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| − | {{Unfinished}}
| + | #REDIRECT[[Key-Gaskell Syndrome]] |
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| − | Also known as Feline Key-Gaskell Syndrome and Feline Autonomic Polygangliopathy.
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| − | Part of a syndrome of generalised autonomic neuropathy. It has been observed throughout Western Europe and The United States.
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| − | ==Signalment==
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| − | * Historically reported most frequently in cats but now also in dogs
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| − | * Usually seen in younger dogs
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| − | * No sex predisposition
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| − | * In a recent study of dogs confirmed as having dysautonomia those raised and housed in rural environments appeared to be at greater risk (56/65 dogs) for dysautonomia than dogs from the city
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| − | * Labrador Retrievers may have a breed predisposition
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| − | ==Description==
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| − | * Degenerative lesions of the autonomic ganglia, spinal cord intermediate grey columns and sympathetic axons
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| − | * Aetiology still largely idiopathic
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| − | ==Diagnosis==
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| − | ===Clinical Signs===
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| − | Those of a generalised autonomic dysfuntion of the gastrointestinal and urinary tracts. Those associated with the oesophagus include:
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| − | * Regurgitation
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| − | * Megaoesophagus
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| − | * Oesophageal hypotmotility
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| − | The most frequent clinical signs associated with the syndrome are depression, anorexia, constipation, regurgitation or vomiting and incontinence (faecal and urinary) less frequently.
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| − | ===Physical Examination===
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| − | Findings associated with the GI system include:
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| − | * Dry mucous membranes
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| − | * Intestinal distension
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| − | ===Radiography===
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| − | ====Plain Radiography====
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| − | Oesophageal dilatation may be observed.
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| − | ====Contrast Radiography====
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| − | Oesophageal hypomotility may be evident on barium contrast study.
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| − | ===Histological Findings===
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| − | Chromatolytic degeneration in autonomic ganglia, spinal cord intermediate grey columns and some sympathetic axons.
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| − | ===Pharmalogical Testing===
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| − | * Topical ocular administration of dilute pilocarpine - miosis implies a postive result. However, not all dogs will respond. Response is dependent on damage to the postganglionic parasympathetic neuron that results in supersensitivity of the iris muscle dogs.
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| − | * IV or SC administration of atropine (a parasympatholytic) - lack of increase in heart rate implies a positive result
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| − | * ID administration of histamine - the wheal and flare response may be dampened in those with dysautonomia
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| − | ==Differential Diagnosis==
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| − | There are few differentials on presentation of the many manifestations of the disease. However, early in the course of disease other causes of megaoesophagus need to be considered.
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| − | ==Treatment==
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| − | ===Supportive===
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| − | Including elevated feeding, gastrostomy tube feedings or total paranteral nutrition.
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| − | ===Parasympathomimetic Drugs===
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| − | Some dogs may show minor improvement on initiation of for example, bethanechol, metoclopramide.
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| − | ==Prognosis==
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| − | Guarded to poor. Recovery rates in the cat are reported as 20-40%, however this may take 2-12 months. In the dog recovery rates are lower. Despite recovery many are also left with residual impairment including intermittent regurgitation.
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