Looking for a Vet's advice. Cat has rare problem...Please help.?

Question

My cat has been diagnosed with ppdh and secondary chylothorax. He is a little over a year old and has had no other problems until now. One opinion I have been given is to have surgeons inject his thoracic duct with dye to find where the chyle is leaking from and ligate. Does this sound accurate? It is so hard when dealing with vets and not knowing their terminology and figuring out what is best for your pet. Any advice would be greatly appreciated and I can offer more info if needed.

Thanks :)

Answer 1

From what I just read that sounds appropriate.  But I'm not a vet and all I did was google.  If I were you I'd do the same.  You can learn quite a bit in spite of the medical terminology.

PPDH:  "Thoracic radiographs can demonstrate small intestinal loops or liver crossing the diaphragm into the pericardial sac. A contrast radiographic examination using oral barium may also identify small intestinal loops or stomach in the pericardial sac. The diagnosis can be made by the findings of abdominal viscera in the pericardial sac on echocardiography as well. Patients with vomiting, signs of hepatic encephalopathy, or other adverse conditions resulting from PPDH should have a surgical reduction of the hernia."

"What is the treatment for diaphragmatic hernia?

If there is a history of recent tra

hat is the prognosis?

t with diaphragmatic hernia is

the patient stabilizes with medical treatment, is it possible to avoid

ases, adhesions may form between the lungs and any herniated abdominal

uma, the dog must be stabilized before the hernia can be corrected. Some patients will require emergency thoracocentesis (a chest ‘tap’) to remove any fluid that is accumulating in the chest cavity. Once the patient is stabilized and a diagnosis is made, the hernia must be corrected surgically. In congenital forms, surgical intervention as early as possible is important to prevent organ entrapment or scarring between the intestines and the chest cavity. Many congenital diaphragmatic hernias are discovered during ovariohysterectomy surgery, and are corrected at that time."

chylothorax:  "The most effective form of treatment is surgical ligation of the thoracic duct combined with partial pericardectomy."

"Treatment of chylothorax is dependent on the cause of the effusion. Both medical and surgical therapy have been used. An underlying cause or primary disease process should be identified and corrected, if possible. Medical therapy consists of thoracocentesis, dietary management, and drug therapy. Thoracocentesis allows palliative drainage and clinical improvement of respiratory distress.2 Initial thoracocentesis may be performed with a needle, but chest tube placement may be required for daily drainage.5 Traditionally, it has been suggested that the animal be placed on a low-fat diet to decrease the amount of lipid absorbed via intestinal lymphatics; however, loss of fat-soluble vitamins, lipids, and protein-rich lymph fluid may contribute to a state of malnourishment in the animal. It has been shown recently that a low-fat diet does not decrease the flow volume of effusion. It was once thought that supplemental medium-chain triglycerides would provide additional dietary lipid and bypass the thoracic duct because they were absorbed directly into the portal circulation. However, it has been demonstrated recently that the medium-chain triglycerides do not bypass the thoracic duct.1,5 In cases of severe malnutrition, parenteral nutrition can bypass the gastrointestinal system and decrease lymphatic flow.2 Rutin (a benzopyrone compound extracted from the fruit of the Brazilian Fava D’Anta tree) administration may result in clinical improvement of cats with idiopathic chylothorax. Suggested mechanisms of action for rutin include reduced leakage of lymph from lymphatic vessels, increased protein removal by lymphatics, increased phagocytosis by stimulation of macrophages, increased recruitment of macrophages in tissues, and increased proteolysis and removal of protein from tissues.7"