #7 of 16

Will be sending you prayers for Milo for sure. I'm going to pray that he grows into his big heart and gets to spend some time being loved here on earth. Yes, it does seem that its the sweetest ones that cross the bridge way too soon, leaving us with broken hearts.  I guess their work is done sooner.  The feisty ones hang on and plague all the other cats in the house for close to 20 years.  A friend of mine had a whole family with congenital heart problems, all of them orange tabbies except for one little black girl.  They lived to be about five years old (which was good) and then one at a time, they left.  Three were gone by the time I met her, and the other two went over the next year, but they had wonderful lives while she had them, and that's a blessing.  I've always said it's quality, not quantity, that matters.  She is also in rescue so is not short of cats to love, but that last orange boy still has her heart (although she foster failed on another orange boy about a year ago and he's a pistol.)  Let us know what you find out when you get back.  :alright:

post #8 of 16
Thread Starter 
Update:
Milo's appt is tomorrow at 12:30. Will update as I know more.
post #9 of 16

Sending Milo prayers and kisses to that little spotted tummy.

post #10 of 16
Thread Starter 
Sorry for the delayed update. It's been a busy few days.

Milo is doing well and I have actually noticed an improvement in his energy level/stamina over the last 24-36 hrs.

Our visit with cardiology was basically uneventful. Milo actually slept through his entire echo, lol!

The finds are:
Mildly enlarged heart (both left and right chambers), as well as an enlarged liver. No shunts, holes, or obvious defects seen in the heart. They also did a quick u/s of abdomen and confirmed no fluid. They don't know the cause of the enlargement at this point, but the plan is to return for a recheck in about 10 weeks. They suggested possibly doing a CT with contrast.

One thing that was noted on his discharge papers (and I wish I had asked while we were there...will be contacting tomorrow) is that the inflammation/enlargement could be vital related.

We have had 2 cats that have suffered heart damage due to Calicivirus. Milo had Calici at intake and still has a few ulceration a that are continuing to heal. I am wondering if Milo had/has the systemic strain of Calici and this has caused the enlargements? Not sure of this can be proven or not, but will definitely enquire further.
post #11 of 16
Thread Starter 
Here's his report if anyone is interested:

History:
Diagnosis:
1. Mild biatrial enlarged of unknown etiology.
2. Mild pulmonary insufficiency - suspect pulmonic valve dysplasia. 3. Normal cardiac function.
4. No obvious intra-cardiac shunts.

Milo is a 7 week old, male intact American domestic shorthair red tabby cat that presented on 7/21/16 to AUVTH Cardiology Services for evaluation of an enlarged heart previously diagnosed on radiographs by the referring veterinarian. Milo was taken in two weeks ago by Steel City Cat Rescue at which time it was noted he had a distended abdomen and an upper respiratory tract infection. He was diagnosed and treated for Calicivirus (treated with Amoxicillin and Teramycin) which has since improved a great deal. His distended abdomen has not gotten bigger, though it has not been reported to have changed much. Two fecals have been run and both tested negative, two sets of radiographs were taken at the veterinarian's clinic, revealing an enlarged cardiac silhouette, and routine labwork was done with results in normal limits. Milo's guardian reports that he is eating and drinking well, urinates more than her other rescue cats, and has exercise intolerance.

Physical Examination:
On physical examination today, Milo was bright, alert and responsive with his TPR within normal limits. His weight was 0.77 kg and his temperature was 100.1 F. Milo's heart rate was 164 beats per minute with no murmurs or arrhythmias noted. Milo's respiratory rate was 60 bpm and his lung fields were normal on auscultation. Mucous membranes were pink with CRT <2 seconds. Pupillary light response and menace response were normal for both eyes; both ears had mild wax build up. Limbs ambulated normally and no pain was elicited on palpation. No masses were found on abdominal palpation, though his abdomen did visually appear distended.

Diagnostics:
1. Thoracic Radiographs:
The cardiac silhouette is enlarged. The pulmonary arteries and veins appear subjectively mildly dilated. No evidence of pericardial hernias of any type. The pulmonary parenchyma appears within normal limits. Final radiology report is pending.

2. Echocardiography:
The left ventricular internal dimensions are within normal limits at end-systole and end-diastole. Normal left ventricular systolic function based on the LVIDs and the calculated fractional shortening. Normal left ventricular wall thickness. The mitral valve appears structurally normal. The left atrium is mildly enlarged. The right atrium is subjectively mildly enlarged compared to the left atrium. The right ventricle is subjectively within normal limits for size and wall thickness. The basilar aspect of the interatrial septum is irregular and appears to have redundant tissue, but no intracardiac shunts are noted based on color and spectral Doppler interrogation. Mild pulmonary insufficiency is noted, but the velocities are not consistent with pulmonary hypertension. Trans-pulmonic velocities are within normal limits. The main, right, and proximal left pulmonary arteries are within normal limits for size. There is no echocardiographic evidence of pulmonary hypertension. The aortic valve appears structurally normal with normal trans-aortic velocities. On certain right parasternal short axis views at the level of the left ventricular papillary muscles, the parenchyma adjacent to the pericardium appears hyperechoic with focal, small anechoic regions. This abnormality was first thought to be invasion of the pericardial space by extra-pericardial tissue (PPDH, etc.), but the abnormality could not be reproduced on other views by other ultrasonographers. Thoracic radiographs do not support PPDH either, so this finding is most likely artifact and of clinical insignificance.

Assessment:
Milo's echocardiogram and thoracic radiographs were not indicative of any type of congenital or acquired cardiac pathology. His physical exam parameters were within normal limits with the exception of his distended abdomen. The abdominal distension is not from fluid in the abdomen based on evaluation via ultrasound probe, nor can the distension be definitively attributed to any form of cardiac disease. On echocardiogram, no significant findings were observed that would explain Milo's distended abdomen or exercise intolerance. The left atrium appeared mildly enlarged, mild pulmonary insufficiency was noted, and the right atrium was subjectively mildly enlarged. However, none of these changes seem to be affecting Milo clinically since signs of pulmonary hypertension or heart failure are not present.

Differentials for Milo's abdominal distension currently include peritoneal inflammation, certain viruses, parasites, PPDH, or normal kitten presentation. For now, the best plan for Milo would be to continue monitoring progression of his exercise intolerance and abdominal distension and look for signs of improvement or worsening. Milo appears clinically healthy and his quality of life is good, so we currently recommend monitoring for any changes in health and scheduling a recheck in 2-3 months if necessary.

Recommendations/Plan for Re-evaluation:
1. Although we did not find evidence of cardiac pathology or congenital abnormalities today on radiographs or echocardiogram, we cannot rule out the possibility of structural defects that were too small to be seen. We recommend scheduling a recheck appointment with AUVTH Cardiology Services around 4-5 months of age to reassess cardiac structure and function if you are still concerned with Milo's temperament or physical signs. If you notice any changes in Milo's health or behavior before then, please make an appointment with AUVTH so that he can be seen by a veterinarian. Any sudden, dramatic increases in respiratory rate or effort should be watched for along with lethargy and signs of GI changes like vomiting, anorexia, or diarrhea.
post #12 of 16

Thanks for sharing that.  I have been waiting to find out and am glad that it's not anything clearly terrible.  Maybe it IS related to the calici -- who knows?  he most important thing is that it didn't show any life-threatening abnormalities, so you can love him and let him grow.  Ahh, too bad, another foster fail, you probably aren't letting him get adopted anytime soon either.  :rub:

post #13 of 16
Wow! Thanks for sharing. Milo is precious and he is so lucky to be in your foster care. Sounds like a great rescue.
Looking forward to updates.

Are you doing anything differently with him? Any special care?

hugs.gif to you and Milo 💕
post #14 of 16
Thread Starter 
Yes, definitely a relief that there isn't anything majorly structurely wrong with his heart. And, also a relief that they confirmed there was no fluid in the abdomen (we felt certain there wasn't, but nice to hear the experts say that!)

No, he certainly won't be going anywhere until he at least has his recheck with cardio. He's currently still with me and he has been socializing with the sweeter adults that I have. He's also being *slowly* introduced to the dogs (they get very excited over babies!) I also have some older kittens (12-ish weeks) that I am introducing him too. All of Milo's sisters are currently fighting Calici (fairly mild infections) and I haven't yet decided if he will go back with them once they're well or not.

A vet tech at one of our clinics has expressed some initial interest in him, so we'll see...
post #15 of 16
Thread Starter 
Wanted to give everyone another update on Milo.

He returned to the cardiologist this past Wednesday for a 6 month recheck. His abdominal distention had completely disappeared about 2 months ago (over about a 3 week period) and he has more energy. I went in thinking they do the echo recheck, possibly an abdominal u/s and basically give him the all clear....that didn't happen.

So, we now know the cause of Milo's enlarged heart and liver. He has been diagnosed with Ateial Septal Defect (ASD), or, in other words, a hole in his heart. The hole is located between the upper left and right chambers and both chambers of the right are enlarged. [

B]There is no treatment to fix this.[/B] Milo will eventually go into heart failure. However, there is no way to predict when this will occur. It could be in 2 years or 6. There are medications to help manage symptoms once they start, but nothing to slow progress. (If anyone knows something different PLEASE let me know!)

So...Looks like Milo will be one of my long-term fosters. He will be loved and spoiled and kept comfortable for however long he is with us.

He will be returning to the vet school next month to get neutered (under cardio supervision, but they expect an excellent outcome.)

Because ASD is genetic, we will need to get Milo's 4 sisters checked out. After talking with the cardiologist, we suspect at least one, maybe two, may have the same malformation. We're working on raising funds ($350 per cat) and will be taking them down beginning next month. Fingers crossed the others are healthy and can be adopted!
post #16 of 16

Oh poor Milo, but he is in excellent hands and love, as a failed foster...long term foster.. or call him your love bug...((hugs))

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