DM3 Pt3-2 Cats with Diarrhoea

Question 1

What are the two main categories of causes for diarrhea in cats?

Answer 1

1. Intestinal diseases: Includes dietary issues, infections, inflammatory bowel disease (IBD), neoplasia, etc.
2. Extra-intestinal diseases: Includes polysystemic infections, endocrine diseases (e.g., hyperthyroidism), renal disease, liver or pancreatic disease, and miscellaneous causes like toxins and drugs.

Question 2

Name three intestinal diseases that can cause diarrhea in cats.

Answer 2

1. Inflammatory bowel disease (IBD)
2. Infectious diseases (e.g., bacterial, viral, parasitic infections)
3. Neoplasia

Question 3

What are three extra-intestinal diseases that can cause diarrhea in cats?

Answer 3

1. Hyperthyroidism
2. Renal disease
3. Liver and/or pancreatic disease

Question 4

Why is it difficult to distinguish between acute and chronic diarrhea in cats?

Answer 4

Many cats have outdoor access, making it difficult for owners to notice changes in stool consistency or frequency. Unless a cat uses a litter tray frequently, it can be challenging to identify whether diarrhea is acute or chronic or to differentiate between small and large intestinal diarrhea.

Question 5

What does a good clinical history help determine in a cat with diarrhea?

Answer 5

A good history helps to identify potential causes, such as dietary changes, infectious agents, environmental factors, medications, toxins, and the possibility of extraintestinal diseases.

Question 6

What clinical signs can help differentiate between small and large intestinal diarrhea in cats?

Answer 6

Clinical signs include differences in faecal volume, presence of mucus, melena, haematochezia, tenesmus, frequency of defecation, and more. These signs can help differentiate the source of the diarrhea, though in cats, the distinctions are often less marked than in dogs.

Question 7

What are the common clinical signs of small intestinal diarrhea?

Answer 7

1. Increased faecal volume
2. Melaena (if present)
3. Weight loss in chronic cases
4. Vomiting (common in acute infectious disorders)
5. Normal or reduced appetite

Question 8

What are the common clinical signs of large intestinal diarrhea?

Answer 8

1. Normal or decreased faecal volume
2. Mucus in stool
3. Haematochezia (may be present)
4. Tenesmus
5. Increased frequency of defecation (>3 times normal)
6. Dyschezia (painful defecation)

Question 9

What feature is commonly associated with small intestinal diarrhea but rarely seen in large intestinal diarrhea?

Answer 9

Steatorrhoea (fatty stools) is associated with malabsorption in small intestinal disease and is absent in large intestinal disease.

Question 10

What is tenesmus, and in which type of diarrhea is it more common?

Answer 10

Tenesmus refers to the feeling of incomplete defecation or the urge to strain. It is more commonly seen in large intestinal diarrhea.

Question 11

Which type of diarrhea is more likely to cause significant weight loss?

Answer 11

Small intestinal diarrhea is more likely to cause weight loss, especially in chronic cases.

Question 12

What is the frequency of defecation in small intestinal vs. large intestinal diarrhea?

Answer 12

In small intestinal diarrhea, frequency of defecation is typically 2-3 times normal. In large intestinal diarrhea, frequency is often more than 3 times normal.

Question 13

Which form of diarrhea is characterized by a large volume of faeces?

Answer 13

Small intestinal diarrhea is characterized by a marked increase in faecal volume.

Question 14

Which type of diarrhea is associated with increased urgency in defecating?

Answer 14

Large intestinal diarrhea often involves increased urgency to defecate and may result in tenesmus.

Question 15

What can physical examination help determine in a cat with diarrhea?

Answer 15

Physical examination helps identify extra-intestinal diseases (e.g., palpable thyroid nodule), dehydration, tachycardia/bradycardia, abdominal discomfort, and palpable abnormalities (e.g., foreign body, mass, intussusception), suggesting whether diarrhea is of primary gastrointestinal or systemic origin.

Question 16

What are the key findings during palpation in intestinal diseases like IBD or diffuse neoplasia?

Answer 16

In cases of IBD or diffuse neoplasia, the intestines may feel regionally or uniformly thick, which can indicate a primary gastrointestinal issue.

Question 17

What is the recommended treatment for a cat with acute diarrhea but no other clinical signs or physical abnormalities?

Answer 17

Symptomatic therapy can be initiated, including small frequent meals of a bland, highly digestible diet. It is also recommended to administer a broad-spectrum dewormer such as Drontal Cat® or Milbemax®, especially if the cat’s worming history is poor.

Question 18

What is the next diagnostic step if diarrhea is chronic or affecting multiple cats in the household?

Answer 18

If diarrhea is chronic or affects multiple cats, the next step is to perform full fecal analysis to assess for gastrointestinal infectious agents.

Question 19

What further diagnostic tests are required if diarrhea persists despite dietary trials or if other clinical signs are present?

Answer 19

Further tests should include:
1. Complete blood count (CBC)
2. Serum biochemistry
3. Serum thyroxine (in elderly cats, to exclude hyperthyroidism)
4. Serological screening for FeLV and FIV

Question 20

What radiographic findings are relevant in cats with diarrhea?

Answer 20

Survey abdominal radiographs are useful for detecting foreign bodies, masses, and intussusception. They are of limited benefit in most diarrhea cases unless a foreign body or obstruction is suspected.

Question 21

When is abdominal ultrasonography particularly useful in diagnosing diarrhea?

Answer 21

Abdominal ultrasonography is useful for detecting masses, intestinal wall thickening, loss of layering, intussusception, and mesenteric lymphadenopathy.

Question 22

What is the purpose of contrast radiography in cats with diarrhea?

Answer 22

Contrast radiography, such as using barium-impregnated polyspheres (BIPS), can help demonstrate partial obstructions or motility disorders when diarrhea is present.

Question 23

What diagnostic step is taken if no diagnosis is reached following blood tests, radiographs, and ultrasound?

Answer 23

Gastrointestinal biopsies may be required if a diagnosis is not reached after previous investigations. However, it is acceptable to perform a dietary trial first, as many cats with chronic diarrhea will respond to dietary management.

Question 24

When are full-thickness biopsies preferred over endoscopic biopsies in cats with diarrhea?

Answer 24

Full-thickness biopsies are preferred when ultrasonographic abnormalities such as mesenteric lymphadenopathy, focal intestinal thickening, or abnormalities of the submucosa/muscularis are detected, or when endoscopic biopsies fail to provide a diagnosis.

Question 25

What regions of the gastrointestinal tract should be examined during endoscopy in cats with diarrhea?

Answer 25

During endoscopy, both upper and lower endoscopy should be performed in cases of diarrhea, as small intestinal disease may be present even when clinical signs suggest large intestinal disease.

Question 26

When is hospitalisation indicated for cats with diarrhea?

Answer 26

Hospitalisation is required for cats with acute onset diarrhea and significant abnormalities detected during physical examination, especially if they are very young or severely dehydrated, necessitating intravenous fluid therapy.

Question 27

What dietary treatment is recommended for simple acute diarrhea in cats?

Answer 27

Introduce small frequent meals of bland food (e.g., chicken and rice) while maintaining oral water intake. Oral electrolyte/glutamine supplementation may also be beneficial. Food restriction or starvation is not recommended due to risks like hepatic lipidosis.

Question 28

What is microenteral nutrition and when is it recommended?

Answer 28

Microenteral nutrition involves delivering small amounts of water, electrolytes, and absorbable nutrients to critically ill or anorexic patients to maintain the integrity of the intestinal mucosal barrier and prevent bacterial translocation. Solutions containing glutamine are particularly useful.

Question 29

When is antibiotic therapy indicated in cats with diarrhea?

Answer 29

Antibiotics are indicated when a specific bacterial agent is identified or if there is evidence of intestinal ulceration (e.g., hemorrhage), to reduce the risk of septicemia due to bacterial translocation through a damaged mucosal barrier.

Question 30

When are corticosteroids indicated in cats with diarrhea?

Answer 30

Corticosteroids are indicated only in cases where inflammatory bowel disease (IBD) is definitively diagnosed through intestinal biopsies. Even in mild to moderate cases, dietary therapy or metronidazole may be used for short-term immunomodulatory effects.

Question 31

Why is the use of sulphasalazine not recommended in cats with diarrhea?

Answer 31

Sulphasalazine, a 5-Aminosalicylic acid derivative, is not recommended in cats due to the risk of toxicity caused by their metabolic differences, even though it is frequently used to treat colitis in dogs.

Question 32

What are the benefits of adsorbents in treating diarrhea in cats?

Answer 32

Adsorbents can help by binding bacteria and toxins, protecting the intestinal mucosa, and potentially having an antisecretory effect. Common adsorbents include kaolin, pectin, and montmorillonite, found in products like Promax®, Diarsanyl®, and Kaobiotic®.

Question 33

When are motility modifiers, such as anticholinergics or opiates, used in cats with diarrhea?

Answer 33

Anticholinergics (e.g., hyoscine) are not recommended as they can promote ileus. Opiates (e.g., diphenoxylate, loperamide) reduce intestinal secretions, promote absorption, and stimulate segmental contractions, so they can be useful in short-term management of acute diarrhea. They should not be used if an obstructive or infectious cause is present.

Question 34

What is the goal of probiotic treatment in cats with diarrhea?

Answer 34

Probiotics aim to repopulate the intestine with beneficial lactobacilli. Several commercial products are available, but the benefits of probiotics in treating feline diarrhea remain controversial, with limited supporting data.