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Diarrhea is the direct result of excessive fecal water and should be categorized as acute versus chronic, serious versus non-serious, and small bowel versus large bowel. This condition refers to a change in the consistency, frequency and volume of feces. Acute diarrhea lasts less than 2 to 3 weeks in duration while chronic diarrhea would last for a period of three weeks or longer. This can be caused by either the small bowel or the large bowel. Your vet should be able to determine the differentiating features of small and large bowel diarrhea by looking at the characteristics of frequency, volume, type of blood (if any), presence of mucus, dyschezia, and urgency.
Signs of small bowel involvement would include a larger volume of feces than normal, frequency of defecation slightly Increased, some weight loss, and oftentimes vomiting is common. There is no blood or mucus in the stool, and efforts to defecate are not spasmodic or non-productive. Signs of large bowel involvement would include a smaller volume of feces with each defecation, a significant increase in frequency of defecation, blood in the stool accompanied by mucus in most cats, as well as tenesmus (Ineffective spasmodic attempts to defecate or void). High risk factors include dietary changes and feeding high fat or poorly digestible diets.
There are four pathophysiological types of diarrhea and the resulting diarrhea may be caused by any single or combination of these. Osmotic diarrhea is caused by poorly absorbed solutes within the gut lumen, which leads to Increased fecal water. This increase in poorly absorbed solutes may be a result of dietary overload, mal-assimilation of ingested foodstuffs, and small intestinal mucosa disease, such as inflammatory bowel disease. With osmotic diarrhea, the diarrhea will usually stop shortly after fasting.
Secretory diarrhea is caused by the mucosal cells secreting fluids and electrolytes at an exaggerated rate. This increase in fluid secretion may be a result of bacterial enterotoxins, gastrointestinal hormones, serotonin, prostaglandins, cholinergic agonists, deconjugated bile acids, and hydroxy fatty acids. Usually, pure secretary diarrhea does not resolve upon fasting. Increased permeability is caused by a change in the mucosal cell membranes, which in turn, cause an increase in the size of the pores. This can lead to mal-assimilation, as well as leakage of fluid, electrolytes, and large particles into the gastrointestinal tract causing diarrhea. Motility disorders may lead to diarrhea as a result of decreased fluid absorption due to increased forward peristalsis, or decreased rhythmic segmentation. More often than not, the cause is a decrease in the rhythmic segmentation rather than an increase in peristalsis.
Extragastrointestinal causes may include hyperthyroidism, renal failure, exocrine pancreatic insufficiency, liver disease, neoplasia, and FeLV/FIV-related diseases. Gastrointestinal causes may include non-specific enterocolitis food intolerance, food allergy, toxins, salmonella and campylobacter, nematodes, giardia, cryptosporidium, inflammatory bowel diseases, and neoplasia.
Diagnostics include submitting a database (CBC, chem. profile, UA) to check for kidney disease, liver disease, hyperthyroidism and lymphoma. Fecal tests are done to check for nematodes and Giardia. Total T4 levels are performed on aged cats also to check for hyperthyroidism, and FeLV/FIV tests are run simply to detect if other diseases are likely to be present. Additionally, there are further serum, fecal, biopsy, imaging and endoscopy tests that can be run to check an even further range of possible causes.
Treatment is usually accomplished by dietary management and medications such as metronidazole, while surgery may be necessary for the treatment of any obstructive diseases. Fluids such as lactated Ringers or normal saline may be required if the cat is dehydrated to replace lost fluids and electrolytes. Acid/base imbalances are always a consideration when dealing with dehydration.
A bland diet may also be beneficial - remember that such should be a highly digestible low fiber diet with no more than 5-10% fat. An easily digestible bland carbohydrate such as rice should be added, and lactose and sucrose should be avoided. This should be fed in small amounts in frequent, but regular, feedings. Metronidazole in an oral dosage (for cats) of 10-20 mg/kg every 8-12 hours for 10-14 days has proven to be. effective. This medication has nonspecific anti-inflammatory gastric effects and is also effective in treating small intestinal bacterial growths.
Resolution of diarrhea usually happens gradually with treatment, and if not, the diagnosis should be reexamined.
The Painted Rose Ranches ~107O5 Zephyr lime SW. Olympia, WA 98512
