Billy, a seven year old tabby mixed-breed cat, was a little overweight and led a quiet but very contented life. And, despite the odd day when he had slightly loose stools or brought up the food that he bolted down too quickly, he had never been ill. So, when Billy refused to eat and lay in his bed all day, his owners were worried. They had booked an appointment to see the vet the following day, but at 10pm, Billy started to vomit, and the owners called the emergency vet, who booked him in that night. 

An emergency trip to the vets

At the vet, it was clear that Billy was very unwell. He was barely lifting his head and started grumbling when his tummy was felt – not his usual good nature at all. His skin and gums had a peculiar yellow tinge, indicating that he was jaundiced. Billy was dehydrated and generally a very miserable cat.

To find out more, the vet recommended a full blood screen and a fPLi blood test for pancreatitis. Pancreatitis is very common in cats and typically causes decreased appetite and severe abdominal pain. 

In light of Billy’s tummy pain and jaundice, it seemed likely that there was an issue in Billy’s abdomen. So, Billy was booked in for a complete ultrasound the following day. In the meantime, the emergency vet performed a quick ultrasound scan to check for any abnormal fluid that might indicate that Billy needed surgery overnight. Luckily for Billy, this was not the case.

Starting treatment

Whilst the vet waited for the blood results, Billy was started on strong opioid pain relief and anti-sickness medication. He was also placed on an intravenous drip to improve his blood flow and gradually rehydrate him. The blood tests showed high liver levels (ALT, ALP and bilirubin), commonly linked to liver cell damage and issues with bile flow from the gallbladder. His white blood cells increased, suggesting infection or inflammation somewhere in his body. His pancreatitis blood test was high, too, making it very likely that poor Billy was suffering from pancreatitis also – no wonder he felt so ill. 

Billy had low potassium levels, which causes fatigue and weakness, so potassium was added to his drip. The blood tests also showed that his glucose levels were higher than expected. This is common in unwell or stressed cats. But, as the pancreas is the organ that makes insulin and controls blood glucose, it was decided to monitor this closely. Sometimes cats with pancreatitis can develop diabetes too. 

Further investigations

The following day, Billy was a little brighter and much more comfortable. He was mildly sedated to allow abdominal ultrasound to be performed. A urine sample was collected by cystocentesis (passing a tiny needle through the wall of the abdomen into the bladder), which showed that his kidneys were working well and there was no sign of any infection. The ultrasound showed that Billy had signs of a condition known as ‘triaditis’. This disease is an inflammatory condition made up of three components:

1. Pancreatitis (inflammation of the pancreas)

2. Cholangiohepatitis (inflammation of the liver and bile ducts)

3. Inflammatory bowel disease (inflammation of the intestines)

The pancreas and gallbladder are closely linked to the small intestines through small tubes (or ducts) where bile and digestive enzymes are passed into the intestines to help digest food. Their close proximity means that an issue with one organ can affect the others. The vet performing the ultrasound took fine needle samples from Billy’s liver for analysis at the laboratory. This can help identify the cause of liver changes and rule out fatty liver disease (hepatic lipidosis). Hepatic lipidosis is a serious condition most commonly seen when cats suddenly stop eating. A bile sample was not taken on this occasion – but these can help check for infections in some cases.

There are various causes of triaditis which are still not fully understood. In most cases, it is suspected to be due to a bacterial infection or an issue with the immune system leading to inflammation. This might be caused by food intolerance or a genetic tendency. Triaditis can make cats extremely ill and, in some cases, can be life-threatening.

Road to recovery

In triaditis cases, providing nutrition to the cells in the intestine is a huge part of a patient’s recovery, and the quicker, the better. So, after his ultrasound, a nasal feeding tube was placed, and tube feeding was started later that day. Billy continued his medication with the addition of intravenous antibiotics. His glucose and potassium levels were monitored several times a day, and his blood pressure was checked to rule out any signs of sepsis (a life-threatening infection in the blood). Billy stayed in hospital for four more days, receiving round-the-clock care, medication, and tube feeding. Finally, on day five, Billy was eating and could be weaned off his strong pain relief. It was time to go home.

Billy’s future

Billy remained on treatment for four weeks, returning to the vet several times for rechecks. His blood tests all improved to normal levels, and luckily (to the relief of his owners), he did not develop diabetes. He did have trouble with diarrhoea, but a faecal sample was normal, so the owners elected to trial a hypoallergenic diet which really helped. 

Billy’s hospital stay and lengthy recovery were extremely worrying for his owners. Thankfully Billy was insured, which meant that the owners knew they’d be reimbursed for most of the costs. This was a huge relief and made it possible to run all the tests needed to reach a diagnosis and provide intensive treatment to get Billy better. Also, if he has a relapse or needs further investigations, such as bowel biopsies in the future, insurance is in place to help.

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Two months after his initial illness, Billy was back to his old self, sunbathing in the garden and scoffing his new hypoallergenic diet. He looked a picture of health, and his owners were over the moon. They also knew the early warning signs for triaditis and were keeping a very close eye on him – just in case.