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Chronic cases of diarrhea in
cats are a familiar headache for many veterinarians. Symptoms
can wax and wane over a period of time, which can complicate
the veterinarians assessment of the response to treatment in
some cases. Many, though not all of these cats, will have inflammatory
bowel disease (IDB). This article will focus on how a veterinarian
is able to diagnose IBD, and what the treatment options are.
There are many possible underlying
causes when a cat presents with vomiting, diarrhea or weight
loss:
Parasites (worms)
Viral disease (Coronavirus, Leukaemia virus)
Bacteria (Salmonella, Campylobacter)
Protozoa (Giardia, Tritrichomonas)
Dietary (food intolerance, food allergy)
Cancer (lymphoma, adenocarcinoma)
Inflammatory bowel disease
Hormonal or metabolic (hyperthyroidism, kidney failure)
Drug or toxin induced
Motility disorders
The veterinarian should take
a full history from the owner, to avoid spending time and money
on unnecessary testing. Factors to be considered are age, diet,
appetite, worming history, weight change and the nature of the
vomiting or diarrhea. It is important to differentiate vomiting
from regurgitation, which is usually an esophageal problem, and
to differentiate small intestinal diarrhea from large intestinal
diarrhea by the frequency and consistency of the feces.
The veterinarian will then
carry out a full clinical examination, before embarking on a
basic approach to the diagnosis as follows:
Blood and urine tests to rule
out disease elsewhere in the BODY BACKGROUND="texture2733585.jpg" BGCOLOR="#ffffff" BACKGROUND="texture2733585.jpg" which has a knock on effect
on the gastrointestinal tract.
Bacterial culture of the feces to rule out Salmonella & Campylobacter
Parasite check on the feces to rule out worms
Xrays to rule out an obstruction by a foreign BODY BACKGROUND="texture2733585.jpg" BGCOLOR="#ffffff" BACKGROUND="texture2733585.jpg" or a tumor
Ultrasound examination of the abdomen to measure gut wall thickness
Bland prescription diet for 4-6 weeks (e.g. Hills Z/D, Royal
Canin Sensitivity Control)
Intestinal biopsies via endoscopy or surgery.
IBD is a diagnosis of exclusion,
so all of the differentials previously mentioned must be ruled
out in order to make the diagnosis.
What is inflammatory bowel
disease?
IBD is a term used to describe
the inflammation of one of the layers in the intestinal wall.
This swelling of the gut wall may occur with many other intestinal
diseases, but when no cause of the inflammation is found after
doing thorough testing as described above, the condition is described
as idiopathic IBD (essentially, IBD of unknown cause). IBD is
thought to be an overreaction to bacteria or dietary ingredients
within the gut.
Are certain types of cats affected
more than others?
Any age of cat can be affected,
and pedigree breeds may be more commonly affected than domestic
shorthair cats.
What are the treatment options
once IBD has been diagnosed?
DIET
Many cats can be managed by
diet alone in the long term. Diets can be hypoallergenic, high
fiber or low residue. Sometimes all three of these types of food
need to be trialed before the most effective one is selected.
Cats are often resistant to dietary trials, and this is the main
reason why many cats are given drugs to treat their IBD, the
cat will just not eat the specific diet.
Hypoallergenic foods usually
contain a new protein source that the cat has not encountered
before such as capelin & tapioca, duck, venison or hydrolyzed
protein. Diets high in fiber are recommended for colonic disease.
DRUGS
Drugs are a last resort, if
the cat is still showing symptoms despite various food trials
or if the cat refuses to eat the prescription diet.
Options are:
Anti inflammatory or immunosuppressive
drugs
Prednisolone, a corticosteroid given at 2-4mg/kg, is the most
effective drug.
Budesonide
This is also a steroid, with fewer side effects on the rest of
the BODY BACKGROUND="texture2733585.jpg" BGCOLOR="#ffffff" BACKGROUND="texture2733585.jpg" but it is unlicensed.
Chlorambucil
Sometimes given in addition to a steroid if the steroid alone
working.
Metronidazole
This reduces the number of bacteria in the gut, so theoretically
will reduce the triggering factor for the inflammation.
Cyclosporine
Normally used in dogs, this modifies the immune system. It has
only been tried in a small number of cats, with mixed results.
Dr Matthew Homfray is one of
the veterinary pet experts at http://www.WhyDoesMyPet.com.
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