Anal Sac Diseases includes inflammation, infection, impaction, or cancer of the anal sacs. The pair of anal sacs are positioned on either side of the anus. The specific anatomy of an animal’s anal sacs, loose stools, and food or environmental allergies may be related to the pathology of the anal sacs. Dogs and cats may “scoot” or lick their hindend, or owners may also notice a foul odor leading them to seek veterinary attention. A proper diagnosis is made by a visual and digital rectal examination. Treatment of the inflamed or infected anal sac(s) may include flushing or infusing the gland(s), medical therapy, or removal of the glands surgically. If there is concern for cancer, a needle biopsy and abdominal x-rays should be performed.
Antibiotic-responsive diarrhea (ARD) , or intestinal dysbiosis, is diarrhea that is responsive to antibiotic therapy. In healthy animals the bacterial ecosystem has several important functions. It protects the host from pathogenic bacteria, makes a variety of vitamins that can be used by the body, and plays a crucial role in the development of the intestinal immune system. Any disease process that affects one or more of the intestinal ecosystem’s protective mechanisms can lead to ARD. Diagnostic testing may include bloodwork, fecal examinations, abdominal x-rays, or abdominal ultrasound. Probiotics and antibiotics are often prescribed to help restore the balance of the healthy intestinal flora.
Gastrointestinal Parasites (includes intestinal worms and protozoa)
Roundworm Infection: Puppies and kittens under 6 months of age are most commonly infected. The primary mode of transmission is transplacental from the infected bitch to the puppies. Puppies and kittens may also be infected by nursing an infected lactating dam or queen (transmammary transmission). The transmammary route is the most commone route of infection in kittens. A third route of transmission is feco-oral transmission. After infection, the parasite may migrate through the liver into the lungs, within the wall of the gastrointestinal tract, or within other body tissues. Eggs are then shed in the feces. The eggs are long-lived in the environment and highly resistant. The eggs also adhere to fomites (bedding, surrounding environment). There is contagious and zoonotic potential through ingestion by people or other dogs or cats. In people, it can lead to human visceral and ocular larval migrans. Young children are most susceptible. The eggs are usually easily detected in a fecal flotation. However, sometimes the worms are in larval or adult worm stages, and the eggs are not found on a fecal flotation. Therefore, deworming of puppies and kittens during their vaccination visits is recommended. Thankfully, many preventives used for monthly heartworm prevention now include dewormer for this intestinal parasite.
Hookworm Infection: This is a type of intestinal worm that can cause blood loss anemia. Commonly affects young puppies and kittens. Dogs can become infected via soil contamination or from the bitch to the offspring through transplacental and transmammary transmission. Cats are infected via ingestion or skin penetration. There is contagious and zoonotic potential to people via infective larva penetrating and migrating through the skin (Cutaneous Larval Migrans). Eggs only develop into infective larvae above 59 degrees fahrenheit, so infection typically occurs in warmer months. The hookworms attach to the small intestinal mucosa which leads to gastrointestinal bleeding. If the intestinal blood loss is significant, the pet may become anemic and a blood transfusion is required. The eggs are usually easily detected in a fecal flotation. However, sometimes the worms are in larval or adult worm stages, and the eggs are not found on a fecal flotation. Therefore, deworming of puppies and kittens during their vaccination visits is recommended. Thankfully, many preventives used for monthly heartworm prevention now include dewormer for this intestinal parasite.
Whipworm Infection: This is an intestinal worm infection that occurs primarily in dogs, and rarely in cats. Infection occurs with ingestion of embryonated eggs. The eggs then hatch in the small intestine and larvae burrow into the mucosa. There is a three month prepatent period for the eggs to be found in feces. The eggs are extremely resistant in the environment, surviving 4 to 5 years, without any seasonality. The contagious and zoonotic potential in humans is rare. As a result of whipworms being intermittently shed (and often in low numbers), this makes multiple fecal examinations necessary for diagnosis. Empirical treatment with fenbendazole or febantel often recommended if whipworm infection is suspected. Due to their persistence in the environment, a specific heartworm prevention that is also effective against whipworms may be prescribed.
Tapeworm Infection: Infection occurs through ingestion of an intermediate host (fleas or rodents). The intermediate host carries the eggs that infect the dog or cat. Zoonosis potential exists for humans if infected feces is ingested. Diagnosis is based on the evidence of tapeworm segments (called proglottids) that look like grains of rice in the feces or on the fur surrounding the anus. The eggs can also be found in a fecal flotation. Deworming is recommended with a confirmed diagnosis or empirically with high risk animals, such as, outdoor cats that like to hunt or animals that have fleas.
Giardiasis: Giardia is a protozoan parasite that can be found in the intestinal tract of humans and most domestic animals. It is spread through the ingestion of feces or from fomites (bedding, surrounding environment). It can cause intermittent diarrhea in some, but can exist as a latent infection in others. There is increased risk in immunodeficient adults, young animals, and animals confined in large groups. Infection occurs by the ingestion of cysts. When excreted in feces, cysts can survive for days to weeks in a cool, moist environment. Zoonosis from dogs and cats should be considered possible. Most infections produce no symptoms. Clinical signs of diarrhea may be acute, intermittent, or chronic. Diagnosis may be made by observation of trophozoites in fresh feces, but a negative result does not rule out infection. There are ELISA test kits available to detect Giardia antigens in the feces. Treatment involves medication to resolve the diarrhea and eliminate the shedding of the infective cysts in the environment.
Coccidiosis: Coccidia, or Isospora, is a protozoan parasite that can be found in the intestinal tract of dogs and cats. It is spread through the ingestion of infected feces or fomites (bedding, surrounding environment). There is increased risk in immunodeficient adults, animals less than one year of age, and stressed animals. Zoonosis may be possible in humans that are immunocompromised. Diarrhea and vomiting are the main clinical signs. Diagnosis is based on oocysts found on fecal examination. Treatment is aimed at resolving the diarrhea and eliminating the shed of oocysts in feces to the environment.
Cryptosporidiosis: Cryptosporidia is a coccidian parasite that can cause chronic diarrhea in dogs and cats after ingestion of infected feces. Increased risk exists for puppies less than 6 months of age, immunosuppressed animals, adult animals with severe intestinal disease, and in overcrowded unsanitary conditions. Clinical signs include chronic diarrhea and, less likely, vomiting. Cats may have a subclinical infection or diarrhea with flatulence. Diagnosis by fecal examination is challenging and ELISA testing determines that an animal has been exposed, and not necessarily an active infection. Therapy is directed at resolving the infection and preventing further oocyst shedding.
Campylobacter Enteritis is a bacterial infection that most commonly occurs in young dogs or cats, immunocompromised animals, or crowded conditions (kennels and animal shelters). It is commonly spread by ingestion of feces and contaminated food and water sources. Zoonotic transmission can occur to humans. Animals can be subclinical, or have acute or chronic diarrhea. This bacteria is found in low numbers in the normal intestinal flora. Therefore, clinical disease depends on the number of bacteria ingested. Diagnosis is based on fecal examination, fecal cultures, or serology. Antibiotics are prescribed for treatment.
Dietary Intolerance is an adverse reaction to the contents or contaminants of an ingested food that can cause vomiting, diarrhea, abdominal pain or distention, and flatulence. This is distinguished from a food allergy due to its nonimmune response. Diagnosis is based on response to treatment with a dietary change or prescription diet. Chronic treatment should involve strict avoidance of offending foods or ingredients.
Food Allergy is an immune response to certain foods causing vomiting, weight loss, diarrhea, abdominal pain, flatulence, or skin disease (dermatitis). An elimination food trial is the diagnostic test of choice. Treatment involves feeding a prescription hydrolyzed diet. Long term control includes continued feeding of the hydrolyzed diet with avoidance of other protein and carbohydrate food sources (flavored medications or flavored heartworm preventions, table food, non-prescription dog treats).
Foreign Bodies include the lodging of foreign solid material in the oral cavity, esophagus, stomach, and intestines.
Oral foreign bodies often get lodged in the roof of the mouth, but can become lodged under the tongue, in the gums, or in the pharynx. Animals at risk have a habit of chewing bones, sticks, and other foreign objects. Clinical signs include oral discomfort, pawing of the face, reluctance to eat, anorexia, difficulty swallowing, or malodor to the animal’s breath. Diagnosis is usually a result of a good oral and/or pharyngeal exam. Other diagnostic tests may include x-rays or advanced imaging. Sedation may be needed to completely evaluate the oral cavity. Treatment involves removal of the foreign object and resolving the inflammation or infection.
Esophageal foreign body is any solid object that lodges in the esophagus. Clinical signs include acute regurgitation, gagging, anorexia, and ptyalism (hypersalivation). This condition may be diagnosed by cervical and chest x-rays, endoscopy, or advanced imaging (such as, CT scan or MRI). Treatment involves the removal of the foreign object.
Gastric (stomach) foreign body occurs with the ingestion of a solid object that lodges in the stomach. Clinical signs include acute or chronic and persistent or intermittent vomiting, abdominal discomfort, anorexia, depression, or lethargy. Diagnosis is acheived with bloodwork, abdominal x-rays, ultrasound, endoscopy, or surgical exploratory. Treatment involves removal of the foreign object by endoscopy or abdominal surgery.
Intestinal foreign body involves solid object(s) becoming lodged in the intestinal tract. Symptoms include acute persistent vomiting, abdominal discomfort, anorexia, depression, lethargy, or fever. Diagnosis may involve abdominal x-rays, ultrasound, bloodwork, or surgical exploratory. Treatment includes the removal of the foreign material and treatment of the infection and inflammation. Concerning sequela to intestinal foreign bodies are localized necrosis or perforation of the intestines. Linear foreign bodies (strings, string-like fibers) are particularly concerning due to the intestinal plication (“bunching”) that occurs as the intestines move along the string.
Gastrointestinal Cancer are benign or malignant tumors of the gastrointestinal tract. Clinical signs include chronic vomiting, vomiting with blood, black or bloody stools, anorexia, weight loss, depression, lethargy, abdominal discomfort, or restlessness. Diagnosis is based on symptoms, bloodwork, x-rays, ultrasound, or advanced imaging (such as CT scan or MRI). Diagnosis is confirmed by biopsy with histopathology. Treatment includes resolving the vomiting and dehydration, pain management, blood transfusion, dietary modification, removal of the tumor, or chemotherapy.
Gastric Ulcer is a disruption of the gastrointestinal tract lining that may cause vomiting (often with blood or black flecks), black or bloody stools, anorexia, hypersalivation, anemia, or abdominal discomfort. Diagnosis is based on symptoms, bloodwork, abdominal x-rays, or ultrasound. Treatment is aimed at treating the ulceration, resolving the vomiting and diarrhea, and addressing the underlying cause of the ulcer. In pronounced cases, a blood transfusion or surgical intervention may be needed.
Helicobacter Gastritis is inflammation of the stomach caused by Helicobacter bacteria. The mode of transmission is unknown, but may be possible via oral-oral contact, fecal-oral contact, or vector transmission. There is possible transmission from humans to cats, but potential of transmission from animals to humans is thought to be very low. Clinical signs include chronic vomiting, inappetance, or pica. Bloodwork, urinalysis, and fecal flotation are performed to rule out other potential causes for the symptoms. Diagnosis may be made via biopsy for histopathology, culture, urease testing, and PCR. Treatment involves antibiotic therapy and resolving the vomiting. The chance for recurrence is high, so repeat treatment may be necessary.
Hemorrhagic Gastroenteritis (HGE) occurs in dogs and is the sudden loss of intestinal mucosal health leading to vomiting and diarrhea containing blood. This can develop rapidly to a decrease in blood volume and progress to shock. Clinical signs may include anorexia, lethargy, acute bloody vomiting and diarrhea, or abdominal discomfort. The diarrhea may have a “strawberry jam-like” appearance or become very watery. Often times, it occurs without a known underlying cause. Diagnosis is based on symptoms, bloodwork, fecal examination and cytology, and abdominal x-rays. Treatment involves IV fluid therapy, antibiotics, resolving the vomiting and diarrhea, and feeding a low-fat easily digestible diet. Approximately 10-15% of dogs will have repeated episodes of HGE.
Inflammatory Bowel Disease is a chronic disease associated with gastrointestinal inflammation causing anorexia, vomiting, and diarrhea. In severe cases, the condition can lead to protein loss and fluid accumulation in the abdomen. Diagnosis is based on bloodwork, specialized blood tests, bile acids testing, urine analysis, fecal flotation, abdominal x-rays and ultrasound, and intestinal biopsies. Therapy is targeted toward resolving the vomiting and diarrhea and maintaining a strict hydrolyzed prescription diet that is easily digestible. Long term management may also include probiotics, antibiotics, vitamin B12 injections, or steroids.
Lymphangiectasia occurs as a lymphatic drainage abnormality of the intestines. Dilation of the intestinal lacteals results in protein loss causing symptoms of weight loss, intermittent vomiting, diarrhea, anorexia, abdominal distention or discomfort, or respiratory distress. Diagnostic testing may include bloodwork, specialized blood tests, fecal examinations, urine analysis, x-rays, ultrasound, fluid analysis of abdominal fluid, and intestinal biopsies by endoscopy or surgery. Treatment goals are directed toward improving the fluid balance, resolving the respiratory distress, and prescribing proper nutritional support. Long term treatment often involves a prescription ultra-low fat easily digestible or hydrolyzed diet, steroids, antibiotics, and antithrombotic medication.
Megaesophagus is dilation of the esophagus due to weakness of the esophageal muscles. This condition occurs most commonly in dogs. It can be congenital (born with the condition) or acquired (develops over time). Clinical signs involve weight loss or failure to gain weight, regurgitation, cough (secondary to aspiration in the lungs), or drooling. Animals born with the disease have a defect in part of the neural reflex that helps control swallowing. Acquired megaesophagus can occur secondary to neurologic, neuromuscular, muscular, or metabolic diseases. Diagnostic testing involves bloodwork, chest x-rays, fluoroscopy, testing for Myasthenia Gravis or hypoadrenocorticism, or electromyography. The primary therapeutic goal is aimed at finding and resolving the underlying cause. Other therapies include treating the aspiration pneumonia, modifying the diet, and prescribing prokinetic and antacid medications.
Perianal Fistula is a chronic inflammatory disease of the tissues surrounding the anus of dogs. The lesions are painful, ulcerative, and may have draining tracts. There is a predisposition in German Shepherds. This condition may be associated with food allergies. Clinical signs include excessive licking of the hindend and a foul odor. Bloody stools, fecal incontinence, self-mutilation, inappetance, lethargy, and weight loss may also occur. Diagnostic testing includes bloodwork, x-rays, cytology, biopsy, and bacterial culture. Treatment includes decreasing the size and severity of the fistulae and treating the infection. Chronic therapy with immunosuppressive medication is often indicated to maintain remission.
Pancreatitis (Canine) is acute or chronic inflammation of the pancreas usually as a result of dietary indescretion or trauma. Clinical signs include vomiting, diarrhea, anorexia, weakness, and abdominal discomfort. Diagnosis is based on the results of bloodwork, specialized blood tests, abdominal x-rays, or abdominal ultrasound. Treatment targets rehydration, pain control, and resolving the vomiting. Long term management for dogs with chronic pancreatitis includes a prescription low-fat diet.
Pancreatitis (Feline) is acute or chronic inflammation of the pancreas. Chronic pancreatitis in cats is a much different inflammatory process than that seen in most dogs. The most common symptoms in cats are anorexia, lethargy, dehydration, vomiting, and weight loss. Diagnostic testing includes bloodwork, specialized blood tests, and/or abdominal ultrasound. Treatment involves dietary modification with a novel protein source or hydrolyzed diet, maintaining hydration or fluid therapy, pain management, resolving vomiting, and stimulating an appetite.