Kote’s Clinical Case - Diagnosis of Feline Triaditis.

Kote’s Clinical Case - Diagnosis of Feline Triaditis.

Kote is a 7-year-old cat who was brought to Veterinarium with lethargy, anorexia, repeated vomiting, and constipation that had begun the previous day.

While obtaining the clinical history, Veterinarium’s small-animal internist and ultrasonographer, Nutsa Besashvili, noted that Kote had been excessively licking his coat (overgrooming) in the weeks prior to presentation. Physical examination additionally revealed gingivitis and multiple oral abscesses that required surgical intervention.

Abdominal ultrasonography and contrast radiography, together with the clinical signs, initially raised strong suspicion for small intestinal obstruction. To rule out this possibility, a diagnostic laparotomy was performed, which confirmed the absence of any intraluminal foreign body. While under anesthesia, Kote also underwent dental sanitation and extractions, performed by Veterinarium’s veterinary dentist, Barbare Kurtsikidze.

Abdominal ultrasonography performed by Nutsa Besashvili revealed the following findings:

• Exocrine pancreatitis
• Gallbladder sediment (sludge)
• Duodenitis (inflammation of the duodenum)

A complete blood count (with morthology) and full serum biochemistry panel performed at the Veterinarium diagnostic laboratory additionally confirmed pancreatitis.

Based on the combination of imaging findings, laboratory results, and clinical signs, 4 days after admission, Nutsa Besashvili established a final diagnosis of feline triaditis.

Feline triaditis is a multi-organ inflammatory syndrome characterized by concurrent: exocrine pancreatitis, inflammation of the biliary system (cholangitis), and inflammation of the small intestine (enteritis).

This condition is considered unique to cats due to their anatomical structure: in most cats, the common bile duct and the pancreatic duct merge and empty together into the duodenum, which facilitates the spread of inflammation from one organ system to another. Recent histopathological studies strongly support this anatomical relationship as a key factor in the pathogenesis of triaditis.

The exact etiology of triaditis remains unclear. Proposed mechanisms include:

• Immune-mediated processes
• Bacterial infections

In Kote’s case, the underlying cause was most likely bacterial, as he had no prior history of similar episodes and showed rapid improvement once appropriate antibiotic therapy was initiated.

Kote exhibited several days of persistent vomiting, anorexia, and lethargy, requiring hospitalization in the clinic’s day-patient ward for continuous monitoring and intensive treatment. Nutsa Besashvili attended to the patient even on her non-working days to ensure close supervision and supportive care.

Because vomiting was severe and unresponsive to single-agent antiemetic therapy, a combination of maropitant and ondansetron was administered, along with repeated intravenous fluid therapy throughout the day.

Considering the most common bacterial agents associated with infectious triaditis (E. coli and Enterococcus spp.) the antibiotic selected was amoxicillin-clavulanate. For the management of cholangitis, ursodeoxycholic acid was prescribed, and a therapeutic highly digestible, balanced diet was formulated specifically for Kote’s condition.

Throughout the case, Nutsa Besashvili was supported by Veterinarium’s small-animal internist Nino Kushitashvili and veterinary assistant Mariam Berishvili.

Following accurate diagnosis, appropriate medication selection, intensive fluid therapy, and timely initiation of antibiotic treatment, Kote showed rapid clinical improvement. He is currently stable and continues on his prescribed therapeutic diet and individualized treatment plan.