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Gastroenteritis

One of the most common reasons that pets end up in the veterinary hospital or ER is due to vomiting and diarrhea, known medically as gastroenteritis. While trauma and poisonings are common and more dramatic, this sometimes simple, sometimes complex condition accounts for a big percentage of veterinary visits. In some cases, the cause can be serious, or elude diagnostics tests, or require hospitalization or surgery. Luckily, for many cases, the cause and treatment are simple, and management can be completed at home. Your veterinarian can help guide you through the steps needed to determine the cause and the best course of action, and some of the information here will help you decide what’s best for your pet before a visit.

Gastroenteritis is not a disease or a diagnosis – it’s just a medically descriptive term for what’s going on with a patient. It just means inflammation of the stomach and intestinal tract, and really, for a vomiting patient, doesn’t tell us that much more than we already knew – something’s up with the tummy. It can be caused by many things, such as:

  • Viruses: Most feared among them is parvovirus
  • ‘Dietary indiscretion’: Eating spoiled food, or too much people food, or getting into the garbage
  • A foreign body causing an intestinal blockage
  • Pancreatitis: Inflammation of the pancreas
  • Medical conditions like kidney disease, liver disease, inflammatory bowel disease
  • Cancer
  • Pain, fear, nervousness

What to watch for, what to do:

If your otherwise healthy pet vomits once, you don’t always need to head to the vet right away. Some symptoms that indicate you’d want to get a veterinary evaluation when convenient (within 24 hours) if the vomiting continues would be:

  • Diarrhea accompanying the vomiting, but not bloody or severe
  • Lack of appetite for less than 24 hours
  • Only 1-2 episodes of vomiting in 24 hours
  • Normal activity level
  • No significant medical history

If any of the following signs develop, however, you should not delay and should seek medical advice and examination right away, day or night:

  • Sudden abdominal distension – a sign of gastric dilatation-volvulus, or ‘bloat’ a surgical emergency
  • Bloody, severe or uncontrollable diarrhea
  • Lethargy, lack of responsiveness, inability to walk
  • Abdominal pain
  • Difficulty breathing
  • Straining to urinate or defecate, straining in the litterbox
  • History of serious medical conditions, like diabetes, kidney disease, heart disease, etc.
  • Epilepsy and inability to keep down anti-seizure medication
  • Vomiting for more than 24 hours, or more than 2 episodes in 24 hours
  • A young, unvaccinated puppy who vomits more than once
  • Episodes of non-productive vomiting or retching that are repeated, another signs of ‘bloat’

For mild cases where there are none of the warning signs described above, some patients will respond to stopping food and water for a few hours, then slowly reintroducing small amounts of water first. For bigger dogs and most cats, no food for 12-24 hours is safe and effective in letting the stomach calm down. Toy breeds like Yorkies, and puppies less than 4 months of any breed can’t go that long without food, and should have the diet and food withholding time directed by a veterinarian.

Once water can be held down for a few hours without vomiting, small amounts of an easily digested bland diet can be fed, using one selection from the ‘protein’ list below and one from the ‘starch’ list.

PROTEIN

  • Cottage cheese
  • Boiled lean hamburger
  • Lean deli meat
  • Cooked chicken breast
  • Scrambled egg white
  • Meat baby food – beef, chicken, turkey (good for cats)

STARCH

  • Plain white cooked rice
  • Plain cooked potatoes
  • Plain cooked pasta
  • Plain bread
  • Rice flake baby cereal (good for cats)

Dogs should be fed in small, frequent meals (every 6 hours or so). Feed the bland diet for 2-3 days, or as directed by your veterinarian.

After 2-3 days of feeding the bland diet, gradually transition back to normal diet (unless another one has been prescribed) by mixing in increasing amounts of normal food over another 2-3 days.

Tests

For dogs and cats that need medical attention, some testing is usually in order to determine the cause of the vomiting and/or diarrhea. While sometimes it may be OK to treat the symptoms and ask your vet to administer an anti-nausea medication, most patients benefit from either an X-ray or some lab tests (or both) to help make sure that surgery is not needed for a blockage, or that some other serious medical issue is causing the symptoms. Blood and urine tests can show several important things, even if they don’t determine the cause – they may rest your mind at ease that certain serious disorders (like diabetes or kidney failure) are not the cause, and they may help your vet gauge the degree of dehydration and plan out treatment better.

Not all causes of gastroenteritis will show up on the first round of tests. In some cases, the diagnosis is elusive, and may require either repeated testing, or more advanced tests like ultrasound, endoscopy, or surgery to explore the abdomen and take biopsies. May foreign objects, like rubber, cloth, or plastic also don’t show up on standard X-rays, so sometimes repeated X-rays are needed to look for abnormal accumulations of gas, or other indications of an obstruction.

For some cases, if the cause is not found on several rounds of testing and the patient is still showing symptoms, an exploratory surgery is needed. While it may seem odd to go to the extreme of surgery without knowing what’s going on, exploratory surgery itself is a form of diagnostic test.

Samples for biopsy can be taken from organs, and if needed feeding tubes can be placed to provide nutrition for patients who can’t or won’t eat. In about 2/3 cases, the cause for vomiting is found upon exploratory surgery, while for the remaining third, the hope is that biopsies will provide the answer. In a few cases, the cause remains elusive despite tests, surgery and everyone’s best intentions.

Summary:

While most cases are simple and respond to simple measures, in some cases advanced testing or treatment may be needed. Your veterinarian can help you decide on the best course of testing and treatment, and get your pet back on the path to better health quickly.

-Dr. Tony Johnson

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