Inflammation of the Pancreas (Pancreatitis) in Cats

Inflammation of the Pancreas (Pancreatitis) in Cats – Overview

  • The pancreas is an organ of the body, located near the upper small intestine; the pancreas produces insulin to regulate blood sugar and produces digestive enzymes involved in digestion of starches, fats, and proteins in the animal’s diet; the digestive enzymes are delivered to the upper small intestine through the pancreatic duct
  • “Pancreatitis” is inflammation of the pancreas
  • Sudden (acute) pancreatitis—inflammation of the pancreas that occurs abruptly, with little or no permanent damage to the pancreas
  • Long-term (chronic) pancreatitis—continuing inflammation of the pancreas that is accompanied by irreversible damage to the pancreas
  • “Edematous pancreatitis” is characterized by fluid buildup in the interstitium (small spaces between tissues or parts of the pancreas) and mild inflammation with neutrophils and lymphocytes (two types of white-blood cells); the pet generally recovers rapidly
  • “Necrotizing pancreatitis” is inflammation of the pancreas characterized by bleeding (hemorrhage) and areas of death of tissues (known as “necrosis,” thus the name “necrotizing pancreatitis”); it usually is a severe and prolonged disease and many affected pets die

Breed Predilections

  • Siamese (cat)

Mean Age and Range

  • Mean age for sudden (acute) pancreatitis in cats is 7.3 years

Signs/Observed Changes in the Pet

  • Dogs—predominantly gastrointestinal tract signs (such as vomiting, diarrhea)
  • Cats—vague, non-specific signs that generally do not localize problem to the pancreas
  • Sluggishness (lethargy), depression, lack of appetite (known as “anorexia”)—common in dogs and cats
  • Vomiting—common in dogs, less common in cats
  • Diarrhea—more frequently seen in dogs than in cats
  • Weight loss—common in cats
  • Dogs may exhibit abdominal pain
  • Yellowish discoloration to gums and moist tissues of the body (known as “jaundice” or “icterus”)—common in dogs and cats
  • Dehydration—common; due to gastrointestinal losses of fluid
  • Mass lesions may be felt during physical examination in both dogs and cats.
  • Fever—common in dogs; both fever and low body temperature (known as “hypothermia”) reported in cats
  • Less common systemic abnormalities include severe breathing difficulties (known as “respiratory distress”), bleeding disorders, and irregular heartbeats (known as “cardiac arrhythmias”)

Causes

  • Usually unknown; possibilities include the following:
  • Nutritional factors (such as an increase in lipoprotein [complexes of lipid and protein] concentration in the blood [known as “hyperlipoproteinemia”])
  • Pancreatic trauma or lack of blood flow (known as “ischemia”) to the pancreas
  • Duodenal reflux (a condition in which contents in the upper small intestine [duodenum] move backward)
  • Drugs or toxins
  • Pancreatic duct blockage or obstruction
  • High levels of calcium in the blood (known as “hypercalcemia”)
  • Infectious diseases—toxoplasmosis, feline infectious peritonitis (FIP)
  • Extension of inflammation from the liver and bile duct system or intestines in the cat

Risk Factors

  • Breed—dog: miniature schnauzer, miniature poodle, cocker spaniel; cat: Siamese
  • Obesity in dogs
  • Another disease (such as sugar diabetes [diabetes mellitus]; increased levels of steroids produced by the adrenal glands [known as “hyperadrenocorticism” or “Cushing’s syndrome”]; long-term [chronic] kidney failure, and cancer) in dogs
  • Recent administration of certain drugs
  • Liver (hepatic) or gastrointestinal tract inflammation in cats

Treatment
Health Care

  • Inpatient medical management
  • Aggressive intravenous (IV) fluid therapy
  • Fluid therapy goals—correct low circulating blood volume (known as “hypovolemia”) and maintain pancreatic circulation
  • A balanced electrolyte solution (such as lactated Ringer’s solution [LRS]) is the first-choice for providing hydration
  • May need colloids; colloids are fluids that contain larger molecules that stay within the circulating blood to help maintain circulating blood volume, examples are dextran and hetastarch
  • Following replacement of fluid deficits, give additional fluids to match maintenance requirements and ongoing losses
  • Potassium chloride (KCl) supplementation usually needed, because potassium is lost from the body in the vomit

Activity

  • Restrict

Diet

  • Continue to feed by mouth, unless vomiting is difficult to control; feeding maintains the integrity of the intestinal lining and minimizes bacterial invasion from the intestines and into the body
  • Pets with intermittent vomiting should be treated with drugs to control nausea and vomiting (known as “antiemetics”), such as metoclopramide or phenothiazines
  • Tube feeding into the jejunum (the middle section of the small intestine) allows feeding into the intestines (known as “enteral feeding”), while allowing the pancreas to rest
  • Withhold all food and water by mouth (known as “NPO”) in pets with persistent vomiting for the shortest time possible; when no vomiting has occurred for 4–6 hours, offer small volumes of water; if tolerated, begin small, frequent feedings of a carbohydrate (such as boiled rice); gradually introduce a protein source of high biologic value (such as cottage cheese or lean meat)
  • Avoid high-protein and high-fat diets
  • Pets needing extended time without food and water by mouth (NPO) may require tube feeding into the jejunum or intravenous feeding (known as “total parenteral nutrition”)

Surgery

  • May need surgery to remove localized accumulations of fluid (known as “pseudocysts”), abscesses, or areas of dead (necrotic) tissue seen with necrotizing pancreatitis (inflammation of the pancreas characterized by bleeding and areas of death of tissues)
  • May need surgical exploration of the abdomen and biopsy of the pancreas to confirm pancreatitis and/or to rule out other diseases not involving the pancreas
  • Bile-duct blockage outside of the liver (known as “extrahepatic biliary obstruction”) from pancreatitis requires surgical correction

Medications

  • Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive
  • Steroids are indicated only for the treatment of shock
  • Drugs that act on the vomiting center of the brain to control nausea and vomiting (known as “centrally acting antiemetics”) are indicated with vomiting that is difficult to control—metoclopramide, chlorpromazine, or prochlorperazine
  • Maropitant (Cerenia)—medication to control nausea and vomiting (antiemetic); useful in controlling sudden (acute) vomiting in dogs
  • Antibiotics, if evidence of sepsis (presence of pus-forming bacteria and their poisons in the blood or tissues)—penicillin G, ampicillin, and enrofloxacin
  • Pain relievers (known as “analgesics”) to relieve abdominal pain, such as buprenorphine

Follow-Up Care
Patient Monitoring

  • Evaluate hydration status closely during first 24 hours of therapy; twice daily check physical examination; body weight; packed cell volume (PCV, a means of measuring the percentage volume of red-blood cells as compared to the fluid volume of blood) and total solids (a quick laboratory test that provides general information on the level of protein in the fluid portion of the blood); and blood urea nitrogen (BUN) and urine output to monitor the kidneys and hydration status
  • Evaluate the effectiveness of fluid therapy after 24 hours, and adjust flow rates and fluid composition accordingly; repeat blood tests (serum biochemistries) to assess electrolyte/acid–base status
  • Repeat plasma enzyme concentrations (pancreatic-lipase immunoreactivity [PLI] assay, a test that determines the levels of lipase, a pancreatic enzyme) after 7 days, to evaluate the status of the inflammation of the pancreas
  • Watch closely for complications involving a variety of organ systems; perform appropriate diagnostic tests as needed
  • Gradually taper fluids down to maintenance requirements, if possible
  • Maintain feeding by mouth or into the jejunum (enteral nutrition)
  • Reassess and correct ongoing low serum cobalamin (Vitamin B12) concentrations

Preventions and Avoidance

  • Weight reduction, if obese
  • Avoid high-fat diets
  • Avoid drugs that may increase the risk of inflammation of the pancreas (pancreatitis)

Possible Complications

  • Failed response to supportive therapy
  • Life-threatening associated conditions

Expected Course and Prognosis

  • Good for most pets with edematous pancreatitis (inflammation of the pancreas characterized by fluid buildup in the interstitium and mild inflammation with neutrophils and lymphocytes [two types of white-blood cells]); these pets usually respond to appropriate symptomatic therapy
  • More guarded to poor for pets with necrotizing pancreatitis (inflammation of the pancreas characterized by bleeding [hemorrhage] and areas of death of tissues [necrosis]) and systemic conditions

Key Points

  • Sudden (acute) pancreatitis—inflammation of the pancreas that occurs abruptly, with little or no permanent damage to the pancreas
  • Long-term (chronic) pancreatitis—continuing inflammation of the pancreas that is accompanied by irreversible damage to the pancreas
  • Need for extended hospitalization
  • Diagnosis and treatment can be expensive
  • Possible complications include lack of response to supportive therapy and life-threatening conditions

Obesity in Cats

Obesity in Cats – Overview

  • An excess of body fat, frequently resulting in adverse health effects
  • Even a moderate excess in body fat can increase incidence of disease (known as “morbidity”) and reduce lifespan

Mean Age and Range

  • All ages, with the greatest prevalence (nearly 50%) in middle-aged cats

Predominant Sex

  • Most common in neutered, indoor pets

Signs/Observed Changes in the Pet

  • Weight gain
  • Exercise intolerance may be reported
  • Excess body fat and high body condition score or BCS (estimate of weight status [under- or overweight] as compared to normal weight)

Causes

  • Obesity is caused by an imbalance between calorie or energy intake and calorie or energy expenditure, with intake exceeding expenditure
  • Neutering, decreased opportunities for activity, and age can reduce expenditure of energy
  • Overfeeding of high calorie foods, frequently alternating foods, and provision of excess treats contribute to excess calorie or energy intake
  • Low levels of thyroid hormone (known as “hypothyroidism”), insulin-secreting tumor (known as an “insulinoma”), or high levels of steroids produced by the adrenal glands (known as “hyperadrenocorticism” or “Cushing’s syndrome”) are infrequent causes of obesity

Treatment
Health Care

  • Weight loss, induced by reducing calorie intake below calorie or energy expenditure
  • Successful weight loss also requires long-term maintenance of the reduced weight
  • Weight loss and maintenance of reduced weight depend on changes in the way the owner feeds and interacts with the pet
  • The owner should assess and monitor the body condition score (estimate of weight status [under- or overweight] as compared to normal weight) of his or her pet; your pet’s veterinarian will provide information on assessing BCS

Activity

  • Calorie or energy restriction results in compensatory decreases in basal energy expenditure or metabolism; increased activity helps compensate for this decrease in metabolism and provides alternate opportunities for owner-pet interactions
  • Leash walking for dogs and trained cats—at least 15 minutes twice daily
  • Activities such as “fetch,” interactive toys for cats, or playing with a laser light
  • Food balls—built to hold treats or kibbles and randomly release them while the dog or cat plays; food used in the ball must be included as part of the daily calorie allowance

Diet

  • Get written instructions regarding specific amounts to provide, using the agreed upon reducing diet (a “cup” of food refers to an 8-oz measuring cup); measure food carefully to ensure appropriate amount is being fed
  • Protein—increased dietary protein facilitates loss of body fat, while minimizing loss of lean body mass (LBM), which is the metabolically active tissue—preserving LBM should help with long-term weight control by maintaining a higher resting energy requirement; protein also stimulates metabolism, increases energy expenditure, and contributes to the feeling of being full or satisfied (known as “satiety”)
  • Fiber—dietary fiber provides little dietary energy, so it helps reduce total calories in the diet; fiber also stimulates intestinal metabolism and energy utilization, and contributes to the feeling of being full or satisfied (satiety)
  • Other dietary factors that may aid in weight management—carnitine, compound necessary for fat metabolism; isoflavones, stimulate energy metabolism and support lean body mass
  • Fat—calorie or energy dense, so low-fat diets are lower in energy
  • Calories should be restricted, without excessive restriction of essential nutrients; a low-calorie therapeutic diet with an increased nutrient-to-calorie ratio is recommended for weight loss
  • Amount fed should target a 1–2% loss in body weight per week; faster weight loss may increase loss of lean body mass and stimulate weight rebound once weight loss is achieved
  • High moisture diets can be used to reduce calories per serving; this approach appears to be more effective for cats versus dogs, as cats tend to control their intake based on volume
  • If the client is not willing to use a therapeutic diet, severe calorie restriction should be avoided; a food diary can be used to record current intake over 3–7 days—subsequently, the pet should be fed 10–20% less than it previously received
  • Treats are often part of the owner-pet bond; complete avoidance of treats is a hurdle to compliance with weight loss programs—instead, offer a “treat allowance” of 10% of the daily calories and use low-calorie treats suitable for dogs or cats, as directed by your pet’s veterinarian

Medications

  • Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive
  • Dirlotapide (Slentrol, Pfizer Animal Health)—approved only for use in dogs; can cause decreased appetite sufficient to lead to weight loss; use with a diet formulated for weight loss; appetite and weight will rebound after discontinuing dirlotapide; talk to your pet’s veterinarian about a feeding plan to avoid rebound weight gain
  • Mitratapide has a similar mechanism of action; use limited to a single course of treatment

Follow-Up Care
Patient Monitoring

  • Frequent communication is important during the weight management program
  • Telephone call from clinic to the owner to address any minor questions and to reinforce the importance of the program
  • Pet should be weighed in the clinic on a monthly basis; if needed, adjustments in food allowance guidelines should be made at this time
  • Once the pet has achieved an ideal body condition score (estimate of weight status [under- or overweight] as compared to normal weight) guidelines should be provided for weight maintenance; continue to measure food, monitor BCS or body weight, and adjust food allowance as needed to maintain the goal weight

Preventions and Avoidance

  • Monitor food intake, weight, and body condition score (estimate of weight status [under- or overweight] as compared to normal weight) throughout life to prevent weight gain and obesity
  • Maintain a healthy diet and reduce caloric intake if pet starts gaining weight (even small weight gains of 1–2 pounds can be significant in small- and medium-size dogs and in cats)

Possible Complications

  • Obesity leads to increased risk for diseases (such as osteoarthritis, diabetes mellitus) or shortened lifespan

Key Points

  • Obesity leads to increased risk for diseases (such as osteoarthritis, diabetes mellitus) or shortened lifespan
  • Weight loss and maintenance of reduced weight depend on changes in the way the owner feeds and interacts with the pet
  • Monitor food intake, weight, and body condition score (estimate of weight status [under- or overweight] as compared to normal weight) throughout life to prevent weight gain and obesity
  • Maintain a healthy diet and reduce caloric intake if pet starts gaining weight (even small weight gains of 1–2 pounds can be significant in small- and medium-size dogs and in cats)

Megacolon

Megacolon – Overview

  • “Mega-” refers to large or oversized; “colon” is another term for the large intestine
  • “Megacolon” is a condition of persistent, increased large-intestine diameter associated with long-term (chronic) constipation/obstipation and low-to-absent movement of the large intestines (known as “colonic motility”)
  • “Constipation” is infrequent, incomplete, or difficult defecation with passage of hard or dry bowel movement (feces)
  • “Obstipation” is constipation that is difficult to manage or does not respond to medical treatment, caused by prolonged retention of hard, dry bowel movement (feces); defecation is impossible in the pet with obstipation

Breed Predilections

  • Some evidence for increased risk of having megacolon in Manx cats as compared to other cat breeds

Mean Age and Range

  • Acquired (condition that develops sometime later in life/after birth) megacolon—none
  • Idiopathic megacolon (enlarged large intestine of unknown cause)—middle-aged to old cats (mean age, 4.9 years; range, 1–15 years)

Signs/Observed Changes in the Pet

  • Acquired (condition that develops sometime later in life/after birth) megacolon—signs may be sudden (acute) or long-term (chronic)
  • Idiopathic megacolon (enlarged large intestine of unknown cause)—typically a long-term (chronic) or recurrent problem; signs often present for months to years
  • Constipation/obstipation (constipation that is difficult to manage or does not respond to medical treatment)
  • Painful defecation or straining to defecate (known as “tenesmus”) with small or no fecal volume
  • Hard, dry feces
  • Infrequent defecation
  • Small amount of diarrhea (often with mucus) may occur after prolonged painful defecation or straining to defecate (tenesmus)
  • Occasional vomiting, lack of appetite (known as “anorexia”), and/or depression
  • Weight loss
  • Enlarged colon with hard bowel movement (feces) may be detected on physical examination
  • Rectal examination may indicate an underlying (obstructive) cause and confirms the presence of hardened bowel movement in the large intestine (colon) or rectum (condition known as “fecal impaction”)
  • Dehydration
  • Scruffy, unkempt hair coat

Causes

  • Idiopathic megacolon (enlarged large intestine of unknown cause)—cats
  • Mechanical blockage or obstruction of the passage of bowel movement (feces)—pelvic fracture; foreign body or improper diet (especially bones); abnormal narrowing of the colon or rectum (known as a “stricture”); prostate disease; condition in which the muscles supporting the rectum weaken and separate, allowing the rectum and/or bladder to slide under the skin and causing swelling in the area of the anus (known as a “perineal hernia”); cancer; birth defect in which the anus or rectum does not have an opening (known as “anal atresia” or “rectal atresia,” respectively)
  • Causes of difficulty defecating (dyschezia)—disease of the anus and/or rectum (such as inflammation of the anal sacs [known as “anal sacculitis”]; anal sac abscess; one or multiple draining tracts around the anus (known as “perianal fistulae”); inflammation of the lining of the rectum [known as “proctitis”]); trauma (fractured pelvis, fractured limb, dislocated hip, bite wound or laceration in the tissue around the anus, perineal [area between the anus and external genitalia] abscess)
  • Metabolic disorders—low levels of potassium in the blood (known as “hypokalemia”), severe dehydration
  • Various medications—examples include vincristine, barium, antacids, sucralfate, anticholinergics (used as preanesthetics or to treat diarrhea, such as atropine)
  • Nervous system and/or muscular disease—congenital (present at birth) abnormalities of the spine (especially Manx cats); paralysis of the rear legs (known as “paraplegia”); spinal cord disease; intervertebral disk disease; abnormal function of the autonomic nervous system (known as “dysautonomia”); sacral nerve disease; sacral nerve trauma (such as a tail fracture/pull injury); trauma to nerves to the large intestine

Risk Factors

  • Pain involving the rectum and/or anus and conditions (such as pelvic and limb fractures or diseases of the nerves and/or muscles) leading to inability to posture to defecate
  • Prior pelvic fractures
  • Possible association with low physical activity and obesity
  • Perineal hernias; a “perineal hernia” develops when the muscles supporting the rectum weaken and separate, allowing the rectum and/or bladder to slide under the skin and causing swelling in the area of the anus

Treatment
Health Care

  • Inpatient medical management; surgery may be indicated, if recurrent or severe problem
  • Medical treatment—restore normal hydration, followed by anesthesia and manual evacuation of the colon using warm water enemas, water-soluble jelly, and gentle extraction of feces with a gloved finger or sponge forceps
  • Continue long-term therapy at home
  • Most pets require fluids to correct dehydration
  • Continue fluid support until the pet is willing to eat and drink

Activity

  • Encourage activity and exercise
  • Restricted activity indicated in the postoperative period, if surgery is performed

Diet

  • Many pets require a low-residue-producing diet; bulk-forming fiber diets can worsen or lead to recurrence of megacolon
  • A high-fiber diet is occasionally helpful
  • A maintenance-type diet can be supplemented with products such as Metamucil or pumpkin-pie filler

Surgery

  • An underlying blockage or obstructive cause requires surgical correction
  • Avoid enema administration/colonic evacuation prior to surgical procedure to remove part of the colon (known as a “subtotal colectomy”)
  • Surgical removal of a section of the colon, with connection of the ends of the remaining sections of the intestines (known as “ileorectal or colorectal resection and anastomosis”)—treatment of choice for idiopathic megacolon (enlarged large intestine of unknown cause) that does not respond to medical management
  • Surgical removal of the colon (known as a “colectomy”) may be required with obstructive megacolon caused by irreversible changes in movement of the large intestines (colonic motility)

Medications

  • Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive
  • Can improve large intestinal movement (colonic motility) in less severe cases with cisapride, a gastrointestinal prokinetic drug; “gastrointestinal prokinetic drugs” are medications that improve the propulsion of contents through the stomach and intestines
  • Stool softeners (such as lactulose) are recommended in conjunction with cisapride and diet
  • Broad-spectrum antibiotics are recommended prior to emptying the colon and rectum of dry, hard bowel movement (feces) and during the time immediately surrounding surgery, if surgery is elected
  • Docusate sodium can be used as a stool softener in place of lactulose

Follow-Up Care
Patient Monitoring

  • Following surgical removal of part of the large intestine (colon) with connection of the ends of the remaining sections of the intestines (known as “colonic resection and anastomosis”)—for 3–5 days check for signs of splitting open or bursting along the incision line (known as “dehiscence”) and inflammation of the lining to the abdomen (known as “peritonitis”)
  • Clinical deterioration warrants tapping the abdomen (known as “abdominocentesis”) and/or flushing the abdomen (known as “peritoneal lavage”) to detect leakage of intestinal contents through the incision site

Preventions and Avoidance

  • Repair pelvic fractures that narrow the pelvic canal
  • Avoid exposure to foreign bodies and feeding bones

Possible Complications

  • Recurrence or persistence—most common
  • Potential surgical complications include inflammation of the lining of the abdomen (peritonitis), persistent diarrhea, abnormal narrowing of the large intestine (stricture formation), and recurrence of obstipation (constipation that is difficult to manage or does not respond to medical treatment)
  • Abnormal opening or hole in the large intestines (known as a “perforation”)

Expected Course and Prognosis

  • Historically, medical management has been unrewarding
  • Cisapride appears to improve the prognosis with medical management in some pets, but may not suffice in severe or long-standing cases
  • Postoperative diarrhea—expected; typically resolves within 6 weeks (80% of cats with idiopathic megacolon [enlarged large intestine of unknown cause] undergoing surgical removal of part of the colon [subtotal colectomy]), but can persist for several months
  • Surgical removal of part of the colon (subtotal colectomy) is well tolerated by cats; constipation recurrence rates are typically low

Key Points

  • In idiopathic megacolon (enlarged large intestine of unknown cause) or with severe colonic injury, medical treatment often is lifelong and can be frustrating
  • Recurrence is common
  • Surgical removal of part of the colon (subtotal colectomy) is indicated, if medical treatment fails

Chronic Diarrhea in Cats

Chronic Diarrhea in Cats – Overview

  • A change in the frequency, consistency, and volume of bowel movement (feces) for more than 3 weeks or with a pattern of episodic recurrence
  • Can be either small bowel (small intestine) or large bowel (large intestine or colon) diarrhea

Signs/Observed Changes in the Pet

  • Underlying disease process determines clinical signs

Small Bowel Diarrhea (Involves the Small Intestines)

  • Larger volume of bowel movement (feces) than normal
  • Frequency of defecation is mild to moderately above normal (2–4 times per day)
  • Weight loss
  • Increased appetite (known as “polyphagia”) in cases with abnormal digestion or absorption of food (known as “maldigestion” or “malabsorption,” respectively) or increased levels of thyroid hormone (known as “hyperthyroidism”)
  • May have black, tarry stools (due to the presence of digested blood; condition known as “melena”); no mucus or red blood in the bowel movement (presence of red blood in the bowel movement known as “hematochezia”)
  • Little to no evidence of painful defecation or straining to defecate (known as “tenesmus”) or difficulty in defecating (known as “dyschezia”)
  • May have excessive gas formation in the stomach or intestines (known as “flatulence”) and rumbling or gurgling sounds caused by movement of gas in the intestinal tract (known as “borborygmus”)
  • Vomiting—variable
  • Poor body condition with some causes of long-term (chronic) diarrhea
  • Dehydration—variable
  • Thickened intestines, abdominal fluid, and enlarged abdominal lymph nodes may be felt by your pet’s veterinarian

Large Bowel Diarrhea (Involves the Large Intestines or Colon)

  • Smaller volume of bowel movement (feces) per defecation than normal
  • Frequency of defecation significantly higher than normal (greater than 4 times per day)
  • No weight loss
  • Often mucus or red blood in the bowel movement (hematochezia); no evidence of black, tarry stools (melena)
  • Painful defecation or straining to defecate (tenesmus) and urgency to defecate
  • Difficulty defecating (dyschezia) with rectal or lower colonic disease
  • Excessive gas formation in the stomach or intestines (known as “flatulence”) and rumbling or gurgling sounds caused by movement of gas in the intestinal tract (known as “borborygmus”)—variable
  • Vomiting—variable
  • Body condition more typically normal
  • Dehydration—uncommon
  • Thickened intestines may be felt by your pet’s veterinarian

Causes

  • Inflammatory bowel disease (IBD)—various types, including lymphoplasmacytic enterocolitis, granulomatous enteritis, eosinophilic enteritis/hypereosinophilic syndrome, and idiopathic inflammatory colitis
  • Tumor or cancer—lymphoma, adenocarcinoma, mast cell tumor, and polyps
  • Blockage or obstruction of the small or large intestines—tumor or cancer, foreign body, IBD, folding of one segment of the intestine into another segment (known as “intussusception”), and abnormal narrowing of the intestines (known as a “stricture”)
  • Metabolic disorders—increased levels of thyroid hormone (known as “hyperthyroidism”), kidney disease, liver disease, diabetes mellitus (“sugar diabetes”)
  • Poisons
  • Side effect of medications
  • Parasites—Giardia, Toxoplasma, roundworms (Toxocara cati, Toxascaris leonina), hookworms (Ancylostoma), Cryptosporidium, Cystoisospora, Tritrichomonas
  • Bacterial infections—Escherichia coli, Campylobacter, Salmonella, Yersinia, and Clostridium perfringens
  • Viral infections—feline leukemia virus (FeLV), feline immunodeficiency virus (FIV), and feline infectious peritonitis (FIP)
  • Fungal diseases—histoplasmosis, aspergillosis
  • Non-inflammatory causes of abnormal absorption of food (malabsorption)—dilation of the lymphatic vessels (known as “lymphangiectasia”); condition in which a high number of bacteria are found in the upper small intestine (known as “small intestinal bacterial overgrowth”); diarrhea and other signs caused by absence of a long section of small intestine, usually because of surgical removal (condition known as “short-bowel syndrome”); and ulcers in the upper small intestines (known as “duodenal ulcers”)
  • Abnormal digestion of food (maldigestion)—liver disease and syndrome caused by inadequate production and secretion of digestive enzymes by the pancreas (known as “exocrine pancreatic insufficiency”)
  • Diet—dietary sensitivity, dietary indiscretion (that is, eating substances that should not be eaten), and diet changes
  • Congenital (present at birth) anomalies—short colon; condition in which blood vessels allow blood to flow abnormally between the portal vein (vein that normally carries blood from the digestive organs to the liver) and the body circulation without first going through the liver (known as a “portosystemic shunt”)

Risk Factors

  • Dietary changes and feeding poorly digestible or high-fat diet

Treatment
Health Care

  • Often must be specific for the underlying cause to be successful
  • When no definitive diagnosis is possible, treatment with dietary management and metronidazole sometimes results in clinical improvement
  • Fluid therapy for dehydration
  • Correct electrolyte (such as sodium, potassium, chloride) and acid–base imbalances

Diet

  • A lower-fat, novel protein and carbohydrate (a protein and carbohydrate to which the pet has never been exposed) diet or fiber-supplemented diet may be beneficial; feed for 3–4 weeks; may resolve diarrhea due to dietary intolerance or allergy
  • Food should be highly digestible

Surgery

  • Biopsy of the stomach, small intestine, and/or large intestine
  • Exploratory surgery of the abdomen and surgical biopsy

Medications

  • Medications presented in this section are intended to provide general information about possible treatment. The treatment for a particular condition may evolve as medical advances are made; therefore, the medications should not be considered as all inclusive
  • Medications vary, depending on underlying cause

Follow-Up Care
Patient Monitoring

  • Fecal volume and character, frequency of defecation, and body weight
  • Recheck for intestinal parasites

Preventions and Avoidance

  • Depend on underlying cause

Possible Complications

  • Dehydration
  • Poor body condition
  • Fluid buildup in the abdomen (known as “abdominal effusion”) with intestinal cancer (adenocarcinoma)

Expected Course and Prognosis

  • Depend on underlying cause
  • Resolution usually occurs gradually with treatment; if diarrhea does not resolve, consider re-evaluating the diagnosis

Key Points

  • Complete resolution of signs is not always possible, despite a correct diagnosis and proper treatment
  • Some causes of long-term (chronic) diarrhea result in actual changes to the lining of the intestines that may require many months to resolve or that may not resolve.