Abdominal Distension & Third Eyelid Protrusion in a Young Cat: Clinician's Brief

[Mij]

Katrine Clarke, BVSc, MRCVS, BSAVA, PGCertSAM, DECVIM-CA, Davies Veterinary Specialist, Hertfordshire, United Kingdom

August 2026

"Marmalade, an 18-month-old, neutered male, indoor/outdoor domestic shorthair cat, was presented with a short but progressive history of vomiting, anorexia, third eyelid protrusion, abdominal distension, and depression. Because Marmalade urinated and defecated outside, the owner was unable to provide information about fecal consistency or urination habits. There was no previous medical history; parasite preventives and vaccinations were current."

Differential Diagnosis
Dysautonomia was considered based on clinical signs (ie, vomiting, anorexia, bilateral nictitans protrusion and mydriasis, tacky mucous membranes, nasal crusting, bradycardia, large urinary bladder) and apparent multisystem dysfunction; however, dysautonomia is largely a diagnosis of exclusion. Methodical investigations are therefore needed to exclude other differential diagnoses (eg, primary GI disturbance causing anorexia, dehydration, presumptive vagally mediated bradycardia due to abdominal pathology, vomiting-induced rhinitis, mydriasis secondary to situational fear of the clinic).

 

[Peter T]

Holy shit, Marmalade received more testing and treatments than anyone I've ever known, and in the UK to boot!

Who paid for this?

That was my thought every time I took an animal to the vet’s with significant health issues.

My mother’s spaniel had lots of health issues and the pet insurance policy was registered with the vet’s. It seemed that the vet just automatically did whatever tests were needed or arranged a specialist consultation, directly billing the insurers. No waiting lists, no quibbles.

Also generally vets respond to presenting symptoms rather than getting distracted by irrelevant psychological issues.

 

[Mij]

Outcome:

Marmalade was hospitalized for 10 days. He had begun eating small amounts of food, and urination behaviors were near normal. Mild constipation that developed during the hospital stay was resolved with lactulose (2 mL/kg every 12 hours). Prazosin (1 mg/cat PO every 8 hours), bethanechol (2.5 mg/cat PO every 8 hours), maropitant (2 mg/kg PO every 24 hours), lactulose (2 mL/kg PO every 12 hours), ocular lubrication, and cisapride (2.5 mg/cat PO every 8 hours) were prescribed, and an esophageal feeding tube was in place on discharge.

 

[InitialConditions]

I read this as third eye protrusion and thought Marmalade had ascended to a higher astral plane.

 

[Mij]

Marmalade wasn't prescribed switching up puzzle toys turn snack time into brain training.