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Denney

Customer Question
Hi Dr. Denney...
Hi Dr. Denney
Submitted: 6 months ago.Category: Cat Veterinary
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Answered in 1 hour by:
8/3/2017
Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 6 months ago
Dr. Meghan Denney
Dr. Meghan Denney, Cat Veterinarian
Category: Cat Veterinary
Satisfied Customers: 1,979
Experience: Veterinarian at Kingsland Blvd Animal Clinic
Verified

You cat had undeniable evidence that she had FIP from her necropsy report from a boarded pathologist.

Nothing else that was going on medically would change her FIP status and that is what led to her having to be euthanized. The FIP had attacked her lungs causing irreparable damage.

I do not believe constipation was a factor here.

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Customer reply replied 6 months ago
another pathologist assessed and this what they wrote..do you think the bacteria was any kind of issue? I worry bacteris from constipation? has that ever happened?Dr. Andrew D. Miller, DVM, DACVP, a veterinary pathologist, was consulted for his opinion on this case. Dr. Miller agrees that
the most significant changes are the granulomatous lymphadenitis noted in the mesenteric lymph node, and the pleuritis in the lung sections. The lymphadenitis is consistent with feline infectious peritonitis (FIP), based on the positive immunoreactivity of macrophages to feline coronavirus antigen. The rare positive immunoreactivity noted in the pleura appears to be equivocal, and is not consistent or striking enough to warrant a firm diagnosis of coronavirus within the pleural tissue. However, this does not exclude an FIP-related pleuritis, as coronavirus may be present in other areas not examined on histology. A differential diagnosis of the pleuritis, given its marked fibrinosuppurative component, would be a bacterial pleuritis. Due to the severe tissue artifact related to autolysis and freeze-thaw, determining the source of bacterial infection is not possible. It is possible that systemic immune suppression related to FIP predisposed this animal to secondary bacterial infection. Culture of frozen lung tissue is available if requested. However, culture may not yield a positive result, and if it does, it will only indicate the underlying bacteria involved; it cannot elucidate the source of the infection.
The remaining changes are expected findings and are largely incidental. In addition to the lesions described in the original
report, an adrenal cortical adenoma, composed of proliferative, well-differentiated adrenal cortical cells surrounded by a thin capsule, was noted. This lesion is incidental, and often seen in aged animals. The renal adenocarcinoma is a potentially significant lesion; however, there is enough remaining renal parenchyma unaffected by the tumor that it likely did not cause renal insufficiency, and there is no observed metastasis in any of the other examined tissues. The chronic interstitial nephritis may have caused clinical renal signs, but this is an expected lesion in aged cats, the etiology of which is uncertain. Finally, rare, well demarcated, lightly basophilic, homogenous, round deposits (Lafora bodies) are noted in multiple sections of brain. These are age-related changes with no pathologic significance.
Dr. Teresa Southard, DVM, PhD, DACVP, a veterinary pathologist, was also consulted and concurs with these findings.
Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 6 months ago

if there was bacterial translocation from the colon she would have gone into septic shock and died, also there would have been evidence of this on the necropsy which there was not any evidence of colon wall perforation.

I still maintain that she has FIP and no amount of treatment was going to save her unfortunately. You can try and come up with other factors but it will not change that FIP is what caused her to de compensate and for her lungs to fail from the damage.

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Customer reply replied 6 months ago
what do you make of the other pathologist comments? what would she have looked like if she septic shock?
Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 6 months ago

She would have died on her own with septic shock:

  • Sepsis is when the infection reaches the bloodstream and causes inflammation in the body.
  • Severe sepsis is when the infection is severe enough to affect the function of your organs, such as the heart, brain, and kidneys.
  • Septic shock is when you experience a significant drop in blood pressure that can lead to respiratory or heart failure, stroke, failure of other organs, and death.
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Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 6 months ago

They agree that is it FIP that caused her lungs to fail and ultimately lead to her needing to be euthanized

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Customer reply replied 6 months ago
are they just suggesting the pleural tissue is not definitive of FIP, alterna tive could bacteria? but the mesenteric lymph node shows FIP? the echo report said there was lunh lobe collapse? I understand what septic shock is but I am not some of clinical signs
Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 6 months ago

Septic shock is not what occurred so knowing the symptoms beyond what I sent is extraneous information and not relevant here.

The lymph nodes give you definitive FIP diagnosis. The lung pathology is most likely from FIP but they cannot say with 100%. As a second possibility they listed bacteria. I still think it was FIP.

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Customer reply replied 6 months ago
what would the lung tissue culture show, if thre was bacteria? I thought they did staing already and said there was no bacteria
Customer reply replied 6 months ago
this was part of the original report: It says histochemical stain of of pleurtis and lung says no bacteria? I don't understand..whats the difference between that and a cultureA Masson's trichrome histochemical stain for collagen confirms mild pancreatic fibrosis. A panel of histochemical stains does
not reveal bacterial or fungal organisms in areas of pleuritis.
Histochemical Stain Results:Histochemical staining of sections of lung (slide 4) reveals the following:
Gram for detection of bacteria: No bacterial organisms are observed in the examined sections.
Gomori's methenamine silver (GMS) for detection of fungi: No fungal organisms are observed in the examined sections.
Modified Steiner silver for detection of argyrophilic bacteria: No argyrophilic organisms are observed in the examined sections.
A Masson's trichrome histochemical stain of a section of pancreas (slide 6) reveals focally coalescing tracts of mature deeply
basophilic collagen coursing between multiple lobules.
Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 6 months ago

I cannot speak for what they saw, but if there was no bacteria then there was no bacteria. A lung culture is not possible because she has been frozen

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Customer reply replied 6 months ago
they said lung cuture is available upon request...when they say no bacterial or fungal "organisms" is that the same as just bacteria in general?
Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 6 months ago

Yes generally no bacteria = no bacteria . I don't know how they would be able to culture as she has been dead for quite some time the samples may not be good anymore.

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Customer reply replied 6 months ago
is that the best way to diagnose FIP, what they did? It says they could do culture. wouldnt the effusion have had bacteria in it if thiat was the case? It said no no infectious agents observed when they tested the effusion when she was at hospital
Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 6 months ago

There are a few tests to do that can diagnose FIP and they did them. It says clearly in the report it is FIP.

FIP does not act like an infectious agent it makes the body's immune system attack itself.

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Customer reply replied 6 months ago
on original report it said there was the moderate fecal impaction and surrounded by green mucous type material, couldn't that be bacteria that ultimately spread bc it couldn't come out?
Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 6 months ago

It is still not a major contributing cause to her demise and it was inside the colon ergo no there was no bacteria spreading outside the colon

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Customer reply replied 6 months ago
would pneunomai have caused inflamed lymph nodes in abdomen? do you thihnk they are suggesting if there was bacteria, it could have come after the when she was in hospital bc the FIP was affecting her?
Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 6 months ago

No pneumonia is not going to affect lymph nodes In her abdomen. Furthermore, we know that there was no way to save her and nothing you could have done to prevent this from occurring. Rehashing everything over and over again like we did with your other cat is not something I am willing to do. You have a detailed necropsy report stating her diseases. They said the likelihood of bacteria was low. She had FIP. That was the main culprit that led to her having to be euthanized.

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Customer reply replied 6 months ago
Im sorry, youre frustrated but I am just trying to understand...where did they say likelihood of bacteria is low?have you ever seen moderate fecal impaction causing bacterial infection?
Customer reply replied 6 months ago
this is what the original pleural effusion got tested for , she even rechecked and said no infectious agents..i don't understandPleural effusion; 2 submitted smears, 2 direct, 1 concentrated direct and 2 concentrated cytospin preparations made from submitted fluid examined
DESCRIPTION/MICROSCOPIC FINDINGS/COMMENTS:
MICROSCOPIC DESCRIPTION:
The sample is highly cellular on a pale eosinophilic lightly proteinaceous background with scattered red cells. Cells are best preserved on the submitted smears and thus differential is performed on one of these smears. The sample consists of 76% non-degenerate neutrophils, 21% large mononuclear cells/macrophages, and 3% small mononuclear cells/small lymphocytes. Additionally rare
intermediate-sized lymphocytes are noted. Macrophages are occasionally aggregated together. The preserved cell population on the slides made from submitted fluid appear similar however there are many cells that are swollen/deteriorating.
MICROSCOPIC FINDINGS:
NEUTROPHILIC EXUDATE
COMMENT:
There is inflammation present. Cause is not apparent. No infectious
agents or apparent evidence of neoplasia observed
Differentials for neutrophilic exudates include: underlying infection
(e.g. walled-off abscess), non-infectious organ inflammation (e.g. pulmonary inflammation/granuloma, pleuritis), occult inflammatory neoplasia, and foreign body reaction. Correlate with clinical information/imaging.
Customer reply replied 6 months ago
hello?
Customer reply replied 6 months ago
if there was no infectious agents in effusion or histochemical stainig of lung tissue, does that eliminate bacteria altogether? I heard that effusion may not have bacteria all the time if its a cause, like pnenomina, I worry it was pneunomnia
Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 6 months ago

I am not frustrated I just do not have the time to keep going back over and over every part of your cat's case to the point where I am repeating myself and you end up not getting the clarification you need.

That sample rules out infectious agents so bacteria was not the main culprit for the fluid. It was the FIP which can and does cause an exudate with those characteristics

No I have never seen fecal impaction cause bacterial translocation. I once again do not think her mild stool constipation had anything to do with her demise

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Customer reply replied 6 months ago
you don't feel like it could be pneumonia if they effusion had no infectious agents and the histochemical staing of lung tissue showed no bacteria? I just don't understand why they mention bacteria a spossiblilty, and saw degenerate yellow fibronous stuff in her pleural space
Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 6 months ago

No I do not think was pneumonia.

Because bacteria is always a possibility even it is is a negligible % and they have to say that to make sure their covered if there is lawsuit

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Customer reply replied 5 months ago
this is what the radiologist wrote when they did xrays...what do you think what is atelectasis? does he feel pneunomnia not likely?Two electronically transmined images including right lateral and ventrodorsal thoracic radiographs are provided
for review, acquired June 1, 2017.
The cardiac silhouette is moderately enlarged and b11Sed on the visible margins, rounded . There is a low volume of pleural fluid obscuring portions of the cardiac silhouette and causing wide pleural fissure lines as well as rounding and retraction of lung lobe margins. There is increased opacity in the area of the right middle lung lobe and caudal subsegment of the left cranial lung lobe consistent with atelectasis or less likely consolidation of other cause.
The hepatic silhouette is moderately enlarged and has rounded irregular margins. Abdominal serosal detail is relatively good
Conclusion
Cardiomegaly consistent with cardiomyopathy and/or pericardia! effusion. Low volume pleural effusion.
Atelectasis or less likely consolidation of other cause (pneumonia, neoplasia, hemorrhage ) involving portions of the left cranial and right middle lung lobes.
Marked hepatomegaly with irregular margins consistent with hepatic cysts and/or neoplasia, granulomas or less likely abscessation.
Recommendations
Thoracic and abdominal ultrasound exams may be helpful in further characterizing the abnormalities identified
on the radiographs, if not already yet performed.
Customer reply replied 5 months ago
hello? are xrays clear cut shoing of pneunmnia? can I forward them to you
Customer reply replied 5 months ago
hello, can you please look at the xrays?
Customer reply replied 5 months ago
Dr. can you please take a look at xrays, I will opena new thread if need be. I am just worried it was pneunomnia
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Dr. Meghan Denney
Dr. Meghan Denney
Dr. Meghan Denney, Cat Veterinarian
Category: Cat Veterinary
Satisfied Customers: 1,979
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Experience: Veterinarian at Kingsland Blvd Animal Clinic

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