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Friday, 26 August 2011

Diarrhoea in dogs and cats

Welcome to PercyPods Pet Emergency blogs. Hope this blog finds both you and your pets well. Following on from the last blog which was about vomiting, this week we are going to talk about diarrhoea which is a common problem in dogs and to a lesser extent cats. It is a problem for which many pets are taken to the vets including outside of normal working hours as a potential emergency. Before we get started, just to remind you that you can contact us in various ways. Via email on percypods@gmail.com; via the PercyPods Facebook page; or via Twitter on @PercyPods.

What is diarrhoea?

Okay so let’s get started by explaining what diarrhoea is. In a normal healthy animal, the stools or faeces have a well-formed relatively solid consistency with no liquid, blood or mucus. Normal stools are formed from food that the animal has eaten once it has been processed by the stomach and especially the intestines. Processing of food basically involves absorbing certain nutrients as well as water and also adding waste substances into the intestines. Diarrhoea refers to stools or faeces that are not solid and not properly formed but instead loose or liquid in consistency. Some animals will have a single one-off episode of soft stools before their faeces appear normal again and we would not usually class this as diarrhoea. Diarrhoea tends to imply multiple episodes of abnormal stools.

Types of diarrhoea

There are basically two types of diarrhoea although it is important to realise that some animals can shows signs of both types if the cause of the problem is widespread throughout the intestines. The first type is what we call ‘small intestinal diarrhoea’ because the cause of the problem is mainly in the small intestine. The small intestine is the part of the gut that is connected to the stomach and this is where most of the digestion of food and absorption of nutrients occurs. Small intestinal diarrhoea tends to be large in volume and have a liquid watery consistency. Animals don’t tend to strain or try to pass stools more frequently, but weight loss is common. In some animals the diarrhoea looks black or tarry and this suggests that there has been some bleeding into the intestine; we call this melaena and it is a sign that should prompt consultation with your vet.

The second type of diarrhoea is ‘large intestinal diarrhoea’. The large intestine is the part of the gut that connects the small intestine to the outside world via the anus and it includes the colon and the rectum. The colon is the main part and people often refer to animals with large intestinal diarrhoea as having ‘colitis’. The main function of the large intestine is to absorb water from the faeces as it passes through to the outside. Animals with large intestinal diarrhoea often try and pass faeces many times a day with straining and only a small volume of diarrhoea produced on each occasion. The faeces may be loose or soft rather than liquid in consistency, and there is often some fresh blood and slimy jelly-like mucus. Weight loss is uncommon with these patients.

Why is diarrhoea bad?

Okay so now that we have described the different types of diarrhoea, let’s consider why having diarrhoea is a problem. As a general rule, large intestinal diarrhoea is usually less of a risk to the animal than small intestinal diarrhoea. Animals with small intestinal diarrhoea may become malnourished and start to look thin and in poor condition because they are not absorbing their food properly. In more severe cases, the animal may become dehydrated and in the worst of cases, he or she may become very weak and depressed eventually going into shock. Some animals can also lose enough blood in their diarrhoea for this to become a problem to them as well. Other considerations that we have to bear in mind are that some causes of diarrhoea cause discomfort to your pet; some pets feel distressed or embarrassed about soiling themselves or being unclean; and of course there may be some practical problems for you in terms of clearing up the diarrhoea especially if your pet has an accident in the home. Many of the causes of diarrhoea also cause vomiting which as we discussed in the last blog can also cause worrying problems.

What about the causes of diarrhoea?

There are a large number of causes of diarrhoea. Like with vomiting, these range from mild and nothing to worry about to very severe and potentially life-threatening. Although as we said earlier, any animal that has diarrhoea that is severe enough, regardless of the cause, can become very ill. The causes of diarrhoea typically are problems which directly affect the intestines causing a failure in the normal actions of the intestine to absorb food and water and also dump waste substances into the faeces. A number of animals recover from diarrhoea without a specific cause being diagnosed. Also it is worth noting that many animals with diarrhoea will also have some vomiting which often occurs before the diarrhoea starts.
 
  • One of the most common causes of diarrhoea is what we call ‘dietary indiscretion’: this is when your pet either eats something that doesn’t quite agree with him or her, for example because it is too rich or rotten, or they overeat. Foreign body ingestion is also a type of dietary indiscretion that can cause diarrhoea.
  • Another relatively common cause of diarrhoea is as a side-effect of certain medications including for example some common antibiotics and also non-steroidal anti-inflammatories.
  • Food intolerance or food allergy is another common cause of diarrhoea: this is when your pet is allergic to either their main diet or any other treats that are fed. However it is important to realise that some animals will develop diarrhoea if their diet is changed suddenly. This does not mean that they are necessarily allergic to the new diet. It is often possible to stop the new diet and then when the diarrhoea has cleared, try introducing it again but much more slowly over several days.
  • ‘Inflammatory bowel disease’ or ‘IBD’ is another cause of diarrhoea affecting the intestines. This is a bit like irritable bowel syndrome in humans and can be very severe.
  • A variety of infections of the intestines can cause diarrhoea, although you should realise that this is actually quite an uncommon cause. In some cases your pet will remain relatively bright and healthy despite the diarrhoea but in others they can become very ill indeed potentially to the point of being life-threatening. One of the most infamous causes of diarrhoea in dogs is a virus called parvovirus which is more common in animals that have not been vaccinated and especially in younger unvaccinated dogs. Parvovirus can very quickly pose a threat to your dog’s life and it is worth noting that the infection is possible even in dogs that have been fully vaccinated. However vaccination has reduced the number of cases of parvovirus in dogs dramatically and you should make sure that your dogs are vaccinated and that this is kept up-to-date as discussed with your vet. Other infections that can cause diarrhoea in dogs and cats include salmonella, campylobacter, giardia, coronavirus and of course worms in the intestine.
  • And one more cause of diarrhoea that we always have to keep in mind unfortunately is cancer affecting the intestines.
So there are a number of problems affecting the intestines which can make a dog or cat have diarrhoea. Some of these problems are potentially more serious than others and as we mentioned before, regardless of the cause, individual animals may be affected more or less badly. In terms of causes of diarrhoea that do not primarily affect the intestines, these include disease of the pancreas, liver or kidneys as well as some hormonal diseases.

What information will your vet need to know?

If you ring your vet practice because your dog or cat has diarrhoea, some of the information they will find useful to try and assess the severity of the problem includes:
  • When did the diarrhoea start?
  • Approximately how many episodes have occurred and is the volume produced each time large or small?
  • Does your dog or cat strain and look uncomfortable at the time of passing the diarrhoea?
  • What does the diarrhoea look like? Is it liquid, water-like or more solid? Is there any fresh blood or slimy jelly-like mucus? Do the stools have a black tarry appearance?
  • Other questions include…Is your pet still eating? Is he or she still drinking?
  • How does your pet seem in himself or herself at the moment? Is he or she still bright and energetic or lethargic and quiet? Are there any other problems such as vomiting – if so, is it bloody? Is your pet’s breathing ok?
  • Are you aware of anything that your pet may have scavenged or did you feed him or her anything out of the ordinary before the diarrhoea started?
  • Has your pet had any medical problems in the past, especially similar episodes of diarrhoea, and is he or she on any medications at the moment?
This might seem like a lot of information but it is important to us as vets when trying to make decisions about your pet so you should try and provide as much as you can.

How is diarrhoea treated?

Right so now that we have considered some of the causes of diarrhoea, let’s talk about the treatment that may be needed. The main thing to realise is that there are really two aspects to this treatment and our job, working with you, is to figure out to what extent each of these aspects is required for your particular pet. The first aspect is what we call ‘symptomatic and supportive care’. This is basically care that your pet may require depending on how severe the diarrhoea is and for how long the diarrhoea has been going on. You will remember that we mentioned earlier how diarrhoea can cause problems such as dehydration and weakness. In terms of the symptomatic and supportive care that may be needed, this can range from no treatment being required to your pet being sent home with treatment for you to give to your pet being admitted to the practice for a fluid drip into a vein and other treatments and tests. The extent of this type of ‘symptomatic and supportive care’ required is dependent on the individual pet rather than the specific cause of their diarrhoea.

It is worth mentioning at this point that there are very few drugs that have been used in dogs and cats to try and directly stop the diarrhoea and those that have been used are not licensed. These drugs are called anti-diarrhoeals. They can have adverse effects and they are usually only used in exceptional cases. It is important that any animal receiving an anti-diarrhoeal also gets whatever other supportive care they need and that they do not remain on an anti-diarrhoeal without also trying to find the cause. Their use is especially not recommended if the diarrhoea is due to an infection.

Anti-diarrhoeals need to be differentiated from probiotics which are not drugs but actually natural supplements that are quite commonly given to dogs and cats with diarrhoea. Probiotics may help by restoring, maintaining and supporting the growth of those bacteria within the bowel that are beneficial. They may also have a number of other positive effects.

The second aspect to the treatment a pet with diarrhoea requires is more specifically aimed at the cause of their diarrhoea and ultimately this is the best way to stop the problem for good. In animals with mild diarrhoea that are otherwise well, it may be enough just to withhold food for 12-24 hours and then offer a bland diet for a few days and see whether this helps. You can buy a special food designed for animals with bowel problems or alternatively feed low-fat easily digestible foods such as boiled chicken or fish with boiled rice or pasta; feeding plain cottage cheese can also be helpful. Once the diarrhoea has cleared, gradually reintroduce your pet’s normal diet over a few days and continue to monitor.

In a number of cases this sort of treatment at home will either not work, that is the diarrhoea will continue, or your pet will already be too unwell and your vet will recommend a consultation at the practice. Once they have obtained more information from you and had a chance to examine your pet, they can make a recommendation about the next best step both in terms of how much of the ‘symptomatic and supportive care’ we discussed previously is required, and also whether they feel that it is necessary to do some tests to try and diagnose the cause of your pet’s diarrhoea. In some cases it will be necessary to do urgent tests because your vet is very worried about your pet, in other cases these tests can be done more slowly over a period of days or even weeks. It will all depend on your individual pet. Your vet may want to test your pet’s stools for infection, do some blood tests to look for causes and also for example for evidence of dehydration, and in some cases it is appropriate to take x-rays or do an ultrasound. Some animals require endoscopy – this basically involves feeding a video camera through your pet’s mouth or anus into the intestines under a general anaesthetic. It may be necessary to take biopsies, which are little tissue samples, of your pet’s intestines either using an endoscope or even by performing surgery.

Depending on the cause of your pet’s diarrhoea, treatments that may be required include trying different diets under strict management, suitable drugs if an infection is identified, or steroids and other medications if for example inflammatory bowel disease is confirmed. Your vet will be able to talk you through the management needed once the cause is known.

Antibiotics in diarrhoea

Before ending this blog we would just like to say a few words about antibiotics. Antibiotics are used to treat infections caused by bacteria. As we said earlier, diarrhoea is not often due to infection and especially not bacterial infection. We would therefore recommend that antibiotics are only used if a bacterial infection is confirmed by specific tests and you should also bear in mind that antibiotics can in fact cause diarrhoea in dogs and cats. It doesn’t make much sense to give an animal antibiotics without confirming that they definitely need them and then the antibiotics actually make the diarrhoea worse.

Okay so that brings us to the end of this PercyPods Pet Emergency blog on diarrhoea in dogs and cats. As you can see, there are a large number of causes of diarrhoea. It is not uncommon for some animals to have very short bouts of diarrhoea that are basically nothing to get too concerned about, especially if they have a varied diet with treats and scraps or because they scavenge on walks and so on. However at the other end of the spectrum, some patients with diarrhoea have very severe and potentially life-threatening disease. In general it is recommended that you consult your veterinary practice if you are at all worried.

We hope that you have found this episode useful and learned a little about diarrhoea in dogs and cats. The next blog will be in approximately 2 weeks time when we will talk about a condition in dogs known as ‘bloat’ or gastric dilation-volvulus syndrome. Before we sign off just to remind you that you can contact us in various ways. Via email on percypods@gmail.com; via the PercyPods Facebook page; or via Twitter on @PercyPods. We would really love to hear your comments on this podcast as well as suggestions for future topics. Also don’t forget to subscribe for future episodes. So thank you for reading this and until next time, may you and your pets be safe.

Saturday, 13 August 2011

Vomiting in dogs and cats

Welcome to PercyPods Pet Emergency blogs. Hope this blog finds both you and your pets well. This week we are going to talk about vomiting which is a common problem in dogs and to a lesser extent cats. It is one for which many pets are taken to the vets including outside of normal working hours as a potential emergency. Before we get started, just to remind you that you can contact us in various ways. Via email on percypods@gmail.com; via the PercyPods Facebook page; or via Twitter on @PercyPods. Thank you to those people who have been in touch so far.

What is vomiting?

Okay so let’s get started by explaining what vomiting is. Vomiting is the forceful expulsion of the contents of the stomach or small intestine back out through the mouth; this might include undigested food, fluid or other debris. Many of you will no doubt have had first-hand experience of this when you have vomited yourself or watched kids do it. It is quite common for dogs and cats to show certain signs before they are about to vomit. This can range from drooling and licking their lips to barking or meowing and they will sometimes walk around looking for a specific place to vomit. Once you have seen your pet do this, you will very likely recognise this behaviour again in the future.

One of the very important things to note about vomiting in dogs and cats is that it is an active process. By this we mean that the animal puts a lot of effort into the vomiting; they show quite exaggerated movements of the tummy area or indeed even their whole body due to muscle contractions; pet carers often say that the dog or cat almost appeared to be convulsing with waves of movement going across their body! It is important for you to note if this is the case in your pet because your vet will want to know this information. There is another problem called ‘regurgitation’ in which an animal may also bring their stomach contents back up. However, unlike vomiting, regurgitation is a passive process; animals often simply open their mouths and the stuff falls out without any obvious effort. The causes of vomiting versus regurgitation can be quite different and this is why it is important for your vet to know what behaviour your pet showed while they were bringing up their stomach contents.

Why is vomiting bad?

Okay so before we discuss some of the causes of vomiting, it is important to understand why vomiting is bad. Clearly vomiting is an unpleasant experience for your pet. They may well have been feeling nauseous for a while beforehand and afterwards and the act of vomiting is unpleasant as you may know yourself. However this is not the only reason vomiting is bad. When an animal vomits, they obviously lose the contents of their stomach which includes any food they have recently eaten or any water they have recently drunk. This may not be a problem if it only occurs once but especially with multiple episodes of vomiting, your pet will start to become dehydrated and weak and they will also lose important electrolytes such as potassium. If this situation becomes very severe, your pet may become very sick and go into shock. This applies to any animal, or human, regardless of the cause of the vomiting. An animal may be vomiting because of something that is relatively non-serious in itself but become quite sick as a result of on-going vomiting. Another possible consequence of vomiting is that your pet may inhale some of the vomit and develop pneumonia in the lungs leading to breathing difficulties. This is especially a worry in short-nosed or so-called ‘brachycephalic’ breeds of dogs and cats.

What information does your vet need to know?

If you ring your vet practice because your dog or cat is vomiting, some of the information they will find useful to try and assess the severity of the problem includes:
  • When did the vomiting start?
  • Approximately how many episodes have occurred?
  • Can you estimate approximately how much each episode of vomiting contains – for example, in terms of dessert spoons or coffee cups
  • What does the vomit look like? Common descriptions include frothy, greeny/yellowy suggesting bile, or containing food material. One important factor to mention is whether you have seen any suggestion of blood in the vomit. Sometimes you can see obvious fresh red blood, other times the vomit may have an appearance of containing ground coffee which represents partly digested blood.
  • Other questions include…Is your pet still eating? Is he or she still drinking? Do they tend to vomit straight after eating or drinking or is there a time delay or indeed does the vomiting occur randomly and is not obviously associated with eating or drinking?
  • How does your pet seem in himself or herself at the moment? Is he or she still bright and energetic or lethargic and quiet? Are there any other problems such as diarrhoea – if so, is it bloody? Is your pet’s breathing ok?
  • Are you aware of anything that your pet may have scavenged or did you feed him or her anything out of the ordinary before the vomiting started?
  • Has your pet had any medical problems in the past, especially similar episodes of vomiting, and is he or she on any medications at the moment?
This might seem like a lot of information but it is important to us as vets when trying to make decisions about your pet so you should try and provide as much as you can.

What are the causes of vomiting?

Okay so let’s spend a bit of time talking about the causes of vomiting in dogs and cats and then we will finish the blog by explaining some of the treatment that may be needed. There are a large number of causes of vomiting that vary in terms of how serious they are. Although as we said earlier, any animal that vomits enough, regardless of the cause, can become very ill.

So the actual act of vomiting is triggered by the brain. However the signals that tell the brain to trigger vomiting can come from a wide variety of places in the body. One useful way of dividing up the causes of vomiting is by separating them into ones that primarily affect the stomach or the intestines, versus causes that occur elsewhere in the body, for example in the pancreas, the liver or even the brain itself. Many, but not all, of the causes of vomiting also tend to cause diarrhoea and we will discuss diarrhoea in the next blog in 2 weeks time.

In dogs and cats vomiting is most often because of a problem in the stomach or intestines. These problems include for example:
  • What we call ‘dietary indiscretion’: this is when your pet either eats something that doesn’t quite agree with him or her, for example because it is too rich or rotten, or they overeat.
  • Foreign body ingestion is also a type of dietary indiscretion. It is very common for dogs, especially certain dogs like young Labradors, to eat foreign bodies such as balls, corn cobs, toy items, socks, bones and so on. Sometimes this goes entirely unnoticed by you but in other cases vomiting may occur. Cats may also eat foreign bodies, although it is less common. Fur balls are one common cause of vomiting in cats. Poisoning is another type of dietary indiscretion that can often result in vomiting in both dogs and cats.
  • Another relatively common cause of vomiting is as a side-effect of certain medications and especially of so-called ‘non-steroidal anti-inflammatories’ such as carprofen, meloxicam or firocoxib. We discussed these drugs in the context of poisoning in episode 3 of these blogs so please make sure you have a read if you haven’t already.
  • Another cause of vomiting is food intolerance or food allergy: this is when your pet is allergic to either their main diet or any other treats that are fed. These pets will usually have diarrhoea too.
  • ‘Inflammatory bowel disease’ or ‘IBD’ is another cause of vomiting affecting the stomach and intestines. This is a bit like irritable bowel syndrome in humans and can be very severe.
  • Infections of the stomach or intestines can cause vomiting, although you should realise that this is actually quite an uncommon cause. The more severe infections are usually accompanied at some point by diarrhoea, which can be very severe, and examples include parvovirus infection and salmonella. Worms in the intestines can also cause vomiting.
  • And one more cause of vomiting is cancer affecting the stomach or the intestines.
So there are a number of problems affecting the stomach or intestines which can make a dog or cat vomit. Some of these problems are potentially more serious than others and as we mentioned before, regardless of the cause, individual animals may be affected more or less badly.

In terms of causes of vomiting that do not primarily affect the stomach or intestines, they often involve inflammation for example in the pancreas (so-called pancreatitis), the liver, the bladder and so on.  Other causes of vomiting include kidney failure, liver failure and hormonal diseases, and there are a number of other potential causes too. Animals suffering from one of these problems may show other symptoms in addition to the vomiting that relate to the particular problem; so for example if the primary problem affects the liver they may be jaundiced, that is having a yellow discolouration of the gums, skin or whites of the eyes, or if the primary problem affects the bladder, they may strain to urinate.

How is vomiting treated?

Right so now that we have considered some of the causes of vomiting, let’s talk about the treatment that may be needed. The main thing to realise is that there are really two aspects to this treatment and our job, working with you, is to figure out to what extent each of these aspects is required for your particular pet. The first aspect is what we call ‘symptomatic and supportive care’. This is basically care that your pet may require depending on how severely he or is she vomiting and for how long the vomiting has been going on. You will remember that we mentioned earlier how vomiting can cause problems such as dehydration and weakness. In terms of the symptomatic and supportive care that may be needed, this can range from no treatment being required to your pet being sent home with treatment for you to give to your pet being admitted to the practice for a fluid drip into a vein and other treatments and tests. The extent of this type of ‘symptomatic and supportive care’ required is dependent on the individual pet rather than the specific cause of their vomiting.

It is worth mentioning at this point that there are a small number of drugs that have been used in dogs and cats to try and directly stop the vomiting. These drugs are called ‘anti-emetics’. For the most part they are not actually licensed for use in dogs and cats but have been used safely on many occasions. They often make the animal feel better and appear brighter in part because they may also treat any nausea present. However it is crucial to realise that there are some occasions in which the use of such drugs is not considered safe or the best course of action and therefore your vet may decide not to administer one of these drugs. Other drugs that are sometimes used with or without an anti-emetic include stomach protectants and antacids.

The second aspect to the treatment your pet requires is more specifically aimed at the cause of their vomiting and ultimately this is the best way to stop the vomiting for good. In some cases it may be enough just to withhold food from your pet for example for 12 to 24 hours after consulting your vet practice for advice. Water however must be readily available throughout although it can help sometimes to manage your pet’s drinking by offering a small amount of water frequently rather than one big bowl that they may gulp in one go and worsen their vomiting. It is essential not to withhold water and if your pet vomits after drinking water then we would very much recommend that your consult your vet practice. In general we would only recommend withholding food for a short period for those animals that have vomited a small number of times, that remain relatively bright and that can keep water down. These animals should still be monitored carefully at home and should improve quite quickly. For more severely affected animals or those showing signs of weakness, depression or changes in breathing, it is better to be seen as soon as possible.

If withholding food is recommended, after the 12 to 24 hour period you can then start to feed your pet little and often for a couple of days or so to make sure the vomiting has resolved; bland low-fat foods such as boiled chicken or fish with boiled rice or pasta work well and feeding plain cottage cheese for example can also be helpful.

In a number of cases this sort of treatment at home will either not work, that is the vomiting will continue, or your pet will already be too unwell and your vet will recommend a consultation at the practice. Once they have obtained more information from you and had a chance to examine your pet, they can make a recommendation about the next best step both in terms of how much of the ‘symptomatic and supportive care’ we discussed previously is required, and also whether they feel that it is necessary to do some tests to try and diagnose the cause of your pet’s vomiting. In some cases it will be necessary to do urgent tests because your vet is very worried about your pet, in other cases these tests can be done more slowly over a period of days or even weeks. It will all depend on your individual pet. The most important decision that your vet will want to make initially is whether they think your pet is vomiting because of a cause that needs surgery to be performed urgently; such causes include obstruction or rupture of the intestines due to a foreign body. Your vet may want to take x-rays or do an ultrasound in order to help them make the decision whether your pet needs surgery or not. Sometimes endoscopy is also used; this basically involves feeding a video camera through your pet’s mouth down into the stomach and intestines under a general anaesthetic.

Okay so that brings us to the end of this PercyPods Pet Emergency blog on vomiting in dogs and cats. As you can see, there are a large number of causes of vomiting. It is not uncommon for some animals to have very short bouts of vomiting that are basically nothing to get too concerned about; for example, my last cat was long-haired and used to vomit fur balls from time to time, which we both just got used to! Some animals vomit for example once a month for their entire lifetime! However at the other end of the spectrum, some vomiting patients have very severe and potentially life-threatening disease. In general it is recommended that you consult your veterinary practice if you are at all worried about your pet vomiting.

We hope that you have found this episode useful and learned a little about vomiting in dogs and cats. The next blog will be in approximately 2 weeks time when we will talk about diarrhoea and as mentioned many of the causes of vomiting also often cause diarrhoea. Before we sign off just to remind you that you can contact us in various ways. Via email on percypods@gmail.com; via the PercyPods Facebook page; or via Twitter on @PercyPods. We would really love to hear your comments on this blog as well as suggestions for future topics. Also don’t forget to subscribe for future episodes via the RSS feed and that these blogs are also available as audio podcasts. So thank you for reading and until next time, may you and your pets be safe.