Digestive System Health
Food Allergies in Pets
Just as people can be allergic to certain foods, so can pets. A food allergy in a dog or cat results most typically from a protein in the food. Food allergies most commonly cause skin issues in dogs and cats, but vomiting and diarrhea can occur, too. Treatment involves removing the offending ingredient from the pet’s diet. Finding the offender usually involves a process of elimination.
Food allergy (also called food hypersensitivity) refers to a type of physical reaction to food.
Food reactions are classified into two categories: those that are the result of immune system stimulation and those that are not. Food allergy occurs when the immune system begins to overreact to ingredients that the pet has eaten with no problems in the past. Food intolerance occurs when what is eaten has a direct, negative effect on the stomach and/or intestines, such as spoiled meat, chewed-up toys, food additives, and abrupt changes in diet. Food intolerance is not an immune disorder and, as such, will not be treated here.
The list of known food allergens (substances that pets can be allergic to) is extensive and includes beef, eggs, poultry, dairy, lamb, pork, fish, corn, wheat, soybeans, preservatives, and dyes. Typically, it is the protein source in a pet’s diet that elicits an allergic reaction.
Overall, the immune system’s job is to find threats to the body and destroy them by sending signals to activate special cells. An allergy results when this system misjudges a safe substance and the cells damage the surrounding tissues. This is why animals with food allergies can sometimes experience vomiting and diarrhea. Food allergies in pets, however, will most commonly cause problems in the skin.
Symptoms and Identification
Skin signs include:
- Itchiness (all over or even in just a few areas)
- Skin infections
- Ear infections
- Hair loss
- Stomach and intestinal signs include:
- Abdominal pain
- Weight loss
Many diseases can cause either gastrointestinal signs or itchiness, so the diagnostic approach undertaken by veterinarians includes ruling these out as part of the diagnosis of a food allergy. Food allergies tend not to be seasonal, and signs are usually seen year-round. The most obvious indicator of a food allergy is that the signs clear up when the responsible ingredient is removed from the diet.
A so-called “elimination diet” is the only proven way to determine which food is affecting a pet. Elimination diets consist of ingredients that haven’t been offered to the pet in the past. We call these “novel” ingredients. Many commercial therapeutic diets are available to offer hard-to-find protein sources.
The elimination diet can be thought of as a diagnostic test that may last up to 12 weeks. This test takes so long because the allergen may continue to stimulate your pet’s immune system for weeks after it is eliminated from the diet. The elimination diet will be the only food that a pet is allowed to eat during the trial period. During this time, no other food or treats may be fed unless they are restricted to the same “novel” ingredients in the elimination diet. Rawhide (usually made of cowhide), pig’s ears, and any other chew items or toys should also be avoided if they contain other ingredients. Even regular medications, such as heartworm preventives, must be given in a non-flavored form to keep the pet from being stimulated anew by the ingredients in these preparations.
Veterinarians will typically treat food allergic pets for secondary skin infections or any gastrointestinal symptoms at the beginning of the diet trial. These problems will often fail to resolve without specific medication aimed at these symptoms.
If the skin and gastrointestinal problems resolve during the trial, a veterinarian may then “challenge” a pet’s immune system by feeding the previous diet to see if the signs come back or by systematically adding specific items back into the diet. The diet used for the elimination trial may be fed after the trial is over. That is, if it is balanced and formulated to provide complete nutrition.
It bears mentioning that blood tests for food allergies are widely available and may be helpful in helping guide the choice of an elimination diet. Unfortunately, recent thinking in dermatology circles suggests these tests are too nonspecific and insensitive to replace the elimination diet as the gold standard test for food allergies in pets.
No breed predilection for food allergies has been firmly established in cats or dogs.
This is one of those conditions for which the diagnostic process may yield the ideal treatment plan. Arriving at the correct diet may seem like a frustrating game of trial and error, but it will often bear fruit treatment wise, too.
Pancreatitis in Dogs
Think of the pancreas as a puffer fish. It’s a notoriously sensitive organ that goes around swimmingly until threatened, and then it swells up, which causes a painful condition called pancreatitis. The disease affects many breeds of dogs and cats. Symptoms can be vague (especially in cats), making it somewhat difficult to diagnose, and include loss of appetite, vomiting, diarrhea, dehydration, and abdominal pain. Even with a positive diagnosis, however, treatment is limited to intravenous fluids, antibiotics, anti-vomiting drugs, pain medication, and electrolyte supplements to support the body as it heals itself.
The pancreas is an organ that produces hormones (like insulin) and secretes enzymes into the intestines to aid digestion. Nestled between the stomach and small intestine, it tends to swell (usually painfully and potentially fatally) when it’s egregiously insulted through a variety of different causes. This inflammation and its effects on the body are referred to as pancreatitis.
Common causes of pancreatitis include the following:
- simple gastritis, enteritis, or gastroenteritis (such as occurs after dietary indiscretion)
- cancer of the pancreas or nearby organ(s)
- gastrointestinal foreign body
Pancreatitis can occur after a dog eats a fatty food such as pork, beef, and some other human foods. Dogs that get into garbage can develop pancreatitis. Pancreatitis can also have other causes, including certain medications and some viral or bacterial infections.
When pancreatitis occurs, the pancreas releases enzymes and other substances into the surrounding area of the abdomen. These substances cause localized inflammation that damages the pancreas and nearby organs and can lead to life-threatening complications. Diabetes can sometimes result from pancreatitis. That’s because the pancreas also secretes insulin, which regulates blood sugar.
Pancreatitis may be considered acute or chronic. Acute pancreatitis comes on suddenly and can be reversible. Chronic pancreatitis, however, is a slow-burn process in which the organ becomes damaged over time. Chronic pancreatitis can result from repeated episodes of acute pancreatitis, but in most cases it is not clear what causes chronic pancreatitis. Both versions can range from mild to severe in its manifestation.
Signs and Identification
Diagnosing pancreatitis is difficult because the symptoms can be nonspecific. To make identification even more complex — and contribute to the disease’s ranking among the more commonly underdiagnosed diseases in small animal medicine — dogs and cats often suffer different symptoms. Clinical signs in dogs can include:
- Anorexia/no appetite
- Abdominal pain
Whereas in cats with pancreatitis, clinical signs are more likely to include:
- Weight loss
- Vomiting and hypothermia
- Abdominal pain
- Abdominal mass
No single test can diagnose pancreatitis in all cases. X-rays, ultrasound examinations, and blood work provide supportive information. More specific blood tests include a test called the PLI (pancreatic lipase immunoreactivity test), SPEC cPL (specific canine pancreatic lipase), and fPL (feline pancreas-specific lipase).
Though the heredity of the disease is not well understood, it’s clear that some breeds of dogs are predisposed. Schnauzers, for example, are more likely to suffer episodes of pancreatitis.
The mainstay of pancreatitis treatment is aggressive, supportive care including intravenous fluids, antibiotics, anti-nausea and anti-vomiting drugs, and pain medication. Another aspect of treatment may involve “resting” the stomach and intestines to give them time to heal and rebound. Your veterinarian may recommend withholding food and water until the pet is no longer vomiting. During that time, the patient can receive fluids by injection; some veterinarians provide additional nutrition through intravenous feeding (directly into a vein) or placement of a feeding tube. If the pet does not respond to medical treatment, there are also surgical procedures to treat pancreatitis.
Severe pancreatitis can be fatal, regardless of veterinary intervention.
Sometimes, a permanent diet change to a reduced-fat diet may be recommended. Pet owners may also be advised to discontinue any table food or other items that may contribute to future episodes of pancreatitis.
Ibuprofen and Naproxen Toxicity
- Ibuprofen and naproxen can be toxic to dogs and cats, but cats are much more susceptible to this toxicity than dogs are.
- A single 200-milligram ibuprofen tablet can be toxic to a cat or small- to medium-sized dog; toxic effects can occur rapidly and damage the kidneys and stomach.
- Ibuprofen and naproxen are drugs intended for humans that should not be given to pets.
- Never administer human medications to your pet unless instructed to do so by your veterinarian, and keep all medications in the home secured to help prevent accidental swallowing by pets.
What Is Ibuprofen and Naproxen Toxicity?
Ibuprofen is the active ingredient in medications like Advil and Nuprin. Naproxen is similar to ibuprofen but is longer-acting; it is the active ingredient in medications like Aleve and Naprosyn. Ibuprofen and naproxen are widely used to treat pain, fever, and inflammation in people. Unfortunately, these drugs can be extremely toxic (poisonous) to cats and dogs. Toxicity occurs when a cat or dog eats enough of one of these drugs to cause damaging effects in the body.
The damaging effects of ibuprofen or naproxen in pets include inhibiting blood flow to the kidneys and interfering with the production of compounds that help protect the inner lining of the stomach. Therefore, toxic effects of ibuprofen and naproxen in dogs and cats include kidney damage that can lead to kidney failure and severe stomach irritation that can progress to stomach ulcers.
How Does Toxicity Occur?
Many cases of ibuprofen and naproxen toxicity in dogs and cats are accidental. A pet may find and chew on a bottle of pills or eat a pill that has fallen on the floor. Because these drugs are so potent, a single 200-milligram ibuprofen tablet can be toxic to a cat or small- to medium-sized dog.
Sadly, some cases of toxicity occur because pet owners give human medication to their pet without being instructed to do so by a veterinarian. Ibuprofen and naproxen are intended for human use and should not be given to pets.
What Are the Clinical Signs of Ibuprofen and Naproxen Toxicity?
Once swallowed, ibuprofen and naproxen are rapidly absorbed from the stomach and intestines. Depending on the amount of drug ingested, toxic effects can occur within an hour, but some signs can take a few days to appear. The most common side effect is stomach irritation. In mild cases, this may cause vomiting. In severe cases, it can cause the pet to vomit blood; the irritation can also be severe enough to cause stomach ulcers and stomach perforations (punctures in the stomach wall that allow stomach acid to leak into the abdomen). If stomach bleeding is severe, blood transfusions may be necessary to save the patient.
Ibuprofen and naproxen toxicity can also inhibit blood flow to the kidneys, which can cause kidney failure. Extremely high toxic doses of these drugs can also affect the brain, causing altered mental status, seizures, and coma. Other clinical signs associated with toxicity can include the following:
- Vomiting (sometimes with blood)
- Diarrhea (may be darker in color due to digested blood)
- Appetite loss
- Abdominal pain
- Pale gums (secondary to blood loss)
How Is Ibuprofen and Naproxen Toxicity Diagnosed?
Diagnosis of ibuprofen and naproxen toxicity is commonly based on a history of recent swallowing of one of these drugs. Your veterinarian may recommend diagnostic testing, such as blood work (a chemistry panel and complete blood cell count [CBC]) and urinalysis to assess the extent of the damage. If stomach perforation or kidney failure are suspected, additional diagnostic testing is warranted.
What Are the Treatment and Outcome for Ibuprofen and Naproxen Toxicity?
Ibuprofen and naproxen are absorbed by the body very rapidly. If swallowing is recognized right away, vomiting can be induced to remove the drug from the stomach before the body can absorb it. Another option may be to sedate the pet to flush out the contents of the stomach. Your veterinarian may also administer a special preparation of liquid-activated charcoal to slow absorption of material from the stomach and intestines. This step may need to be repeated every few hours, as these medications have a long-lasting effect.
There is no specific antidote for ibuprofen or naproxen toxicity. Treatment may include intravenous fluid therapy, blood transfusions, medications to help heal stomach damage, and other medications to help support and stabilize the patient. Hospitalization may be required so that blood values, urine output, and vital signs can be monitored. Ibuprofen or naproxen toxicity can be fatal. However, pets can survive if the condition is recognized, diagnosed, and treated quickly. The amount of drug involved also has a direct effect on recovery and long-term outcome.
Most cases of ibuprofen or naproxen toxicity are preventable. Never administer human medications to your pet unless instructed to do so by your veterinarian, and keep all medications in the home secured to help prevent accidental swallowing.
Pica and Coprophagy
Pica is the eating of non-food substances such as rocks, soil, and clothing. Coprophagy is the consumption of feces, and it is much more common in dogs than cats. Veterinarians do not know why pets engage in these behaviors, but rarely, underlying diseases may lead to them.
When eaten, some objects may block the digestive tract and require surgical removal or retrieval with an endoscope. Owners can prevent pets from eating objects by eliminating access to the objects, making the objects unpleasant to taste, enriching the pet’s environment to prevent boredom, or using muzzles on walks. Owners may also choose to work with a veterinary behaviorist to eliminate the behavior.
Pets with pica or coprophagy eat substances that are not considered food. Pica involves the eating of objects. Dogs may be more likely to eat objects such as rocks and toys, while cats may eat more curious items such as clothing, strings, and kitty litter. Oriental breeds of cats are more likely to eat fabrics and wool.
Coprophagy is the consumption of feces. It is a natural behavior for nursing mothers to eat the feces of their puppies or kittens. Coprophagy is much more common in dogs than in cats, and female dogs are more likely to display this behavior than males.
Though coprophagy is generally more distasteful than it is harmful to the pet, eating non-food objects may result in vomiting, diarrhea, or a blockage in the digestive tract, which may require an emergency surgery or use of an endoscope to retrieve the object while the pet is under anesthesia.
The exact cause of pica and coprophagy is unknown. Some pets chew on objects out of stress or boredom. Dogs may eat feces because they are not being fed enough or if they go too long between meals, but it is usually not because they are lacking a nutrient in the diet.
Dogs who have been punished for defecating in the house may eat their feces to avoid further punishment. Others who are (or have been) confined for long periods of time may become accustomed to eating their feces by way of keeping their bedding from being soiled.
Rarely, an underlying condition such as anemia, intestinal parasites, gastrointestinal disorders, or liver disease may lead to an animal eating strange objects. Administration of some drugs, such as steroids, can increase hunger and lead to pica as well.
Symptoms and Diagnosis
Usually, owners either see the pet eating the objects or find remnants of the objects around the house. Cats are especially likely to eat linear objects, such as strings, dental floss, rubber bands, and yarn, which can cause serious problems in the digestive tract. Signs that a pet may have ingested an object that is causing a blockage in the digestive tract include:
- Diarrhea or constipation
- Loss of appetite
- Lethargy (tiredness)
If you suspect that your pet may have this problem, see your veterinarian immediately.
Though most cases of pica and coprophagy are simply behavior problems, it’s important for veterinarians to determine if there is a medical cause. Your veterinarian will perform a complete physical exam and ask about your pet’s diet, appetite, and environment. Additional tests may include blood work, fecal tests, and, possibly, an intestinal biopsy. Usually, treating the underlying disease will help eliminate the behavior.
If your veterinarian suspects a blockage in the digestive tract, he or she will probably recommend X-rays and other tests to evaluate the intestinal tract.
The following tips are often offered to help curb pica and coprophagy:
1. If there isn’t an underlying medical problem leading to the behavior, the best thing to do is to eliminate access to objects the pet likes to eat. Be sure to store clothing, plastics, wool, and linear objects where your pet cannot find them. If your dog eats objects in the yard, consider a basket muzzle. However, never leave a muzzled dog unattended.
2. You can also try covering the objects with an unpleasant-tasting substance, such as cayenne pepper or bitter apple products, which are available at most pet stores.
3. If you find your pet chewing on something inappropriate, employ a firm negative command and give him an appropriate chew toy. Avoid direct punishment, which can cause stress and further exacerbate the problem.
4. If you suspect that your pet is eating objects out of boredom, increase the amount of attention and exercise your pet receives every day, and enrich his or her environment with appropriate toys that can’t be swallowed.
5. For dogs with coprophagy, remove and dispose of feces from the yard immediately. Better yet, increase the number of daily leash walks and reward your dog with a treat after he defecates to distract him from the feces. Then pick up and dispose of feces appropriately.
6. Some owners may try sprinkling feces with cayenne pepper or bitter apple so the dog experiences an unpleasant taste, but it’s generally a better idea to just remove the feces.
7. Alternatively, monosodium glutamate (MSG) is a chemical marketed commercially for flavoring foods, meat tenderization, and as a product that can be sprinkled on the dog’s food to give the feces an unpleasant taste. It’s important to note that once the product is no longer added to the food, the dog may go back to eating feces.
8. In some cases, a change of diet may help eliminate the problem, but always consult your veterinarian before changing your pet’s diet.
9. Because eating foreign objects may cause serious gastrointestinal problems, you may want to work with a veterinary behaviorist to eliminate the behavior.
Foreign Body Surgery
- A foreign body surgery is a procedure to remove an object from a pet’s digestive tract that will not pass through on its own. Diagnosis of a foreign body is usually made by physical examination and radiographs (X-rays).
- This is typically an emergency procedure that must be performed before injury occurs to the esophagus, stomach, or intestines.
What Is a Foreign Body Surgery?
Pets aren’t picky eaters. It’s common for them to eat objects, such as string, toys, rocks, and articles of clothing. Smaller objects may pass through the digestive tract uneventfully. Objects that don’t pass through easily may cause obstructions that can damage or perforate the digestive tract, which can lead to death. A foreign body surgery is an emergency procedure to retrieve an object before it damages the esophagus, stomach, or intestines.
What Types of Objects Are Typically Involved?
Dogs are more likely to eat foreign objects than cats. Common foreign objects found in dogs include bones, rawhides, corncobs, and fishhooks. Some types of glue are particularly troublesome, because if a dog chews on the glue bottle, the glue expands in the stomach and can be difficult to remove. Of course, large or sharp objects and those containing poisonous substances should be removed as soon as possible.
For cats, eating string (such as dental floss or yarn) is especially dangerous. String can become lodged in the digestive tract and cut through the tender tissue as the continual motion of the intestines attempts to push it along. While most hairballs generally pass through the digestive system, some may become large enough to cause a blockage.
What Are the Signs of a Foreign Body?
The signs may vary depending on the location of the foreign body. If the object is in the esophagus, the pet may gag, cough, salivate, or gulp as if attempting to swallow. If the object is in the stomach or intestines, the pet most likely will vomit and may be lethargic (tired) and/or have a loss of appetite, vomiting, or diarrhea.
How Is a Foreign Body Diagnosed?
In some cases, the veterinarian may be able to feel the object with his or her hands while gently pressing on the pet’s abdomen during a physical examination. Usually, radiographs, or X-rays, are required.
While some objects, such as bones and metal, are obvious on radiographs, others, such as clothing, are not. In these cases, the veterinarian may have the animal swallow barium, which is a liquid that is visible on radiographs. A series of radiographs enables the veterinarian to watch the barium move through the digestive tract. The barium may actually surround the object and make it visible, or the barium may stop moving, indicating the possible location of the obstruction.
If an animal shows signs of having eaten a foreign object but the radiographs are inconclusive, a veterinarian may recommend an exploratory surgery. While this surgical procedure may enable the veterinarian to locate and remove the foreign body, occasionally, no foreign body is found.
How Is the Surgery Performed?
In most cases, animals suspected of having a foreign body undergo an abdominal surgery under general anesthesia. Depending on where the object is, the veterinarian may need to open the stomach and/or the intestines to remove it.
If the foreign body is in the esophagus within the chest, the veterinarian may recommend endoscopy to remove the object. In this procedure, the animal is anesthetized, and a flexible tube with a camera is placed down the animal’s esophagus. The camera enables the veterinarian to see the object and manipulate prongs or a basket at the end of the tube to grasp and retrieve it.
The advantage of endoscopy is that it is noninvasive and your pet will require less recovery time. If endoscopy is not available, the veterinarian will need to open your pet’s chest.
What Are the Risks and Benefits of the Surgery?
There are always risks associated with anesthesia and surgery. Performing blood tests will provide the veterinarian with information that will help him or her stabilize the pet before surgery.
A foreign body surgery is an invasive procedure that involves opening the abdomen or chest, as well as making incisions into the digestive tract. In addition to the risk of infection, there is always the possibility that the sutured area of the incision may come apart, requiring the veterinarian to perform another surgery.
Without emergency surgery, however, an obstruction caused by a foreign body can be fatal. Prompt diagnosis and surgical treatment can help eliminate the problem and set your pet on the road to recovery.
The best way to prevent a foreign body surgery is to remove small or chewable objects from the floor and yard. Keep strings and rubber bands in boxes or drawers, and cover wastebaskets to prevent curious pets from eating the contents.
Vomiting in Cats and Dogs
- Vomiting is the forceful emptying of the stomach.
- If vomiting is prolonged, it can lead to dehydration.
- Vomiting can be associated with several medical conditions ranging from motion sickness to foreign body ingestion to cancer.
- Treatment is aimed at controlling the vomiting and resolving the primary cause.
- A safe environment, healthy diet, routine veterinary care, and wellness blood work will go a long way toward preventing vomiting.
What Is Vomiting?
Vomiting is defined as the forceful emptying of the stomach’s contents. It is caused by a signal from the brain to the stomach that originates in a part of the brain known as the vomiting center. Vomiting initially developed because it helps save animals from poisoning. Nerves in the abdomen or certain substances in the bloodstream indicate to the brain that the animal may have eaten something toxic, and vomiting can help to rid the body of the toxic substance. Although this does occur now, the actual ingestion of toxins has become less of a threat to our pets than to their wild ancestors; over time, many more triggers began to induce the brain to signal vomiting. Prolonged vomiting can be dangerous because it can lead to life-threatening dehydration.
What Are the Causes of Vomiting?
Primary stomach or intestinal diseases that can cause vomiting include:
- Foreign bodies
- Spoiled food
- Food allergies
- Stomach ulcers
- Inflammatory bowel disease
Secondary or nonstomach disorders that can cause vomiting include:
- Thyroid disease (in cats)
- Pancreatitis (inflammation of the pancreas)
- Pyometra (uterine infection)
- Kidney or liver disease
- Canine parvovirus or distemper
- Feline panleukopenia virus
How Is the Cause of Vomiting Diagnosed?
Before attempting to diagnose what may be causing a pet to vomit, it is very important to differentiate between vomiting and regurgitation. Vomiting requires abdominal effort (constriction of the abdominal muscles) and is the active expelling of stomach contents. In contrast, regurgitation is the passive elimination of contents in the esophagus that happens without nausea or retching. This distinction is important because the medical conditions that tend to cause regurgitation are different from those associated with vomiting.
Once your pet’s vomiting has been confirmed, your veterinarian will begin to approach your pet’s diagnosis and treatment. In order to narrow the list of possible causes, your veterinarian will take into account your pet’s age and species. For instance, a young energetic dog that is vomiting is more likely to have eaten something it shouldn’t have, while a senior cat with weight loss, increased drinking, and vomiting is more likely to have a medical problem such as kidney disease or thyroid disease. Your veterinarian will likely ask detailed questions regarding duration of sickness, weight loss, medications, changes in appetite, and timing of the vomiting with regard to meals. A thorough physical exam will be performed to determine if there is abdominal pain, dehydration, or other abnormalities suggesting the cause of the vomiting. You may want to bring some of the vomit to the hospital because the appearance of the vomit can help with the diagnosis. For example, vomit with black coffee ground-like material indicates that the stomach may be bleeding.
Your veterinarian may also recommend performing laboratory tests on blood, feces, and urine. It may also be necessary to evaluate X-rays and perform an abdominal ultrasound examination. If your veterinarian suspects that the problem may be limited to the stomach and the intestines close to the stomach, an endoscopic examination may be recommended. This procedure requires anesthesia and involves passing an endoscope (a long tube containing a tiny video camera) down your pet’s esophagus to look into the stomach and intestines.
How Is Vomiting Treated?
Dehydration from prolonged or severe vomiting is of immediate concern, and it may be necessary to admit your pet to the hospital for fluid replacement while a diagnosis is being pursued. Treatment is aimed at controlling the vomiting itself (to prevent further dehydration) and at gaining control of or eliminating the primary cause of the vomiting. Some causes of vomiting are easily treated, such as when a pet with an allergy to a certain food stops vomiting when the diet is switched. On the other hand, a pet with stomach cancer may need surgery, chemotherapy, or more prolonged and aggressive treatment.
How Can I Prevent Vomiting?
Vomiting is a signal to the owner and the veterinary team that something is wrong. If your pet vomits once, remove food and water for a few hours. Continuing to eat and drink may cause the vomiting to continue instead of stopping after one episode. If your pet continues to vomit without having anything to eat or drink, call your veterinarian. Also, do not allow your pet to eat grass — this is an old wives’ tale and does not benefit the pet.
In fact, eating grass can contribute to additional medical problems. Sometimes it can be very difficult to determine the cause of vomiting. This is especially true if a pet is not well supervised or has access to a variety to things that can cause vomiting. Keeping a watchful eye on what your pet eats and preventing his or her access to harmful substances will help prevent many causes of vomiting.
Having routine physical examinations, fecal testing, and wellness blood work performed regularly can permit the early discovery and treatment of medical conditions such as parasites, diabetes, kidney or liver disease, thyroid disease, and other conditions that can cause vomiting. A watchful eye, along with early diagnosis and treatment of primary disease, provide the opportunity to prevent vomiting in many cases.
Gastroenteritis (Vomiting and Diarrhea) in Dogs and Cats
Vomiting and diarrhea are the most common signs of gastrointestinal upset. There are many possible causes for these conditions, including viruses and parasites, something very simple like having eaten something bad, or something more complicated like cancer or organ problems (such as kidney failure). Ideally, treatment is aimed at the underlying problem, and can be as simple as temporarily withholding food or as complex as surgery or chemotherapy.
Loosely translated, the term gastroenteritis means an upset or inflamed stomach and intestines. As in people, gastroenteritis in pets can be caused by a multitude of underlying problems ranging from minor to serious and life threatening.
Vomiting usually indicates irritation in the stomach and upper small intestine, while diarrhea can mean irritation anywhere along the intestinal tract. But these are mere generalizations, of course.
Symptoms and Identification
You can tell a lot about the nature of the problem from the character of the vomiting or diarrhea. For example:
- Foreign material such as bones, sticks, leaves, grass, toys or garbage contents may be seen in vomited material when dogs and cats eat indiscriminately. Vomitus that contains dark, gritty material that looks like coffee grounds can mean irritation or bleeding in the stomach.
- Feces that are dark or look like tar can indicate bleeding in the stomach or high up in the intestines. The blood is digested before it’s passed, which is why it takes on such a dark color.
- Diarrhea that is watery or covered with mucus typically means a problem in the colon, which is the organ responsible for absorbing excess moisture from the stool.
- Streaks of red, undigested blood in feces tends to indicate a problem lower down in the digestive tract, typically the colon or rectum.
Because your pet can’t talk, your veterinarian counts on you for important information, like the signs noted above. Watch your pet’s gastrointestinal activity so you can describe the amount, frequency, and appearance of the vomiting or diarrhea. If possible, take a sample of the material to show your veterinarian. Your vet will also need to know whether your pet is drinking normal amounts of water, has a normal appetite, and is otherwise acting okay. After doing a physical exam, the vet may need to run some diagnostic tests. These may include:
- Blood work to look for organ problems like kidney disease
- Fecal testing to check for intestinal parasites or other abnormalities (checking several samples is often needed)
- Abdominal X-rays to look for masses, foreign bodies, or signs of obstruction
- Abdominal ultrasound examination to look closer at the intestines and other abdominal organs
- Depending on the results of these tests, more specific diagnostic tests may be recommended.
Cases of mild vomiting and/or diarrhea typically respond well to TLC and basic home care. Withholding food for 24 hours to allow the gastrointestinal tract to rest may be recommended. If you have a young puppy or kitten or a pet that already has another medical problem, ask your veterinarian if it is safe to withhold food. If the signs resolve, your pet can then be started on small amounts of bland, highly digestible food, such as boiled chicken and rice, or a prescription intestinal diet. (See the entry on both vomiting and diarrhea as symptoms for more information on how this condition is best treated.)
If parasites are the problem, medication can generally be prescribed to treat the condition.
If gastroenteritis has been severe, long lasting, or accompanied by other signs of illness your vet may give fluids intravenously or under the skin to protect against dehydration. Medications are sometimes prescribed to calm the gastrointestinal tract and decrease the urge to vomit. In some cases, hospitalization for continued treatment and observation is recommended. If the underlying problem can’t be determined, your vet may recommend supportive treatment (like fluids and medications) to help your pet through the illness and give the body a chance to heal.
Unfortunately, not all cases of vomiting or diarrhea are simple and easy to treat. These conditions can sometimes be a sign of more serious problems, such as liver or kidney failure, diabetes, inflammation of the pancreas, severe viral infection, or allergic bowel disease. Some types of cancer can also cause vomiting and diarrhea, especially if a tumor pinches off the bowel and causes intestinal obstruction or damages the structures of the stomach or intestines.
Intestinal obstruction can be associated with intense pain, vomiting, and straining to defecate but passing only small amounts of runny stool, often with blood. This is a true emergency that requires immediate surgery to remove the blockage before the bowel ruptures or is irreparably damaged.
When in doubt, call your veterinarian if you notice vomiting or diarrhea in your pet.
Small Intestinal Bacterial Overgrowth (SIBO) in Dogs
While it’s true that certain bacteria must be present in the gut for digestion and absorption of nutrients to take place, if bacterial growth gets out of control, trouble ensues. That trouble is called, quite simply, small intestinal bacterial overgrowth or SIBO. The disease can occur for a variety of reasons and it can affect any dog. Gas and diarrhea are the major symptoms. Antibiotics can help quell bacteria overgrowth while underlying causes are treated accordingly.
The upper part of the small intestine is responsible for the continued digestion of food as it exits the stomach and for beginning the process in which nutrients are absorbed into the bloodstream for dissemination throughout the body. The bacteria present here normally aid in the process of breaking down partially digested food within the intestines. In dogs, the overgrowth of this bacteria results in a common process that’s descriptively labeled, “small intestinal bacterial overgrowth” or SIBO.
It’s a big problem for some dogs, and it occurs for several reasons including the following:
- Ileus: When normal peristaltic waves moving partially digested food forward aren’t present, bacterial populations increase. Neurologic problems, gastrointestinal obstruction, pancreatitis, peritonitis, parasitism, and other processes can all cause the lack of forward intestinal movement called ileus.
- Altered Digestion or Absorption of Nutrients: This can occur with exocrine pancreatic insufficiency (inadequate secretion of digestive enzymes by the pancreas) and other disorders that can lead to poor digestion and absorption of nutrients.
- Malnutrition or immunodeficiency: When the body’s overall condition is adversely affected, all the normal defenses can break down, leading to uncontrolled bacteria growth.
The above tend to be labeled secondary causes of SIBO. But SIBO can also be idiopathic, which means veterinarians don’t understand exactly why it happens.
Symptoms and Identification
Secondary SIBO can affect any dog, depending on the underlying cause. But idiopathic SIBO tends to affect relatively young dogs. Diarrhea and flatulence (gas) are the most common signs of SIBO. Chronic, intermittent diarrhea is most typical, with many dogs also suffering weight loss, stunted growth, and/or generalized failure to grow or gain weight. Some dogs may appear inordinately hungry and may even eat their stools or other indigestible items.
SIBO is identified by noting small bowel diarrhea (characterized by limited straining and large volumes) and finding large numbers of bacteria in the fecal material. Diagnosis is aimed primarily at ruling out other potential causes of bacterial overgrowth and diarrhea. Because these are numerous, the process usually involves X-rays, serial fecal examination (not cultures, which are notoriously unreliable), and sometimes endoscopy to test the upper part of the small intestine for high bacteria counts.
Blood tests that reveal high folate levels and decreased cobalamine may also be indicative of the process. That’s because folate is synthesized by the bacteria, and cobalamine is bound by them. However, these tests may be inconclusive.
German Shepherds are over-represented among those who suffer with SIBO, but dogs of any breed can be affected.
Treating the underlying process is the approach best undertaken for secondary SIBO. For idiopathic SIBO, antibiotics are highly effective in helping owners manage their dogs’ clinical signs. That’s why this version of the disease is often referred to as antibiotic-responsive SIBO or antibiotic-responsive diarrhea (ARD).
For secondary SIBO, if the underlying cause can be addressed, the condition is more easily corrected. However, there is no cure for idiopathic SIBO. Some young dogs may seem to outgrow the condition (possibly as their immune system matures), but in other cases dietary therapy and supplements may be recommended to help manage the condition long term.
Megaesophagus is the medical term for an enlarged esophagus. Relatively rare in cats, but common in dogs, the typical sign of megaesophagus is regurgitation, or effortless vomiting without the use of abdominal muscles. Treatment varies, depending on the cause. Sometimes medications help. In rare cases, surgery can correct an underlying problem. And certain feeding strategies can help dogs keep their food down. But most dogs with megaesophagus will have chronic signs and risk serious complications on a long-term basis.
Megaesophagus is a relatively common condition in dogs characterized by a distension of the esophagus, the vital tube that moves food from the mouth into the stomach. In this condition, the associated nerves or muscles do not function properly, so that the esophagus cannot constrict and relax to propel the food into the stomach after swallowing. As a result, the food accumulates in the esophagus, and is regurgitated at some point.
The problem with megaesophagus is not only that food doesn’t serve its nutritional purpose but, more dangerously, that food moving in the wrong direction can enter the trachea and lungs. This results in an inflammatory lung condition, called aspiration pneumonia, which is the most common reason dogs die from this disease.
Dogs with megaesophagus usually fall into two groups: Those with congenital megaesophagus (which typically appears in the first weeks to months of life) and those with the acquired form (which usually occurs in older dogs).
Congenital megaesophagus usually results from incomplete development of the nervous system or by a remnant of a fetal artery that wraps around and constricts the esophagus, preventing the normal passage of food.
Acquired megaesophagus is often the result of neuromuscular diseases such as myasthenia gravis, glandular diseases including Addison’s disease and possibly hypothyroidism, as well as toxins in lead and lawn products. Although foreign bodies can also result in an enlarged esophagus, though these cases are typically considered separately.
Unfortunately, most cases of megaesophagus have no known cause. These dogs are referred to as having the idiopathic form of the disease.
Symptoms and Identification
The typical sign of megaesophagus is regurgitation. Dogs will bring up undigested food with no abdominal effort (as opposed to what we observe with vomiting, where dogs will vomit partially digested food while making significant abdominal movements).
Should aspiration pneumonia ensue (as is very common), dogs will experience coughing, lethargy, and a fever.
The typical megaesophagus patient will be identified through clinical signs along with X-rays. Chest X-rays will reveal a distension of the esophagus and may demonstrate aspiration pneumonia as well.
The hard part of diagnosing megaesophagus is not identifying the condition itself, but determining its underlying cause (if one can be identified). Blood tests for specific diseases or toxins, biopsies or tissue samples, and sometimes medical treatment (to attempt to isolate the cause by treating for it) are the most common approaches to this condition.
For the congenital form, Great Danes, Irish Setters, Newfoundlands, miniature Schnauzers, German Shepherds, Shar-Pei, and Labrador retrievers are predisposed. In the acquired version, the breed predisposition varies according to the different disease processes that underlie the megaesophagus, but German Shepherds, Golden Retrievers, and Irish Setters seem predisposed.
Treatment of megaesophagus is typically relegated to preventing aspiration pneumonia, and assuring that nutritional needs are met. Although some can be treated with medications and surgical approaches that can correct the underlying problem, most patients will continue to experience long-term symptoms from the unfortunate stretching of and permanent nerve damage to so vital a structure.
Because food will continue to accumulate in the esophagus for most patients (to varying degrees) and because aspiration pneumonia will therefore remain a significant risk, several strategies to control the regurgitation of food are typically employed:
- Feeding from a height to facilitate downward movement of food
- Feeding a slurry instead of firm, wet food or crunchy kibble
- Maintaining elevation of the body after eating
- Esophageal tube feeding or surgical stomach tube placement
Preventing megaesophagus comes down to removing affected individuals from breeding programs, regardless of the cause of the disease. Their siblings and parents should also be tested for the disease underlying the megaesophagus before they are allowed to continue or enter breeding programs.
Inflammatory Bowel Disease (IBD) in Dogs and Cats
Inflammatory bowel disease (IBD) is intestinal trouble on a chronic basis. It is not really known what causes IBD, but it is autoimmune related and some forms may be genetic. Any breed of dog or cat can get IBD. Frequent diarrhea is the big indicator of the disease, which is typically treated with careful management of the pet’s diet, drugs to suppress the immune system, and the occasional round of antibiotics to keep down the growth of unwanted bacteria in the digestive tract.
IBD is a relatively common chronic disease that affects the intestines of both dogs and cats. In this poorly understood disease (the cause of which is currently unknown), the lining of the intestines (particularly of the colon) becomes inflamed through a process mediated by the patient’s immune system.
Despite the prevalence of this disorder, its cause remains elusive. It is suspected that IBD is caused by chronic stimulation of the immune system from various factors, including dietary ingredients, parasites, or bacteria within the digestive tract. Genetics may also play a role. Regardless of the cause, the results tend to be same: inflammation occurs, intestinal bacterial overgrowth occurs, and the animal is unable to properly digest foods and absorb nutrients.
Symptoms and Identification
Clinical signs of IBD are primarily associated with intermittent bouts of diarrhea or soft stool, though some pets may also suffer bouts of vomiting and weight loss. For IBD, signs typically come and go, appearing to enter a spontaneous remission before returning with a vengeance.
The idea behind the diagnosis of IBD is that veterinarians attempt to exclude parasites, dietary sensitivity (in the form of a true food allergy or dietary intolerance), infectious diseases, digestive tract cancers, and other diseases that may cause similar clinical signs.
Food trials to determine whether true food allergies or dietary intolerance are at play are also deemed an acceptable way of excluding these alternative diagnoses. Alternatively, pets suspected of having IDB may be treated with medications to treat parasites and unwanted intestinal bacteria in an effort to help rule out these potential causes of illness.
Ideally, suspected cases of IBD should be confirmed via biopsy of the intestinal tissue. This can be done during abdominal surgery, endoscopy, and/or colonoscopy.
Dogs and cats of any breed can develop IBD. Middle-aged pets tend to be affected most commonly.
Treatment of IBD tends to involve several strategies:
1. Dietary management. Administering foods with a reduced ability to stimulate the immune system is a fundamental approach to helping manage IBD. However, performing a successful “diet trial” requires commitment. During the trial, it is important that the pet eats only the prescribed food and nothing else. All treats, edible chews (such as rawhide), and human foods must be discontinued, since feeding these items may expose the pet to undesirable components that then confuse the results of the dietary trial. Typically, the animal is on the diet trial for a minimum of 12 to 16 weeks. Administering dietary supplements in the form of specific fatty acids, prebiotics, and probiotics may also help some patients with IBD.
2. Immune system-affecting drugs. Drugs like corticosteroids and other immunomodulating drugs are often prescribed to help interfere with the immune system’s ability to cause inflammation.
3. Antibiotics. Reducing overgrowth of unwanted quantities of bacteria is typically required intermittently over the course of IBD treatment.
There is no known way to prevent IBD. Most pets with IBD may require a special diet and/or medication intermittently throughout life. Although IBD can’t always be cured, it can frequently be controlled. Pets with IBD may have occasional relapses.
Aspirin Toxicity in Cats and Dogs
- High doses of aspirin can be poisonous (toxic) to dogs and cats; cats are more susceptible to aspirin toxicity than dogs are.
- Toxic effects can occur within hours of the pet swallowing aspirin or may take a few days.
- Never administer a medication intended for humans to your pet unless instructed to do so by your veterinarian.
What Is Aspirin Toxicity?
Aspirin has been considered a safe and reliable over-the-counter fever and pain medication for decades. Because aspirin is considered very safe, some pet owners give aspirin to their pets. There are also aspirin formulations specifically for dogs. However, high doses of aspirin can be dangerous for dogs and even more hazardous for cats. Aspirin toxicity occurs when a cat or dog swallows enough of the drug to cause damaging effects in the body.
Aspirin is broken down primarily by the liver, and some of the resulting substances are later eliminated by the kidneys through urine. Because cats lack certain proteins that are needed for the liver to safely break aspirin down, aspirin’s effects last longer in cats than in dogs (5 to 6 times longer). The risk of aspirin toxicity is also higher in cats.
How Does Aspirin Toxicity Occur?
Many cases of aspirin toxicity in dogs and cats are accidental. A pet may find and chew on a bottle of pills or eat a pill that has fallen on the floor. Sadly, some cases occur because pet owners give medication intended for humans to their pet without being instructed to do so by a veterinarian. Some medications meant for humans, like Pepto-Bismol and oil of wintergreen, are related to aspirin and can cause aspirin-like side effects in pets.
There are situations in which your veterinarian may prescribe a specific dosage of aspirin for your dog or cat. Be sure to follow your veterinarian’s dosage directions very carefully, and report any vomiting or other problems right away.
What Are the Clinical Signs of Aspirin Toxicity?
Signs of aspirin toxicity can occur within a few hours; however, some signs can take a few days to appear. The most common side effect of aspirin toxicity is stomach irritation. In mild cases, this may cause vomiting. In severe cases, it can cause the pet to vomit blood. The irritation can also be severe enough to cause stomach ulcers and stomach perforations (punctures in the stomach wall that allow stomach acid to leak into the abdomen). Aspirin also affects platelets—blood cells that help the body form blood clots and prevent bleeding. Aspirin toxicity can cause such severe bleeding that blood transfusions can be necessary to save the patient. Aspirin toxicity can also inhibit blood flow to the kidneys, which can cause kidney failure. Clinical signs associated with aspirin toxicity can include the following:
- Vomiting (sometimes with blood)
- Diarrhea or black stools
- Abdominal pain
- Increased respiratory rate
- Pale gums (secondary to blood loss)
Cats can develop anemia because of aspirin’s effects on their bone marrow. Severe liver damage can also occur in cats as a result of aspirin toxicity.
How Is Aspirin Toxicity Diagnosed?
Diagnosis of aspirin toxicity is commonly based on a history of recently chewing or swallowing pills. Your veterinarian may recommend diagnostic testing, such as a chemistry panel and complete blood cell count (CBC), to assess the extent of the damage. If stomach perforation, liver damage, or kidney failure are suspected, additional diagnostic testing is warranted.
What Is the Treatment and Outcome for Aspirin Toxicity?
If aspirin toxicity is recognized right away, vomiting can be induced to remove the drug from the stomach before the body can absorb it. Another option may be to anesthetize the pet to flush out the contents of the stomach. Your veterinarian may also administer a special preparation of liquid activated charcoal to slow absorption of the drug from the stomach and intestines.
There is no specific antidote for aspirin toxicity. Treatment may include blood transfusions, intravenous fluid therapy, medications to help protect or heal stomach damage, and other medications to help support and stabilize the patient.
Aspirin toxicity can be fatal. However, pets can survive if the condition is recognized, diagnosed, and treated quickly.
Most cases of aspirin toxicity are preventable. Never administer medications intended for humans to your pet unless instructed to do so by your veterinarian, and keep all medications in the home secured to help prevent accidental swallowing.
Acetaminophen Toxicity in Cats and Dogs
- Acetaminophen can be toxic to dogs and cats, but cats are 7 to 10 times more susceptible to acetaminophen toxicity than dogs are.
- Once swallowed, acetaminophen reaches the blood stream within 30 minutes; toxic effects are rapid and damage the liver and red blood cells.
- Never give a medication intended for people to your pet unless instructed to do so by your veterinarian.
What Is Acetaminophen Toxicity?
Acetaminophen is the active ingredient in Tylenol and some other related medications that are used to treat pain and fever in people. Unfortunately, this drug can be extremely toxic (poisonous) to cats and dogs. Acetaminophen toxicity occurs when a cat or dog swallows enough of the drug to cause damaging effects in the body.
Acetaminophen is mostly metabolized (broken down and eliminated from the body) by the liver. Some of the substances that are created during this process can have harmful effects on cats and dogs. Cats are at much greater risk of toxicity than dogs because they lack certain proteins necessary for the liver to safely metabolize acetaminophen.
How Does Acetaminophen Toxicity Occur?
Many cases of acetaminophen toxicity in dogs and cats are accidental. A pet may find and chew on a bottle of pills or eat a pill that has fallen on the floor. Sadly, some cases occur because pet owners give medication intended for people to their pets without being instructed to do so by a veterinarian.
Acetaminophen is a drug meant for people. However, there are situations in which your veterinarian may prescribe a specific dosage of acetaminophen for your dog. Be sure to follow your veterinarian’s dosage directions very carefully and report any vomiting or other problems right away. Cats are 7 to 10 times more susceptible to acetaminophen toxicity than dogs are. Because cats are extremely sensitive to the drug’s toxic effects, acetaminophen is not given to cats.
What Are the Clinical Signs of Acetaminophen Toxicity?
Once swallowed, acetaminophen is rapidly absorbed from the stomach and intestines and can achieve significant levels in the blood within 30 minutes. The main toxic effects take two forms:
- Liver damage: One of the substances produced by the breakdown of acetaminophen binds to liver cells, damaging them. Severe damage can lead to liver failure.
- Damage to red blood cells: One of the substances produced by the breakdown of acetaminophen binds to red blood cells. Once bound, this substance changes hemoglobin (the protein in red blood cells that enables them to carry oxygen) into a molecule that is no longer able to carry oxygen. This means that the blood can no longer supply adequate amounts of oxygen to the body’s vital organs. The altered hemoglobin molecule is called methemoglobin; its lack of oxygen-carrying ability changes the color of blood from red to brown.
Cats and dogs can develop both forms of acetaminophen toxicity. However, cats are more likely to suffer hemoglobin damage while dogs are more likely to suffer liver damage. The main clinical signs associated with acetaminophen toxicity that result from liver injury and an inability of the blood to carry oxygen include:
- Decreased appetite
- Lethargy (tiredness)
- Difficult or rapid breathing
- Abdominal pain
- Brown discoloration of the gums (a result of methemoglobin)
- Brown urine
- Blue gums (known as cyanosis, indicates inadequate oxygen supply)
- Swelling of the face or paws
- Shock, collapse, death
How Is Acetaminophen Toxicity Diagnosed?
Diagnosis of acetaminophen toxicity is commonly based on a history of recently chewing or swallowing pills. Your veterinarian may recommend diagnostic testing, such as a chemistry panel and complete blood cell count (CBC), to assess the extent of the damage.
What Is the Treatment and Outcome for Pets Suffering from Acetaminophen Toxicity?
Acetaminophen is absorbed and metabolized very quickly. If you realize right away that your pet has swallowed acetaminophen, vomiting can be induced to remove the drug from your pet’s stomach before the body can absorb it. Another option may be to anesthetize your pet in order to flush out the contents of the stomach. Your veterinarian may also administer a special preparation of liquid activated charcoal to slow absorption of toxic material from the stomach and intestines.
There is a specific antidote for acetaminophen toxicity. This medication, N-acetylcysteine, limits formation of the toxic substance that damages the liver and red blood cells. Additional treatments may include blood transfusions, intravenous fluid therapy, and other medications to help support and stabilize the patient.
Acetaminophen toxicity can be fatal. However, pets can survive if the condition is recognized, diagnosed, and treated quickly.
Most cases of acetaminophen toxicity are preventable. Never give medications meant for people to your pet unless instructed to do so by your veterinarian, and keep all medications in the home secured to help prevent accidental swallowing.