cat hernias

8/10/2019 Cat hernias

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Veterinary TIMES

FOCUS LIV ER FLUKE LARGE ANIMAL

lead to problems in younger animals that subse-quently graze the land, says Mr Haslam. Treat-ment before cattle go out to grass will alsohelp take the pressure off the other available

ukicide treatments later in the year, he says.Another veterinary medicine containingmg/ml oxyclozanide (Douvistome) is avail-

able in France and the treatment has a zeromilk withdrawal in that country. As a licensedveterinary medicine containing an identi-cal active ingredient (Zanil), with a clear milkwithdrawal identied in the SPC now availablein the UK, Douvistome should not be pre-scribed or dispensed for use in UK dairy cows.

Triclabendazole per cent (Fasinex )and per cent (Endouke mg/ml) arelicensed for the treatment of acute, suba-cute and chronic infection due to triclaben-dazole-susceptible Fasciola hepatica indairy cattle. Triclabendazole is highly effec-tive against all stages of F hepatica fromtwo-week-old, early, immature forms toadult uke , though triclabendazole-resist-ant parasite strains have been reported.

Fasinex is not authorised for use inlactating cattle producing milk for humanconsumption and is not intended for usewithin days of calving. Milk for humanconsumption may only be taken from hours after calving. Should a cow calve ear-lier than days after the last treatment,milk for human consumption may only betaken from days after the last treatment.

Endouke mg/ml oral suspension islicensed for use in dairy cattle, although it is notintended for use within days of calving. Ifcalving occurs before days after treatment,milk for human consumption may only be takenafter day plus hours after the treatment.

Along with triclabendazole, albendazole andoxyclozanide, a number of products are avail-able for pre-turnout treatment of mature ukein adult beef cattle. These include productscontaining closantel, nitroxynil and clorsulon.

When treating cattle after turnout, choos-ing the correct product is vital. No ukicidehas persistent action, so reinfection may occur

soon after treatment. Each treatment is effec-tive at killing a different range of larvae agesand adult uke, so dosing frequency shouldbe carefully observed. In addition, accuratedosing is important, as underdosing may leadto ineffective treatment or increase the risk ofresistance developing. Overdosing may have

toxic side effects. All cattle in the group shouldbe dosed according to the heaviest in thegroup. If there is wide variation in bodyweight,then the group may be split and cattle dosedaccording to the heaviest in each sub-group.

With unpredictable weather patterns andgrowing risk factors for liver uke, manysheep farmers are nding fasciolosis a seri-ous problem. Help is desperately neededto help increase understanding of differ-ent testing regimes and medicines and todrive new diagnostics and testing options,said NFU south-east livestock board mem-ber and Surrey farmer Hugh Broom.

Recently, a cross-industry working groupwas convened to further the need for answersand involved key research and industry bod-ies such as the Moredun Research Institute,the National Sheep Association, SustainableControl Of Parasites in Sheep, Defra, farmersand vets. This group has started to talk aboutsolutions to the issues surrounding timelydiagnosis and triclabendazole resistance.

The challenges of diagnosis in sheep mirrorthose in cattle, but with acute disease in sheepcaused by migrating immature parasites, anearly diagnosis is particularly important. Typ-ically, faecal egg counts are not reliable withintermittent and irregular shedding of ovaonly occurring to weeks post-infection,limiting the benet of faecal egg counts.

A new Fasciola antigen ELISA detection kit(Bio K ) is available from BioX, which allowsthe detection of specic anti-parasite circu-lating antibodies in faeces within three to ve

weeks of initial infection . This technique mayexpedite diagnosis in the previously nave ock,but its use may be limited in endemic ukeareas, where antibody titres remain consistentlyhigh with or without active parasite levels.

The concern around triclabendazole resistanceis always present, but this treatment can stillplay an important part in the control of uke in

many ocks. Before conrming resistance, vetsshould be sure reinfection has not occurred,the product was not faulty and has been storedcorrectly, and ask if the dose was adminis-tered correctly and in the correct volume, saidFiona Anderson of Novartis Animal Health.

Mr Broom believes following these threesimple rules has allowed him to control ukeon his farm using triclabendazole, despitemany of the uke risk factors being pres-ent. Attention to detai l and weighing ewesand lambs to ensure accurate dosing hasbeen the key to our success, he said.

With ever-changing weather patterns increas-ingly commonplace and the importance ofretaining the efcacy of the medicines availa-ble to the livestock practitioner, an understand-ing of the disease burden on farm, supportedby laboratory diagnosis of disease, will be vitalin choosing the correct treatment and ensurethe health, welfare and continuing productiv-ity of all the cattle and sheep under our care.

References

. Met Ofce data.

. Dobbs M ( ). Current challenges in uke control fordairy producers, Vet Times ( ): - .

. Bennet R and Ijpelaar J ( ). Economic assessmentof livestock diseases in Great Britain. Final report to Defra.The Department of Agricultural and Food Economics,University of Reading.

. ww w.moredun.org.uk/research/research-% -moredun/parasitic-worms/liver-uke

. Armstrong D ( ). Liver uke in cattle costsand control. www.eblex.org.uk/wp/wp-content/uploads/ / /Liver-uke-in-cattle-costs-and-control.pdf

. The University of Reading, Department of Agricultureand Food Economics, The Economics of Fascioliasis.

. Mezo et al ( ). Association between anti-F hepaticaantibody levels in milk and production losses in dairycows, Veterinary Parisitology ( - ): - .

. Taylor M A ( ). Emerging parasitic diseases ofsheep, Veterinary Parasitology ( ): - .

. www.nadis.org.uk/parasite-forecast.aspx. www.farminguk.com/News/Liver-uke-treatment-

re-introduced-by-MSD_ .html. www.defra.gov.uk/ahvla-en/ / / /

ahvla-further-warning-ukes/. www.noahcompendium.co.uk/Virbac_Limited/Albenil_

Low_Dose_ _ACU-_w_v_oral_suspension/- .html. www.noahcompendium.co.uk/MSD_Animal_

Health/Zanil_Fluke_Drench_ _mg_ml_Oral_Suspension/- .html

. www.cattleparasites.org.uk/

. www.noahcompendium.co.uk/Novartis_Animal_Health_UK_Ltd/Fasinex_ __ _ACU-_Oral_Suspension_for_cattle/- .html

. Mezo et al ( ). Optimized serodiagnosis of sheepfascioliasis by FPLC fractionation ofFasciola hepatica excretory-secretory antigens, Journal of Parasitology :

- .

MATT DOBBS became a directorand vet with Westpoint VeterinaryGroup in Sussex, after time in practicein the West Country and as lecturer indairy practice at the University of Syd-ney and the RVC. His current researchand consultancy interests include animal healthpolicy and the law of livestock agriculture.

continued from page

Main : Wetter weathercan mean increasedrisk for cattleand sheep. Inset :Intermediate hostGalba truncatula .

CLINICAL FELINE0

PERINEAL hernia is causedby a failure of the pelvicdiaphragm muscles result-ing in loss of support tothe colorectal junction andrectum. It is a common con-dition in male entire dogsand is generally considereda disease of middle-agedand older individuals.

It is much less commonlydocumented in the cat whereit seems to occur mostly inneutered animals and typi-cally develops as a secondaryproblem, rather than a pri-mary one. However, numbersreported in the literature aretoo small to draw any rmconclusions about relation-ships between specic pri-mary conditions and perinealhernia (Ashton, ; Benitahand et al, ; Johnston andGourley, ; Galanty, ;Pratschke, ; Rashbaum,

; Risselada et al, ;

Vnuk et al, ; Welches etal, ). Bilateral herniationis apparently more commonthan unilateral (Welches et al,

). The following casesdescribe perineal hernia-tion linked with concurrentanal sac/rectal disease andpotential inammatory boweldisease (IBD) in three cats.

Case A four-year-old, male, neu-tered Burmese cat wasreferred with a two-year

history of recurrent rectal pro-lapse. Medical treatment withlaxatives and placement ofpurse string sutures had beenattempted. Over the two-yearperiod, the prolapse becameprogressively larger, with themost recent episode resultingin ve centimetres of rectumbeing prolapsed. The cat wasalso receiving treatment withprednisolone for feline asthmaand had been tentatively diag-nosed with IBD in the past.

On presentation, the cat was

bright and alert with routineclinical parameters withinnormal limits other than aslightly low body conditionscore (BCS) of / . Abdomi-nal palpation revealed faecalballs within the colon and milddiscomfort. No rectal prolapsewas present at this time. Hae-matology and biochemistrywere unremarkable, except

for a mildly increased urea( . mmol/L; reference range[RR] . - . mmol/L) andalanine transaminase (ALT;

U/L; RR < U/L). Ultra-sonography showed promi-nent peristalsis, although thelumen diameter, intestinal wallthickness and layering werenormal. The entire colon waslled with solid faecal mate-

rial. Rectal palpation underanaesthesia conrmed severebilateral perineal hernias andbilateral anal sac impactions.

Surgical correction of theperineal hernias, combinedwith colopexy for the recur-rent rectal prolapse, wasrecommended. The ownerswere also advised the previ-ous diagnosis of IBD should

BILATERAL PERINEAL HERNIA INTHREE CATS: CASE STUDIES

KATHRYN PRATSCHKEMVB, MVM, CertSAS, Dipl ECVS, MRCVS

LAURA MARTINBVM&S, MRCVS

present case studies that detail the problemssurrounding this condition, explaining diagnosticapproaches and surgical techniques carried out

ABSTRACT

Two males and one female with bilateral perineal hernias were treated; all were neutered. Twocases had a history of rectal prolapse, one had chronic constipation and all had recurrent analsac impaction. All cases were treated surgically with bilateral internal obturator muscle aptransposition, plus incisional colopexy in the two with concurrent rectal prolapse. All had fullthickness intestinal biopsies and mesenteric lymph node biopsies.

Histological diagnosis was suggestive of inammatory bowel disease, and two cases hadpositive cultures for known intestinal pathogens. Postoperative outcome was good or excellentwith follow-up at least six months after surgery.

Keywords: perineal hernia, cat, anal sac, internal obturator muscle aptransposition, colopexy.


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be conrmed and accuratelycharacterised with full thick-ness intestinal biopsy samples.At surgery, the liver appearedgrossly paler than normal,with a mottled appearance,so a hepatic biopsy wastaken in addition to jeju-nal and mesenteric lymphnode. An incisional colopexywas performed as describedin the literature ( Figure )

(Popovitch et al, ).Bilateral perineal hernior-

rhaphy was then performedwith the internal obturatorelevation technique ( Figures

and ; Bellenger and Can-eld, ). The overall sur-gery time was minutes.Perioperative analgesia wasprovided with a constant rateinfusion of fentanyl ( . g/kg/min to . g/kg/min; Mar-tindale) and buprenorphine IM( . mg/kg every six hours,Vetergesic; Alstoe). Prophylac-tic antibacterial therapy wasprovided with cefuroxime IV( mg/kg, Zinacef; Glax-oSmithKline). Postoperatively,the cat received oral amoxicil-lin-clavulanate tablets ( mg/kg every hours, Synulox;Pzer) for seven days, meloxi-cam ( . mg/kg every hours, Metacam; Boehringer),ranitidine for two days( . mg/kg every hours,Zantac; GlaxoSmithKline)and lactulose ( ml every hours; Sandoz). Predniso-lone was stopped temporar-ily while on treatment withNSAIDs. The cat recoveredwell from surgery, with noearly signs of recurrent pro-

lapse and was dischargedve days after surgery.

Histopathology of the sam-ples taken during surgeryshowed vacuolar hepatopathyof the liver, a likely conse-quence of glycogen accu-mulation due to the predni-solone medication for felineasthma. The jejunal biopsyshowed mild chronic enteritis,consistent with mild inam-matory disease previouslydiagnosed. The mesentericlymph node showed lym-phoid hyperplasia, consist-ent with a reactive node.

During a follow-up tele-

phone interview sevenmonths after surgery, theowner reported excellentresults, stating the cat had a

changed life, a good regularappetite and no apparentdifculty or tenesmus whendefaecating. There had beenno recurrence of the rectalprolapse since surgery.

Case A -year-old female, neu-tered domestic shorthair (DSH)was referred with a one-month history of constipation.The straining was so severethat vomiting had occurredand the cat had become dis-tressed and lethargic. Weightloss had occurred despite agood appetite. Medical treat-ment had been attemptedwith laxatives and enemas,which helped transiently.

On presentation, the cat wasbright and alert with routineparameters within normallimits other than a high BCSof / . Abdominal palpationrevealed impacted faecesin the colon and discomfort.Haematology identied aleukocytosis ( . /L;RR . - . /L) withneutrophilia ( . /L;RR . - . /L). Viraltesting was negative for FeLVand FIV, and the coronavirus

titre was zero. Ultrasonog-raphy showed a prominentspleen with slightly hypo-echoic parenchyma, but anultrasound-guided aspirateshowed no signicant abnor-malities. The ileocolic lymphnodes were prominent andreactive, and the surround-ing mesentery hyperechoic.Radiography showed a dif-fuse interstitial pattern in thelungs, likely due to obesity.Abdominal radiography wasunremarkable. Rectal palpa-tion under sedation diagnosedbilateral perineal hernias andbilateral anal sac impactions.

A standard midline explor-atory coeliotomy was per-formed, which identied achain of enlarged ileocolic

lymph nodes. Two wereremoved for histopathology,one of which was abscessed.A swab of the abscessed nodewas also taken for bacteriol-ogy. Incisional full thicknessbiopsies were taken of thecolon and jejunum and a liverbiopsy was collected. Bilateralperineal herniorrhaphy wasthen performed as describedin case one (Bellenger andCaneld, ). The total sur-gery time was minutes.

The cat received an epiduralprior to surgery, contain-ing both morphine ( . mg/kg; Martindale) and bupiv-acaine ( . mg/kg; Astra-Zeneca). Amoxicillin-clavulanicacid ( mg/kg, Augmentin;GlaxoSmithKline) was givenIV for perioperative antibac-terial therapy, followed byoral amoxicillin-clavulanicacid ( . mg/kg every hours, Synulox; Pzer) forseven days. Analgesia wasprovided postoperatively withbuprenorphine ( . mg/kgevery six hours, Vetergesic;Alstoe) and meloxicam( . mg/kg every hours,Metacam; Boehringer). Inaddition, ranitidine was pro-

vided for ve days ( mg/kgevery hours, Zantac; Glax-oSmithKline) and lactulose( ml every hours; Sandoz).The cat was discharged twodays after surgery with noearly complications and own-ers were advised on dietarymanagement with IBD.

Histopathology identiedcholangiohepatitis with alymphoplasmacytic inltrate,neutrophilic and lymphoplas-macytic colitis and lymphop-lasmacytic enteritis. Lymphoidhyperplasia, in addition tosevere necrotising and pyo-granulomatous page

Perineal hernia is an uncommon conditionin the cat. It is most often seen in neutered

animals and has most commonly beenreported as a secondary condition.

Figure 1 . Incisional colopexy. B = bladder, C= colon, S = small intestine.

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Veterinary TIMES

CLINICAL FELINE2

lymphadenitis, were also diag-nosed. A pure growth of Strep-tococcus canis was culturedfrom the abscessed node,which was sensitive to theantibiotics already dispensed.

At routine check-up, twoweeks after the surgery, thecat was making very goodprogress. Motions were being

passed without any dif-culty daily, with no recurrentpain or tenesmus. At tele-phone interview six monthsafter surgery, the ownerreported continued improve-ment. There was still minimaltenesmus when defaecating,but this was much improvedcompared to before surgery.

Case A three-year-old male, neu-tered DSH was referred witha three-month history ofrectal prolapse. A purse stringsuture had previously beenplaced, but the conditionrecurred. Apart from occa-sional anal sac impactions,the cat had no other historyof gastrointestinal problems.

On presentation, the catwas bright and alert withroutine clinical parameterswithin normal limits and noabnormalities on abdominalpalpation. There was a smallarea of everted rectal mucosain the left dorsal quadrantof the anus. The tissue waspink and looked healthy,although the owners notedit bled occasionally. Routinehaematology was unremark-

able, but serum biochemistryrevealed mild elevations inALT levels ( U/L; RR< U/L)as well as urea ( mmol/L;RR . - . mmol/L) andcreatinine ( mol/L; RR

- mol/L), althoughurine specic gravity waswithin normal limits. Radi-ographs and ultrasonogra-phy scan of the abdomenwere unremarkable, butrectal examination undersedation revealed bilateralperineal hernias, with bilat-eral anal sac impactions.

Perineal hernia repair, com-bined with colopexy, wasrecommended, but in light ofthe mild elevations in ureaand creatinine, it was recom-

mended the procedures beseparated into two surgeriesrather than having one longeranaesthetic episode. At sur-gery, a subjective assessmentwas made that the small andlarge intestinal walls werethinner and more accid thannormal, with overall poormotility throughout the gas-trointestinal tract. Full thick-ness biopsies were taken from

the jejunum and the colon, aswell as the mesenteric lymphnodes. Incisional colopexy wasthen performed using a stand-ard technique and surgerylasted minutes (Popovitchet al, ). Perioperativeanalgesia was provided witha constant rate infusion ofremifentanil ( . g/kg/min,Ultiva; GlaxoSmithKline) plusmethadone ( . mg/kg everyfour hours for four doses; Mar-tindale) followed by buprenor-phine ( . mg/kg every sixhours, Vetergesic; Alstoe). IVuid therapy with isotoniccrystalloids was continuedovernight at ml/kg due tothe raised renal parameters.Amoxicillin-clavulanic acid( mg/kg every eight hours,Augmentin; GlaxoSmith-Kline) was used for perioper-ative antibacterial therapy.

Two days after the initialsurgery, bilateral perinealherniorrhaphy was performed,as described previously, witha surgery time of min-utes (Bellenger and Caneld,

). The cat received anepidural with bupivacaine( . mg/kg; AstraZeneca)preoperatively. Biochemis-

try taken before anaesthe-sia showed the urea levelshad returned to within nor-mal limits ( mmol/L; RR

. mmol/L to . mmol/L),but the creatinine levels hadincreased further ( mol/L;RR mol/L to mol/L),again suggestive of renalinsufciency. IV uid therapywas administered at ml/kg/hr during surgery, maintainedat ml/kg/hr overnight andurine output was monitored.Perioperative analgesia andantibacterial therapy were thesame as for the rst operationwith postoperative buprenor-phine ( . mg/kg every sixhours, Vetergesic; Alstoe)and metronidazole ( mg/

kg every hours, Flagylsolution; Winthrop). The dayafter surgery, the creati-nine level had fallen slightly( mol/L; RR mol/Lto mol/L), but ureawas slightly raised further( . mmol/L; RR . mmol/Lto . mmol/L) and manage-ment for renal insufciencywas continued. Repeat bloodstwo days later conrmed

both and urea ( . mmol/L;RR . mmol/L to . mmol/L)and creatinine ( mol/L;RR mol/L to mol/L)were within normal limitsagain. There was still a smallportion of protruding rectalmucosa present, but the catwas passing faeces withoutdifculty at this stage and wasdischarged four days after thesecond surgery. The own-ers were advised to ensureadequate bre intake in thediet to promote intestinalmotility and stool formation.

Histopathology showed aneutrophilic, chronic-active,diffuse colitis and enteritis.The sample from the jejunumwas signicantly more severethan the colonic sample. Neu-rons were present in expectednumbers within the intestinalsamples and the architecturewas normal. The mesentericlymph node showed evidenceof active lymphoid hyperpla-sia. Bacteriology from thisnode identied a non-haemo-lytic Escherichia coli . Therewas no evidence of nema-tode eggs, cryptosporidiumoocysts or faecal protozoaon faecal examination.

At telephone interview months after surgery,

the owner reported goodimprovement. The cat stillhad occasional tenesmus anda small persistent area ofmucosal prolapse, but the con-dition had improved markedlyin terms of severity since thesurgery and the owners felt itwas now readily manageable.

DiscussionPerineal hernia is an uncom-mon condition in the cat. It ismost often seen in neuteredanimals as in the three casesreported here and has mostcommonly been reportedas a secondary condition.Bilateral herniation has beenmore commonly reported incats, as was the situation inall three cases reported here(Bellenger and Caneld, ;Fossum, ; Welches etal, ). It is tempting tospeculate the more privatenature of cats toilet habitscompared to dogs makes itless likely a problem will benoticed until the condition ismore advanced and the clin-ical signs are more obvious.

Potential causes of perineal

herniation in cats have beenreported to include previ-ous perineal urethrostomysurgery, megacolon, perinealmasses, chronic brosingcolitis, trauma and cutane-ous asthenia (Bellenger andCaneld, ; Benitah et al,

continued from page

Figures 2(left) and3. Internalobturatormuscle apelevation.A = anus,IOMF =internalobturatormuscle ap.

Potential causes of perineal herniation incats have been reported to include previous perineal urethrostomy surgery, megacolon,

perineal masses, chronic brosing colitis,trauma and cutaneous asthenia.

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; Johnson and Gourley,, Welches et al, ).

Two of the cases reportedhere had a history of rectalprolapse, all three had recur-rent anal sac impaction andone had chronic constipationin addition to which all threehad histopathology resultsthat were suggestive of acomponent of underlying IBD.Anecdotally, recurrent anal

sac impaction is often seenwith perineal hernia in thedog, presumably due to lossof normal muscle contractionsat the rectocutaneous junc-tion, compromising expres-sion of anal sac contents. Itseems reasonable to assumea similar phenomenon existsin cats with perineal her-nia. Once recurrent anal sacimpaction is present it willthen contribute to perinealand rectal irritation, and couldpotentially become a per-petuating factor. The ndingof rectal prolapse in two ofthe cats supports previousreports of its occurrencealongside perineal hernia(Welches et al, ). Indogs, it is mainly reportedas a postoperative compli-cation occurring because ofstraining due to pain, fromsutures placed within therectal lumen or from nervedamage during surgery (Bel-lenger and Caneld, ;Matthiesen, ). The casesseen in this study, however,support the theory that rectalprolapse may be an impor-tant predisposing cause forperineal hernia develop-

ment in cats. All three caseshad histopathology resultssuggestive of IBD, and twocases had positive cultures forintestinal pathogens ( S canis and E coli ) from mesentericlymph node biopsies. It couldbe theorised the inam-matory intestinal disease inthese cats may have affectednormal gastrointestinal con-tractility, transit times andperistalsis, thereby contrib-uting to tenesmus and rectalprolapse and thus further pro-gression to perineal hernia.

Medical management is oflimited value as a sole methodin the treatment of perinealhernias due to the progressivenature of the condition andas quality of life can becomeaffected by its presence. Long-term use is contraindicated,as life-threatening visceralentrapment and strangu-lation can occur (Fossum,

). It has its main use inmild hernias and those with

minimal clinical signs, hencesurgery is generally the pre-ferred treatment choice, withsuccess rates of per centreported in cats (Welches etal, ). The internal obtura-tor muscle ap transpositiontechnique (IOFT) was used inall three cases here and aidsto ll the ventral defect in theperineal diaphragm, whichcan prove difcult with other

techniques (Bellenger andCaneld, ; Hardie et al,

). The procedure followsthat for the dog and has beendescribed in previous reportsof perineal hernia repair incats. Our ndings providefurther evidence the tech-nique is an effective way ofmanaging the condition in catsand that bilateral one-stagerepair can be safely performed(Benitah, ; Galanty,

; Welches et al, ).The traditional anatomic

repair, similar to the techniquedescribed in dogs, has alsobeen used in the past, butthere are important speciesdifferences to note. Cats haveno sacrotuberous ligamentand the muscles of the peri-neum are much less substan-tial than in the dog, meaningthis technique is likely to beless satisfactory in the cat. Asit is already associated with asignicantly higher recur-rence rate in dogs than IOFT,it cannot be recommendedfor routine use in cats in bilat-eral, chronic or large hernias(Bellenger and Caneld, ;Martin et al, ; Vnuk et al,

). There has been one

report documenting the useof a semitendinosus muscleap technique in a cat witha trauma-induced perinealhernia, with the semitendino-sus muscle being transectedat the mid-belly and rotatedventrally beneath the anus toll the defect. The right sem-itendinosus muscle was usedto repair a left-sided traumatichernia with a good outcomereported (Chambers and Rawl-ings, ; Vnuk et al, ).

Overall, perineal hernia isan uncommon, but potentiallyimportant, and very possiblyunder-diagnosed, condition incats that can have a signicantadverse effect on the qualityof life. Although it does havesome similarities in pres-entation to dogs, it should benoted it may present quitedifferently and we suggestcats presenting with tenesmusand constipation all warrantfurther investigation to ruleout perineal hernia and also

that rectal examination shouldbe utilised more frequentlyin cats with this type of pres-entation. Based on our cases,clinicians should consider per-ineal hernia may be associatedwith rectal prolapse, anal sacimpaction and IBD in cats, butgood outcomes are possiblewith the appropriate diagnos-tic and surgical approach.

References

Ashton D G ( ). Perineal herniain the cat a description of twocases, Journal of Small AnimalPractice ( ): - .Bellenger C R and Caneld RB ( ). Perineal Hernia. InSlatter Textbook of Small AnimalSurgery ( rd edn), W B Saunders,Philadelphia pp - .Benitah N, Matousek J L, Barnes RF et al ( ). Diaphragmatic andperineal hernias associated withcutaneous asthenia in a cat, Journalof the American Veterinary Medicine

Association ( ): - .Chambers J N and RawlingsC A ( ). Applications of a

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KATHRYN

PRATSCHKE graduated fromUniversity CollegeDublin in 1994, where she alsocompleted an internship andresidency training in small ani-mal surgery. She was appointedsenior university clinician at theUniversity of Glasgow in April2008 and has been head ofsurgery since 2009. Kathryn is adiplomate of the European Col-

lege of Veterinary Surgeons andan RCVS-recognised specialistin small animal surgery.

LAURA MARTIN graduated fromthe Royal (Dick)School of VeterinaryStudies in 2008. She workedfor two years in mixed practicein Durham and then moved tothe University of Glasgow tocomplete a small animal intern-ship. She has remained in smallanimal practice and works atPDSA in Edinburgh.

semitendinosus muscle ap intwo dogs, Journal of the AmericanVeterinary Medicine Association

: - .Fossum T W ( ).Surgery of thedigestive system in Small AnimalSurgery ( nd edn), Mosby, St Louispp - .Galanty M ( ). Perineal hernia in

cats, Polish Journal of VeterinaryScience : - .Hardie E M, Kolata R J, Earley T Det al ( ). Evaluation of internalobturator muscle transposition intreatment of perineal hernia in dogs,Veterinary Surgery : - .

Johnson M S and Gourley I M( ). Perineal hernia in a cat: apossible complication of perinealurethrostomy, Veterinary MedicineSmall Animal Clinician : - .Martin W D, Fletcher T F and Brad leyW E ( ). Perineal musculaturein the cat, Anatomical Record :

- .Matthiesen D T ( ). Diagnosisand management of complicationsoccurring after perinealherniorrhaphy in dogs, Compendiumof Continuing Education for thePracticing Veterinarian : - .Popovitch C A, Holt D and Bright R( ). Colopexy as a treatmentfor rectal prolapse in dogs and cats:

a retrospective study of cases,Veterinary Surgery : - .Pratschke K ( ). Managementof hernias and ruptures in smallanimals, In Practice : - .Rashbaum R A ( ). Perinealhernia in a cat, Journal of the

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Activyl contains 195mg/ml indoxocarb. For dogs and cats and the treatment and prevention of flea infestation(Ctenocephalides felis). Legal category POM-V. Activyl is the property of IntervetInternational B.V. or affiliated companies or licensors and is protected by copyrights, trademark and other intellectual property laws. Copyright 2014 Intervet International B.V. All rights reserved.Further information is available f rom: MSD Animal Health, Walton Manor, Walton, Milton Keynes MK7 7AJ Tel :01908 685685, [email protected], www.msd-animal-health.co.uk. Usemedicines responsibly www.noah.co.uk/responsible*YouGov survey. Total sample size was 2004 GB adults who own a cat or a dog. Fieldwork was undertaken between 2629 October 2013. The survey was carried out online.

Its not about whereActivyl switches on.Its about where it doesnt.Given that 48% of owners let their cat or dog regularly sleep on their bed, and 12% on theirpillow,* prescribing a bioactivated flea treatment is an ideal way to beat fleas. Activylswitches on inside the flea, therefore minimising active chemicals being spread across the

duvet. And as it kills flea eggs and larvae too, theres less chance of an infestation right whereyoud least want it. So the next time you prescribe Activyl you can be sure it will only workwhere its meant to on fleas.

The first flea treatment with bioactivation

Switch on. Beat fleas.

cat hernias

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