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Encyclopedia of Canine Clinical Nutrition
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Acute Gastrointestinal Diseases

Author(s):
German A.J. and
Zentek J.
In: Encyclopedia of Canine Clinical Nutrition by Pibot P. et al.
Updated:
JAN 08, 2008
Languages:
  • DE
  • EN
  • ES
  • FR
  • IT
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    3. Acute Gastrointestinal Diseases

    Diagnosis

    Acute gastroenteritis is a common reason for owners to seek veterinary advice; classification is shown in Tables 8 and Table 9. At the time of initial presentation, the veterinarian must quickly make a number of decisions about diagnosis and treatment (Table 10 and Table 11).

    Table 8. Classification of Acute Gastroenteritis on Severity

    Non-fatal, Self-limiting Acute Gastroenteritis

    Secondary to Extraintestinal / Systemic Disease

    Severe, Potentially, Life-threatening Acute Gastroenteritis

    Uncomplicated parasitism

    Dietary 

    - Dietary indiscretion

    - Dietary sensitivity

    - Food poisoning

    - Scavenging

    Systemic infections 

    - Canine distemper

    - Leptospirosis

    Metabolic disorders 

    - Uremia

    - Hypoadrenocorticism

    Enteric infections 

    - Enteroviruses

    - Salmonellosis

    Hemorrhagic gastroenteritis (HGE) Intestinal obstruction by foreign body 

    - Intusssusception

    - Volvulus

    Table 9. Classification of Acute Gastroenteritis on Region Affected

    a) Acute Gastritis

    b) Acute Enteritis

    c) Acute Colitis

    • Predominant region affected is the stomach
    • Frequent vomiting
    • Often associated with acute diarrhea (i.e. acute gastroenteritis)
    • Predominant region affected is the small intestine
    • Profuse small intestinal diarrhea is the principle sign
    • Often associated with acute vomiting
    • Predominant region affected is the large intestine
    • Frequent, small volume diarrhea predominates ±
    • Tenesmus
    • Mucoid feces
    • Hematochezia
    • Fairly common in dogs

    Etiologies include:

    • Dietary indiscretions, garbage intoxication
    • Ingestion of foreign material esp. in young, e.g., poisonous plants, hairballs (bezoars)
    • Drug therapy e.g., corticosteroids, digoxin, erythromycin, chemotherapy
    • Acute systemic disease (uremia, liver disease, sepsis)

    Etiologies include:

    • Dietary indiscretions, garbage intoxication
    • Enteric infections e.g., bacterial, viral, protozoal, parasitic

    Etiologies include:

    • Dietary indiscretion e.g., garbage ingestion
    • Whipworm (Trichuris vulpis) infection
    • Protozoal infections e.g., Giardia, Cryptosporidia
    • Bacterial overgrowth

    Table 10. Decision-making for Acute Gastroenteritis

    Are the clinical signs non-specific, and will symptomatic treatment be sufficient?

    Most cases will fit this category

    Are further investigations, hospitalization or treatment necessary?

    Diagnostic investigations are required:

    - Potential underlying non-enteric cause of gastroenteritis

    - Emergency database required for stabilization (Table 11)

    - Abnormality in history requiring follow-up

    - Physical examination finding requiring follow-up

    Intensive emergency treatment is required:

    - Severe dehydration

    - Electrolyte and/or acid/base disturbances

    - Shock

    - Severe blood loss or pale mucous membranes

    Surgical management is or may be required:

    - Abnormality in history requiring follow-up

    - Physical examination finding requiring follow-up

    An infectious cause is likely ± isolation is required

    Table 11. Database for Emergency GI Disease Cases

    Hematology

    Biochemistry

    Urinalysis

    Additional (if available)

    PCV

    Total Protein (refractometer)

    Blood smear examination

    Urea

    Glucose

    Electrolytes

    Urine sample:

    - Dipstick

    - Specific gravity by refractometer

    Blood gas analysis:

    - Acid-base

    - PCO2, PaO2*, HCO3-, etc.

    *partial oxygen arterial pressure

    Table 12. History and Physical Examination for Acute Cases of GI Disease

    History. Relevant historical findings include:

    Physical examination. Relevant findings on physical examination include:

    • Age and vaccination status
    • Recent dietary history
    • Concurrent drug therapy
    • Possible exposure to toxins, plants, foreign bodies or infectious disease
    • Nature of signs e.g.,
    • Onset and severity
    • Content of vomitus
    • Stool characteristics
    • Presence of blood (hematemesis, melena, hematochezia)
    • General body condition
    • Hydration status (may also require PCV/TP)
    • Oral examination - mucous membranes etc.
    • Rectal examination
    • Abdominal palpation

    Clinical signs usually include a combination of vomiting and diarrhea, the latter of which may have either small or large intestinal characteristics (depending on the region of the gastrointestinal tract affected). Other clinical signs include appetite changes, abdominal pain and tenesmus. For non-fulminating cases, history and physical examination are sufficient to allow an appropriate treatment to be formulated (Table 12). Based on this preliminary information, the decision-making process can commence. In some cases further diagnostics will be required (Table 13).

    For cases that present as emergencies, with acute or peracute clinical signs diagnostic investigations should be performed in parallel to preliminary treatment to stabilize the condition of the patient. It is advisable to run an emergency database to allow decisions to be made about preliminary treatment (especially fluid therapy) (Table 11).

    Table 13. Diagnostic Investigations for Acute Cases of GI Disease

    Hematology, serum biochemistry and urinalysis

    Fecal examinations for parasites

    Bacteriology. Bacterial culture is indicated if:

    - Febrile

    - Inflammatory leukogram / rectal cytology

    - GI bleeding

    - Young animal?

    PCR for enteropathogenic E. coli?

    Virology

    - Fecal examination, e.g., ELISA test for viral antigen (e.g., parvovirus) or electron microscopy (e.g., rotavirus, coronavirus)

    - Serology. Paired samples required to demonstrate recent infection.

    Imaging

    - Plain radiographs are helpful to rule out gastrointestinal obstruction and other surgical diseases.

    - Abdominal ultrasonography is also useful for this purpose.

    Response to empirical treatment

    Diagnosis can be confirmed by response to any of the following therapies:

    - Dietary restriction

    - Discontinuation of drugs

    - Avoidance of plants or other environmental agents

    - Anti-emetics

    - Anti-diarrheals

    - Parasiticides

    Treatment

    If a primary cause can be identified this should be treated (e.g., antibacterials for infectious diarrhea). However, in most cases a cause is not obvious; nevertheless most will improve spontaneously in 2 - 3 days, suggesting that treatment is not always necessary. Prognosis for complete recovery is usually good.

    However, the animal should be reassessed if:
    - Clinical signs persist for >48 hours, despite symptomatic treatment
    - Clinical signs are deteriorating.

    The mainstay of therapy is dietary management. Concurrent drug therapy is often prescribed empirically (Table 14). Antimicrobials are often prescribed but have only occasional true indications (Table 15).

    Table 14. Medical Therapy for Acute Cases of GI Disease

    Anti-inflammatory medication (NOT recommended!)

    Glucocorticoids

    NSAIDs

    Anti-emetic medication

    Metoclopramide

    Antihistamines e.g.,  chlorpromazine

    Ondansetron (last recourse)

    Anticholinergics (not recommended)

    - Atropine

    - Methylscopolamine

    Gastric mucosal protectants and antacids (only if persistent vomiting or GI ulceration is present)

    H2-receptor antagonists

    Ranitidine

    Famotidine

    Nizatidine

    Sucralfate

    Antacids (not useful and not recommended)

    Aluminum hydroxide

    Magnesium hydroxide

    Anti-diarrheals

    Absorbents / protectants

    - Kaolin-pectin

    - Montmorillonite

    - Smectite

    - Aluminum hydroxide

    - Bismuth

    - Activated charcoal

    - Magnesium trisilicate

    Motility modifiers

    Opioids

    Diphenoxylate

    Loperamide

    Kaolin-morphine

    Anticholinergics (not recommended for most cases): Atropine, Hyoscine

    Antispasmodics (not recommended for most cases): Buscopan

    Antibiotics (not recommended for most cases)

    (Table 15)

    Table 15. Indications for Antimicrobial Therapy in Acute Conditions

    Specific bacterial infection documented (Note: NOT Salmonella*)

    Severe mucosal damage

    GI ulceration/hemorrhage

    - Hematemesis

    - Melena

    - Hematochezia

    Pyrexia

    Leukopenia or neutropenia

    * Antibiotic treatment is not prescribed if Salmonella is isolated in a healthy dog. Such treatment risks the development of antibiotic resistance and/or chronic bacterial shedding.

    Nutritional Management of Swallowing Disorders

    The mainstay of therapy for acute gastrointestinal disease is dietary management. Two major approaches exist:

    1. "Resting the Gut" i.e. Restricted Oral Intake
      If the patient is vomiting water, is dehydrated, or there is evidence of an electrolyte/acid-base disturbance, the patient should be maintained nil per os (NPO) and parenteral fluids should be administered (Marks et al. 2000;Devitt, et al. 2000;Sanderson et al. 2000). Suitable choices would include Hartmann's or 0.9% saline (both ± 10 mM/L KCl).
      If the patient is not vomiting, oral glucose-electrolyte rehydration solutions can be administered. However, parenteral fluids should be administered if evidence of dehydration exists (>5%) or if the patient is exhausted or refuses to drink.
      In both cases the animal should be fasted, i.e. food should be withheld for at least 24 hours. The patient should then be given frequent small, bland, low-fat meals for 24 - 72 hours. Examples would include boiled 1 part rice or pasta with 1 part boiled lean meat (chicken or turkey), eggs or low-fat cottage cheese.
      Milk and milk products should be limited due to their high lactose concentration. An alternative would be to use a proprietary food with low-fat concentration and a high digestibility.
      The fiber content of diets for patients with acute intestinal problems should be limited to ensure high digestibility. Due to the expected losses of electrolytes the dietary levels of potassium, sodium and chloride should be increased. Assuming clinical signs resolve, the normal diet can be reintroduced gradually over 3 - 5 days.
    2. "Feeding Through Diarrhea"
      An alternative approach is to continue to feed the animal despite the clinical signs. Such an approach has been adopted for diarrhea in human infants, and may speed recovery. Further, there is preliminary evidence in dogs with parvovirus that such an approach may reduce morbidity (Mohr et al., 2003). However, it is less practicable if vomiting is persistent or if diarrhea is profuse.
      A certain risk may exist because the gastrointestinal tract is likely to have altered permeability that allows easier passage of dietary antigens. Therefore, the patient may be at risk of developing a hypersensitivity to the dietary proteins used in the enteral diet. It is often recommended to use a protein source that is not part of the normal diet (sacrificial protein).

    Enteral nutrition was associated with a shorter time to recovery, increased body weight gain, and improved gut barrier function in puppies with parvoviral enteritis, compared to nil per os
    Enteral nutrition was associated with a shorter time to recovery, increased body weight gain, and improved gut barrier function in puppies with parvo-viral enteritis, compared to nil per os (
    Mohr et al., 2003). (© Renner).

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    References

    1. Baillon ML, Marshall-Jones ZV, Butterwick RF. Effect of probiotic Lactobacillus acidophilus strain DSM 13241 in healthy adult dogs. Am J Vet Res 2004; 65(3).  - PubMed -

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    About

    How to reference this publication (Harvard system)?

    German, A. and Zentek, J. (2008) “Acute Gastrointestinal Diseases”, Encyclopedia of Canine Clinical Nutrition. Available at: https://www.ivis.org/library/encyclopedia-of-canine-clinical-nutrition/acute-gastrointestinal-diseases (Accessed: 08 February 2023).

    Affiliation of the authors at the time of publication

    1Faculty of Veterinary Sciences, University of Liverpool, United Kingdom. 2Faculty of Veterinary Medicine, University of Berlin, Germany.

    Author(s)

    • German

      German A.J.

      Professor of Small Animal Medicine
      BVSc(Hons) PhD CertSAM DipECVIM-CA MRCVS
      Department of Veterinary Clinical Sciences, Small Animal Teaching Hospital , University of Liverpool
      Read more about this author
    • Zentek J.

      Professor of Animal Nutrition and Dietetics
      DVM Prof. specialist degree in Animal Nutrition Dipl ECVN
      Faculty of Veterinary Medicine, Berlin University
      Read more about this author

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