Rumbly, Tumbly Tummies

The Scoop on the Poop and the News on the Spews

published in the Northeast Times

This month we thought it would be a good idea to discuss two of the most common reasons we see pets for sick visits: Vomiting and diarrhea.  The only complaint that surpasses these two complaints is the category of allergic or infectious skin disease. 

Generally speaking, food should go in the front end, travel in an orderly fashion to the tailpipe and be deposited in a regular, timely fashion.  Sometimes that doesn’t happen just right and the result is either vomiting or diarrhea.

Diarrhea is a term used to describe stool with an excess amount of water.  Anything that increases water in the stool will cause diarrhea.  If the body doesn’t absorb enough water or if the body puts extra water in the stool, you get diarrhea.

Vomiting is when the body expels the contents of the stomach and first few inches of small intestines back out of the mouth.  Dogs and cats have more control of the vomiting reflex than we humans do, and as a consequence, it is easier for them to vomit.  This is handy if you live in the wild and eat something bad that you need to get rid of quickly.  It’s also handy if you are a cat with some hair in your stomach that you want to get rid of into your owner’s slippers.

Vomiting is a complex reflex which originates in multiple places in the body.  There are centers in the brain that are triggered by toxins in the blood and there are nerves in the abdomen that can cause vomiting if they are over-stimulated.

Occasional vomiting or the occasional diarrhea episodes are very common and completely normal.  Just think of your own gastrointestinal history.  Some days you have an upset tummy, some days you’re normal.  But you don’t worry if you have a single episode or two.  However, if you have super duper blow-out diarrhea and you feel horrible at the same time, you ought to consider seeing the doctor.

The list of potential reasons for vomiting and diarrhea is a very, very long list.  Nearly every medical condition imaginable can present with diarrhea or vomiting as part of the history.  The age, lifestyle, and medical history all go into our decision making while we try to shorten the list of possible causes.

Common Causes of Vomiting

By far the most common reason for vomiting (and diarrhea) is that the pet ate something they should not have.  This could be foreign material that ends up getting stuck in the gut (string, plastic toys, balls, Barbie heads, socks, panties, or rocks).  Or it could be something rotten out of the garbage or yard.  I have personally found a half-eaten crow in my back yard.  Beside the remains of the bird there was a nice pile of partially digested crow that my dog had tried to eat.  I have no idea how it got there, but it did explain the diarrhea I saw the next day.  You just never know!

Vomiting can also happen when the chemical receptors mentioned above in the brain are triggered.  In cases of kidney failure, the buildup of nitrogen waste products will cause ulcers in the stomach and will trigger the vomiting center in the brain.  Certain toxins or drugs can also trigger vomiting.  Many medications when given intravenously can cause vomiting (some antibiotics and narcotics, for instance.)

Sometimes there is actual damage to the intestines and that can trigger vomiting.  Stomach ulcers, foreign material that has punctured the bowel, severe viral infections, or tumors to name a few. 

Thankfully tumors of the gastrointestinal tract are much less common than all of the above.  One exception is lymphoma (a tumor of white blood cells) in older cats.  This disease has actually been on the rise over the past 15 years.

Common Causes of Diarrhea

As I said before – ANYTHING that causes extra water to end up in the stool will cause diarrhea.  By far, the most common reasons are parasites or treats that were too rich to be properly digested.  This could include trash diving or a special treat like a big plate of meatloaf.  If the small intestine isn’t used to the special food and doesn’t get a chance to properly digest, absorb, and assimilate the nutrition it gets, all that extra food makes it into the colon and the bacteria that normally live there throw a HUGE party.  The types of bacteria that overgrow are usually the ones that produce their own toxins that cause cramping, increased water to be secreted into the bowel, and ultimately diarrhea.

Inflammatory bowel disease is a general term that describes all kinds of inflammation in the small or large bowel.  This can happen in cases of food allergy or in response to parasites.  The small bowel can’t digest things very well, it contracts too fast, and the ‘end’ result is diarrhea.

Parasites that cause diarrhea include coccidia, giardia, whipworms, hookworms, tritrichomonas, roundworms, cryptosporidium, and tapeworms.  Bacteria that cause diarrhea include Clostridium, Campylobacter, E. coli, and Salmonella.  Viral causes of diarrhea include corona virus, parvovirus, and calicivirus.

How can I tell WHY my dog or cat is having problems?

The first thing you veterinarian will ask you is to give a complete history.  Is your dog alone in the yard all day?  What kind of food does she usually eat?  Does she have a history of diarrhea?  What kind of heartworm preventative is he on?  Have you given him any special treats lately?  What does the diarrhea or vomit look like?  Is the diarrhea accompanied by straining?  How frequent is the diarrhea?  When did it start?  How does she feel?  Does this occur in any relation to when he eats?

The second item is to consider the age, breed, and medical history of the patient.  Young labrador retrievers are notorious for eating things they should not, whereas older boxers may be more likely to develop cancer.  Older cats with a history of “sensitive stomach” may be more likely to be inflammatory bowel disease or intestinal lymphoma.  Indoor cats are less likely to have parasites (but they still get them!) compared to outdoor kitties.

Those two sets of information can help us narrow down the list of possibilities dramatically.  We can then proceed with our physical exam and diagnostics.  On physical exam the doctor is looking for things such as belly pain, belly gas, hydration status (is she dehydrated), pulses, overall body condition, bad odor to the breath, checking lymph nodes, and evaluating the mouth, tongue, eyes, genitalia, and anus.

The most simple diagnostic test we do is a fecal floatation.  This goes for both vomiting and diarrhea.  Since parasites are so common – ESPECIALLY in puppies and kittens – a fecal float is ALWAYS on the menu.  Some parasites are more difficult to find than others and we may have to do multiple fecal checks.  Sometimes we look for eggs, sometimes we culture the bacteria or parasites.  Some tests just look for DNA of the offending parasites or bacteria.

Blood tests evaluating organ function, blood proteins, electrolytes, and blood cell counts are often necessary.  Blood testing may be followed by radiographs (x-rays) of the abdomen and chest.  Radiographs help us to evaluate gas patterns, look for tumors, look for foreign material, and evaluate the size and shape of many of the abdominal contents.

If none of the above have given us a reason for the problem we may try to treat presumptively.  We may treat with a dewormer, an antibiotic to control the overgrowth, and either an anti-vomiting medicine or anti-diarrheal medicine.  Sometimes the reason for the problem is never found.  Again, it’s just like with you or I.  Sometimes you just have a “bug” and it’s not necessary to spend tons of time and money finding out which bug.  As long as it goes away and doesn’t come back!

Sometimes it won’t go away.  Or it keeps coming back.  We may have to consider getting more diagnostic information like biopsy at that point.  We may also repeat some of the previous testing for parasites.  Depending on the problem and the patient, dietary management can sometimes solve the problems.  Changing to a diet with a protein source the pet has never seen before (like potato and rabbit or a partially digested, or hydrolysate diet) may be appropriate and may resolve the problem.  There are other medicines that can be used in cases of inflammatory bowel disease such as steroids or other immune controlling drugs.

What can I do at home?

There are a few over the counter medications you can use in dogs, but very few you can safely use in cats.  The benefit of plain yogurt with active cultures should not be under-estimated.  The active cultures of bacteria in the yogurt help to compete with the overgrowing bacteria and get the gut back under control.  For a cat or small dog, a teaspoon twice a day might suffice.  For a larger dog, maybe ¼ to 1/3 cup twice daily could work.

Medications like bismuth (Pepto Bismol®) or loperamide (Immodium®) can be used sparingly in dogs, but should NOT BE USED IN CATS.  Cats are much too sensitive to them.  Use loperamide at a low dose (1/4 tab for a smaller dog, ½ tablet for a larger dog) and it may be repeated twice. 

The next thing you can do at home is pay attention!  Does your pet feel “ok” or does he feel “bad.”  Is there some history of eating something new or special?  Is there blood in the stool or vomit?  How long has it been going on?  Get all of those answers and write them down if you need to.  Also BRING A STOOL SAMPLE WITH YOU TO THE APPOINTMENT.  It’s important! 

When is it an emergency?

Bloody diarrhea, bloody vomiting, vomiting and diarrhea along with severe lethargy or depression, or intractable vomiting should all be considered emergencies.  Blood in the stool or vomit isn’t always horrible.  Dogs, especially, will have some blood in the stool if the colon is unhappy enough.  But it’s too difficult to tell this at home, so always treat bloody stool or vomit as an emergency and report to your primary care doctor or the emergency hospital.