Gastroenteritis in Dogs

Dogs

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Acute vomiting and diarrhea are characterized by a sudden onset and short duration of less than two to three weeks. Acute vomiting, a reflex act that results in the forceful ejection of gastric (stomach) and/or duodenal (intestinal) contents through the mouth, and diarrhea, an increase in fecal water content with an accompanying increase in the frequency, fluidity, or volume of bowel movements, are both extremely common in the dog.

An occasional bout of vomiting and diarrhea is quite common in dogs however, severe, acute vomiting and diarrhea is not normal, and can be associated with life threatening illnesses. It can cause extreme fluid loss, acid-base imbalance, and electrolyte disturbance.

What To Watch For

  • A continuation or worsening of signs (greater than several days)
  • Dehydration
  • Depression
  • Listlessness
  • The presence of blood in the stool or vomit.

    General Causes

  • Dietary indiscretion – eating inappropriate food/material
  • Dietary intolerance
  • Infectious agents – bacterial, viral, fungal, parasitic
  • Drugs and toxins
  • Obstruction/blockage – intussusception, which is telescoping of the bowel into itself; masses/tumors; foreign bodies        
  • Metabolic disorders – kidney and liver disease, diabetes mellitus, hypoadrenocorticism
  • Abdominal disorders – pancreatitis, peritonitis, pyometra, prostatitis, sepsis
  • Inflammatory bowel disease
  • Miscellaneous – gastroduodenal ulcers, hemorrhagic gastroenteritis, stress, gastrointestinal lymphosarcoma (cancer)

    • In severe cases of vomiting and diarrhea, intravenous fluid and electrolyte therapy may be necessary to correct dehydration and electrolyte abnormalities.

    Veterinary Care

    Diagnostic Tests

    Many cases of acute vomiting and diarrhea are short lived, resolve easily and do not require an extensive diagnostic evaluation. Diagnostics should be performed on those pets that are having severe vomiting and diarrhea, are exhibiting other systemic signs of illness, or when the vomitus or stool contains blood. These tests may include:

  • Complete blood count (CBC)
  • Biochemical profile
  • Urinalysis
  • Abdominal radiographs (X-rays)
  • Multiple fecal examinations

    Treatment

    There are several things your veterinarian might recommend to treat your pet symptomatically. The principal goals of symptomatic therapy are to restore and maintain fluid and electrolyte imbalances and to completely rest the gastrointestinal tract.

  • Fluid and electrolyte therapy
  • Drugs that coat and sooth the GI tract
  • Drugs that symptomatically stop vomiting and diarrhea
  • Nothing orally for several hours, with a gradual introduction of water followed by a bland diet

    Home Care

    Call your veterinarian, and follow all recommendations regarding feeding and medication. This will probably include withholding all food and water. Observe your pet very closely. If clinical signs are not improving over a day or two, and/or your pet is getting worse, have your pet evaluated at once.

  • Vomiting and diarrhea are quite common in dogs, largely due to their indiscriminate (not terribly selective) eating habits. It is important to realize that an occasional bout of vomiting and diarrhea can be normal in a healthy animal, and may occur as often as a couple of times in a month. The question that needs to be answered is when is the problem serious enough for you to seek veterinary care and potential hospitalization for your pet? Acute vomiting and diarrhea is addressed quite differently from chronic vomiting and diarrhea with regard to the diseases that cause each, diagnostic plans, and treatment regimes.

    In patients that are otherwise feeling well without concurrent problems, symptomatic therapy is recommended, and usually curative. This involves removing all food and water for a period of several hours, and gradually reintroducing a bland diet for several days prior to reinstituting your pet's regular diet. If the problem recurs once your pet is fed, or the problem persists despite being held off food, your pet should be evaluated by a veterinarian in a timely fashion. In addition, if your pet seems painful, in distress, or you notice red or dark brown/black vomitus or diarrhea (suggestive of internal bleeding), one should seek veterinary attention at once. Small dogs are particularly prone to dehydration and hypoglycemia in the face of prolonged vomiting and diarrhea, therefore should be watched very carefully. Prolonged, frequent vomiting and diarrhea can lead to severe dehydration, shock, and potentially death if not addressed in a timely fashion.

    Causes

    There are many causes of acute vomiting and diarrhea. Although many of these patients have self-limiting disease, and respond nicely to symptomatic therapy, some causes of acute vomiting and diarrhea can be life threatening, and initially, may be difficult to differentiate from more benign disorders.

  • Dietary indiscretion includes eating spoiled food, over eating, ingesting foreign material and sudden dietary changes.

  • Dietary intolerance most often occurs because of a particular protein, but can be associated with lactose, diets high in fat and certain food additives.

    There are many infectious agents that can cause acute vomiting and diarrhea:

  • Bacterial (Salmonella, Clostridium)
  • Viral (Infectious canine hepatitis, parvovirus).
  • Fungal (Histoplasmosis, aspergillosis)
  • Rickettsial (Salmon poisoning)
  • Parasitic (roundworm, hookworm, whipworm, giardia).

  • Drugs and toxins can cause vomiting and diarrhea by directly irritating the lining of the gastrointestinal tract. Examples include anti-inflammatory agents (aspirin, corticosteroids), antibiotics, anti-cancer drugs, insecticides, heavy metals, and pesticides.

  • Gastrointestinal obstruction/blockage often causes vomiting and diarrhea. Foreign bodies, tumors, intussusceptions (telescoping of the bowel into itself), and parasites are the most common causes of obstruction.

  • Metabolic disorders such as kidney and liver disease, diabetes mellitus and hypoadrenocorticism (addison's disease) are often associated with vomiting and diarrhea.

  • Abdominal disorders such as pancreatitis (inflammation of the pancreas), peritonitis (inflammation of the abdominal cavity), pyometra (infected uterus), prostatitis (inflammation of the prostate) and sepsis (systemic infection) are often associated with an acute onset of vomiting and diarrhea.

  • Inflammatory bowel disease (IBD) is a microscopic accumulation of inflammatory cells of any/all parts of the gastrointestinal tract. IBD is most often associated with chronic vomiting and diarrhea, although there are cases that present rather acutely.

    Miscellaneous disorders:

  • Gastroduodenal ulcers can be associated with liver, kidney, or pancreatic disease. Acute vomiting and diarrhea, with or without blood, are often the first signs exhibited by the pet.

  • Hemorrhagic gastroenteritis presents with acute bloody diarrhea, and occasionally acute vomiting as well.

  • Gastric dilation volvulus/torsion is the bloating and/or twisting of the stomach upon itself. The affected individual usually present with acute unproductive retching or vomiting, often accompanied by diarrhea. This is a life-threatening disease that needs to be addressed immediately.

  • Stress can cause a combination of acute vomiting and diarrhea.

  • Lymphosarcoma is most often a microscopic accumulation of cancerous cells within the gastrointestinal wall. Although signs are usually that of chronic vomiting and diarrhea, occasionally acute signs develop first.

  • Diagnosis In-depth

  • Obtaining a complete medical history, and performing a thorough physical examination are necessary to create an appropriate diagnostic plan for the patient who present with acute vomiting and diarrhea.

  • A complete blood count (CBC) will evaluate for the presence of infection, inflammation and anemia, associated with some diseases that cause acute vomiting and diarrhea.

  • A biochemical profile evaluates very important parameters of the patient including the kidneys, liver, electrolytes, total protein and blood sugar status.

  • A urinalysis helps evaluate the kidneys and hydration status of the patient.

  • Abdominal radiographs (X-rays) evaluate the abdominal organs, presence of fluid, and the presence of a foreign body or tumor.

  • Multiple fecal examinations are important to rule out gastrointestinal parasites.

    Your veterinarian may recommend additional diagnostics to ensure optimal medical care. These tests are selected on a
    Case-by-case basis.

  • An ACTH stimulation test may be recommended to rule out hypoadrenocorticism (addison's disease), which is an insufficiency of the adrenal glands. It is a safe timed blood test that can be performed at your regular veterinarian.

  • Bile acids should be considered in those patients where assessing liver function is in order. It is a safe timed blood test that can be performed by your regular veterinarian.

  • An upper gastrointestinal (GI) barium (dye) series should be considered in those cases where the baseline diagnostics are not confirming a diagnosis, and the vomiting and diarrhea is persisting. It may be of benefit in those cases where foreign bodies or tumors are not apparent on radiographs, or to confirm a diagnosis if GI ulceration. A safe dye is given to the patient by mouth, and is then watched as it travels through the GI tract. It is a non-invasive test that can often be performed by your local veterinarian, however in some cases may need to be transferred to a specialty facility.

  • An abdominal ultrasound evaluates the abdominal organs and helps assess for the presence of tumors or masses. Abdominal organs, lymph nodes and masses can be biopsied with the guidance of ultrasound through the abdominal wall. The procedure is relatively safe, however may necessitated a mild sedative. It is often recommended that a specialist perform the procedure.

  • Gastroduodenoscopy (upper GI endoscopy) may be of benefit in these patients. It may facilitate the removal of foreign bodies, help evaluate for ulcer disease, and sample tissue for the presence of inflammation or cancer. Hospitalization is brief, and healing is generally quick and uncomplicated. The procedure does necessitate general anesthesia, and therefore is associated with minor risks. It is often necessary to refer the patient to a specialist. Endoscopy is performed when other diagnostics are inconclusive, inflammatory bowel disease or gastrointestinal lymphosarcoma is suspected, or a foreign body is located in an accessible area and needs to be retrieved.

  • Lastly, an exploratory laparotomy should be performed as a diagnostic tool in any individual who has had extensive diagnostics without a confirmed underlying cause, or in the patient with a poor response to therapy who continues to vomit and have diarrhea.

    Therapy In-depth

    Your veterinarian may recommend one or more of the diagnostic tests described above. In the meantime, treatment of the symptoms might be needed, especially if the problem is severe. The following nonspecific (symptomatic) treatments may be applicable to some, but not all pets with acute vomiting and diarrhea. These treatments may reduce severity of symptoms or provide relief for your pet. However, nonspecific therapy is not a substitute for definite treatment of the underlying disease responsible for your pet's condition.

  • Withholding food and water for several hours allows the GI tract to "rest", and is the single most important means of symptomatic therapy in the patient with acute vomiting and diarrhea. Complete dietary restriction allows the lining of the GI tract to heal. Gradual reintroduction of small amounts of bland food should be instituted after the fast, and the original diet may be slowly reintroduced after 2-3 days if there has been no vomiting. If at any point vomiting recurs, discontinue everything given by mouth and contact your veterinarian.

  • Oral medication of any kind should be avoided if at all possible. Even a tiny pill can perpetuate vomiting by contacting an already inflamed stomach lining.

  • Fluid and electrolyte therapy may be necessary in some patients with acute vomiting and diarrhea, and is directed toward correcting dehydration, acid-base and electrolyte abnormalities. Occasionally, subcutaneous (under the skin) administration may be acceptable, and is able to be performed by the pet owner at home. In severe cases, intravenous administration may be necessary, and necessitates hospitalization.

  • Antiemetics and antidiarrheal agents (drugs that stop vomiting and diarrhea) should be used with caution. It is best to identify and treat the underlying cause of vomiting and diarrhea, however in selected cases may be recommended.

  • Antacids (drugs that decrease acid production) such as Tagamet® (cimetidine), Pepcid® (famotidine) or Zantac® (ranitidine), may be of benefit in many cases.

  • Gastrointestinal protectants and adsorbents (medications that protect or sooth) are felt to coat an "irritated" intestinal lining and bind "noxious" (harmful) agents.

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