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 Diarrhea is an important clinical sign of disease. It may be caused by gastrointestinal or systemic disorders. If it persists for longer than 3-4 weeks or if there is a pattern of episodic occurrence, the condition is considered chronic. The initial approach to chronic diarrhea depends on the clinical condition of the patient. Patients in otherwise good heath may benefit from a 2-3 week therapeutic trial consisting of a prescription diet and treatment for common intestinal parasites. Unfortunately, not all patients with chronic diarrhea respond to this therapy, and additional testing and treatment will be needed in the majority of cases. A more aggressive initial approach is needed when there are signs of systemic disease such as weight loss, vomiting, anorexia and lethargy and in cats with advanced or rapidly progressing disease.
Initial screening and treatment for stable patients (unstable patients require more extensive testing and treatment in the initial plan):
- Medical history (including diet)
- Comprehensive examination
- Fecal sample for cytology and parasite testing
- FeLV/FIV testing
Symptomatic treatment may include:
- Treatment for intestinal parasites
- Probiotics
- Antibiotics if indicated by fecal cytology
- Food trial with i/d (small bowel) or w/d (large bowel) or occasionally a hypoallergenic food trial may be recommended
Medical progress exams are key to evaluating response to treatment and to indicate if a more aggressive diagnostic approach is needed. All kitties with chronic diarrhea must return in two weeks to evaluate their progress.
Two-week progress examination:
If the problem has not resolved, then additional testing and treatment may include:
- Complete blood count (CBC)
- Metabolic and thyroid profile
- Gastrointestinal profile (a fasting blood sample is needed)
- Vitamin B12 injection
- Exclusive protein diet trial with prescription Pea and Venison
Four-week progress examination:
If the problem persists, the following tests may be recommended:
- Specialized fecal tests (culture, PCR for Tritrichomonas)
- Radiographs or ultrasound
- Histoplasma antigen testing (performed on a urine sample)
- Intestinal biopsy (surgical or endoscopic)
The keys to successful resolution of the problem are performing appropriate tests to reach a diagnosis, treating appropriately, utilizing appropriate food trials, and providing supportive care. By following the outlined steps, most cats with chronic diarrhea can be managed successfully.
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