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My 17yo cat has had a chronic diarrhea problem for more than

Customer Question
5yrs. No vet seems to...
My 17yo cat has had a chronic diarrhea problem for more than 5yrs. No vet seems to be able to diagnose the cause. For the past year, she only has completely liquid and is not able to control it, leaking much of the time. She eats with enthusiasm, several times a day, but is very thin. Lab work done has not identified a reason.
JA: I'm sorry to hear that. What is the cat's name and age?
Customer: She is currently 17 1/2. Her name is*****: Is there anything else the Veterinarian should be aware of about Beauty?
Customer: She was always chubby before this all started. In the beginning of the problem, she had a gelatinous stool. That slowly changed to liquid. I have tried probiotics and vitamin supplements. She remains affectionate but no longer plays.
Submitted: 1 month ago.Category: Cat Veterinary
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Answered in 20 minutes by:
11/13/2017
Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 1 month ago
Dr. Meghan Denney
Dr. Meghan Denney, Cat Veterinarian
Category: Cat Veterinary
Satisfied Customers: 1,643
Experience: Veterinarian at Kingsland Blvd Animal Clinic
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Hi I am Dr. Denney. I am currently reviewing your post now. Please give me a few minutes to type my response. Thank you for trusting us with your question. This service is used for general information only and is no substitute for a veterinarian patient relationship by examination.

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Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 1 month ago

Can you tell me if Beauty has had blood work done or any imaging like an abdominal ultrasound ?

Older cats with these symptoms often are a concern for severe inflammatory bowel disease (IBD) or a type of internal cancer called lymphoma.

Diet changes can sometimes help for IBD cases but for lymphoma cases steroids and a medication called chlorambucil is used to try and get remission

We can also see pancreatitis cause these symptoms which would be seen on blood work with a feline lipase test or an ultrasound to visually evaluate the pancreas.

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Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 1 month ago

Inflammatory bowel disease (IBD) refers to the condition that results when cells involved in inflammation and immune response are called into the lining of the GI tract. This infiltration thickens the bowel lining and interferes with absorption and motility: the ability of the bowel to contract and move food. With abnormal ability to contract and absorb, the bowel’s function is disrupted. Chronic vomiting results if the infiltration is in the stomach or higher areas of the small intestine. A watery diarrhea with weight loss results if the infiltration is in the lower small intestine. A mucous diarrhea with fresh blood (colitis) results if the infiltration occurs in the large intestine. Of course, the entire tract from top to bottom may be involved. Many people confuse inflammatory bowel disease with irritable bowel syndrome (IBD) a stress-related diarrhea problem. Treatment for IBD is aimed at diet and stress management; IBS is a completely different condition from IBD.

Infiltration of the bowel with inflammatory cells occurs when something inflammatory (or, in other words, stimulating to the immune system) is on-going within the intestinal tract. In food allergy, the digested food stimulates the immune system and causes inflammatory cells to infiltrate the bowel lining. With intestinal parasites, the parasites themselves stimulate the immune system. In some cases, we think the bacteria that live in the bowel may be producing inflammatory products that call in the infiltrating immune cells. In most cases, the cause of the immune stimulation cannot be determined.

The World Small Animal Veterinary Association defines IBD as an inflammatory infiltration for which no specific cause can be found. This means that if no cause for the inflammation is definable, therapy is directed at suppressing the immunological/inflammatory infiltration and relieving the long-standing inflammation regardless of its cause.

Why would the Veterinarian Think my Pet Might have Inflammatory Bowel Disease?

A little vomiting or diarrhea here and there seems to be pretty standard for pet dogs and cats. After all, cats groom themselves and get hairballs. Dogs eat all sorts of ridiculous things they aren’t supposed to. Still, many owners notice that their pets seem to have vomiting or diarrhea a bit more often than it seems they should. It might be subtle where one notices that one is cleaning up a hairball or vomit pile rather more frequently than with previous pets or it could be the realization that one has not seen the pet have a normal stool in weeks or months. Typically, the animal doesn’t seem obviously sick. Maybe there has been weight loss over time but nothing acute. There is simply a chronic problem with vomiting, diarrhea or both. IBD is probably the most common cause of chronic intestinal clinical signs and would be the likely condition to pursue first.

How is Inflammatory Bowel Disease Diagnosed?

The diagnosis of IBD requires a tissue biopsy, which is obviously invasively collected with some expense. Since there are a number of other conditions that cause similar signs, a step-by-step testing sequence precedes biopsy. An abdominal ultrasound can also be fairly diagnostic as well for clinical suspicion of IBD.

The first step in pursuing any chronic problem is a metabolic database. This means running a basic blood panel and urinalysis to rule out biochemically widespread problems, such as liver disease or kidney disease, pancreatitis, or hyperthyroidism in cats that could be responsible for the signs. Since IBD is localized to the GI tract, such a database is usually normal but might express a general inflammatory response in the blood or a loss of blood proteins as often there is a leak of albumin, an important blood protein, from the intestine into the bowel contents. The database not only serves to rule out metabolic causes for the patient's symptoms but also assesses other areas, potentially turning up unanticipated problems and identifying factors that could change what medications are used.

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Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 1 month ago

Treatment for IBD

Diet changes

Hydrolyzed proteins are "predigested" so as to create protein segments that are too small to stimulate the immune system. Further, they typically are made with medium chain fatty acids, which are easier to absorb than the more custo***** ***** chain fats, and favorable omega 3 to omega 6 fatty acid ratios. In other words, there is more to these diets than just their predigested proteins, but approximately 50% of patients showed good improvement after approximately one month on a hydrolyzed protein diet.

-Royal Canin has a hydrolyzed protein diet for cats

Another approach is the use of the novel protein diets. The idea here is that the patient cannot have an immunological reaction to a protein source it has never experienced. (It takes long-term exposure to a protein before the immune system will respond against it, so a new protein should be safe.) This means using an unusual protein such as rabbit, venison, fish, or duck, so long as the patient has not been fed these foods before. Again, it takes about a month to see a good response.

Patients that are sick enough to have a low albumin level or low vitamin B12 level are too sick for an approach this conservative. They will need medication.

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Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 1 month ago

Treatment for IBD medication

Medication
The cornerstone of treatment for IBD is suppressing the inflammation. In milder cases of large intestinal IBD, the immunomodulating properties of metronidazole (Flagyl®), might be adequate for control but usually prednisone or prednisolone is needed. Prednisone will work on IBD in any area of the intestinal tract. In more severe cases, stronger immune suppression is needed (as with cyclosporine, chlorambucil, or azathioprine). Higher doses are usually used in treatment at first and tapered down after control of symptoms has been gained. Some animals are able to eventually discontinue treatment or only require treatment during flare-ups. Others require some medication at all times. Long-term use of prednisone should be accompanied by appropriate periodic monitoring tests due to the immune suppressive nature of this treatment.

In cases where it is particularly important to spare the patients from the side effects of long-term steroids, a medication called budesonide can be used. This medication is not readily absorbed from the GI tract and serves as a topical treatment for the lining of the intestine.

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Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 1 month ago

Is it at all Reasonable to just Try Treatment and Skip the Expensive Diagnostics?

Possibly. Certainly, with IBD the diagnostic tests tend to be much more costly than the treatment. The problem is making sure there is enough confidence in the diagnosis of IBD that there will be no harm in skipping diagnostics. It is not unusual to take the work-up all the way through ultrasound and making a treatment decision based on the information obtained up to that point. If the patient is stable enough, there is time to change the diet or try medications and see how it goes.

The biggest problem in simply putting the patient on prednisone or prednisolone involves the possibility of intestinal lymphosarcoma, also called lymphoma. This type of cancer produces chronic diarrhea or vomiting just as IBD can. Lymphoma is temporarily responsive to prednisone but better responses can be obtained from stronger chemotherapy agents. Exposure to prednisone will make the lymphoma much more difficult to diagnose should biopsies be obtained later. Plus, exposure to prednisone can lead to resistance to other medications. (This is less of a problem for cats, but in dogs even a few days of prednisone can make a lasting remission impossible to achieve.)

In short, if you try prednisone or prednisolone without confirming a diagnosis, harm can be caused should the pet have lymphoma instead of IBD. Sometimes it is financially impossible to complete the ideal test sequence so it is important to discuss all the pros and cons with your veterinarian if going this route.

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Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 1 month ago

With the information you have provided The above information should help give you some ideas on where to go next and what to test for.

Beauty needs baseline blood work including checking a feline lipase and thyroid levels to see if she is hyperthyroid or has pancreatitis

Then I would recommend an abdominal ultrasound to check for IBD or lymphoma or other structural abnormalities that could explain the chronic diarrhea

I would keep her on the probiotic forever and I would look into a diet change to either a hydrolyzed protein diet or a diet with a single meat source protein that she has never come into contact before ( venison, duck etc)

If you are wanting to try treatment instead of testing the above toe over the pros and cons of this and with her being an older cat it may be worth trying a course of steroids or doing a long acting steroid injection to get her some relief from the diarrhea.

I would also start vitamin B injections with your veterinarian to help her levels as with this much diarrhea her vitamin levels are low causing her to not absorb nutrients and loose more weight.

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Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 1 month ago

You could also consider taking Beauty into see an internal medicine specialist or a boarded feline specialist to look for more rare diseases if those I have mentioned above have been tested for and ruled in or out.

If this was helpful I would be most appreciative if you could take the time to rate my assistance so the site will credit me with helping you

Without a rating (the stars at the top) the site will not compensate me for helping you.

I am also here for additional questions you may have just reach out to me here and I will be more than happy to assist you.

Kind regards,

Dr. Meghan Denney

This Content is not intended to be a substitute for a professional veterinary exam, diagnostics, diagnosis, or treatment. Always seek the advice of your attending veterinarian with any questions you may have regarding a medical condition of a pet.

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Cat Veterinarian: Dr. Meghan Denney, Cat Veterinarian replied 1 month ago
Hi,

I'm just following up on our conversation about your pet. How is everything going?

Dr. Meghan Denney
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