Feline GI Medications

Antiemetics

• These prevent nausea and vomiting
• Examples include maropitant, metoclopramide, and ondansetron

Prokinetics

• These enhance gastric motility and emptying
• Examples include metoclopramide, erythromycin, and cisapride

Gastric Protectants

• Proton pump inhibitors like omeprazole
• H2 agonists like famotidine and ranitidine
• Sucralfate is another option

Choleretics

• Silymarin (supplement) can be used
• Ursodeoxycholic acid (ursodiol) is another option

Copper Chelating Agents

• D-penicillamine
• Trientine

Antioxidants

• Vitamin E supplement
• S-adenosyl methionine (SAMe)

Antibiotics

• Metronidazole
• Amoxicillin
• Doxycycline
• Neomycin

Corticosteroids

• Prednisolone

Analgesics

• Partial opiate agonists (buprenorphine, butorphanol, tramadol) are for mild to moderate pain
• Full opioid agonists (morphine, methadone, fentanyl) are for more severe pain

Supportive Treatments

• Lactulose
• IV fluids

Tritrichomonas foetus infection in cats

• Diarrhea due to Tritrichomonas foetus primarily affects young cats and kittens under 12 months.
• Clinical signs include diarrhea, increased defecation frequency (small amounts), hematochezia, mucus in feces, inflamed/painful anus, and fecal incontinence
• Spread is through close contact and infected feces in shared environments like litter boxes
• Diagnosis involves faecal/rectal smears, PCR, faecal cultures, and X-ray/ultrasound with blood samples
• Treatment includes highly digestible, high-fiber diets, probiotics, or synbiotics.

Acute Hemorrhagic Diarrhea Syndrome in Dogs

• It is a severe gastrointestinal condition characterized by sudden hemorrhagic diarrhea and vomiting with rapid dehydration and shock from fluid loss
• Possible underlying causes are Clostridium perfringens, dietary indiscretion, or immune-mediated factors
• The condition causes severe dehydration, electrolyte imbalance, hypovolemic shock, intestinal lining damage via necrosis with increased permeability and bacterial translocation
• Treatment involves aggressive fluid therapy to address dehydration and shock, plus antimicrobials like amoxicillin-clavulanic acid and metronidazole if bacteremia/sepsis is present

Acute Pancreatitis in Dogs and Cats

• Treatment depends on the severity, but always includes IV fluids, electrolyte replacement and analgesia

Clinical signs in dogs:

• Acute vomiting onset
• Anorexia
• Abdominal pain
• Praying stance
• Dehydration
• Collapse

Clinical signs in cats:

• Milder, even with necrotizing pancreatitis
• Anorexia
• Lethargy
• Vomiting
• Abdominal pain

Treatment for pancreatitis:

• IV fluids and electrolyte replacement (Lactated ringer’s/ Hartmann's) is crucial
• Mild/moderate cases require twice maintenance rate fluids (50 ml/kg/day) while severe cases need a shock rate (90 ml/kg/hr) for 30-60 minutes
• Analgesia with ketamine CRI or partial/full opioid agonists is important
• Enteral feeding
• Enzyme supplements
• Antiemetics like maropitant, metoclopramide, and ondansetron
• Gastric protectants like H2-blockers or proton pump inhibitors
• Antibiotics
• Severe cases may require plasma transfusion to replace proteins

Hepatic Encephalopathy

• It is caused by increased ammonia or intestinal toxins in the cerebral cortex, stemming from reduced functional hepatic mass or altered blood flow

Clinical signs:

• Anorexia/depression
• Weight loss
• Lethargy
• Nausea
• Fever
• Hypersalivation (cats)
• Intermittent vomiting
• Diarrhea
• Neurological signs

Canine Hepatitis

• This is a common hepatobiliary disease in dogs

Types:

• Chronic hepatitis is most common, affecting young to middle-aged dogs, like Labrador Retrievers and Sky Terriers
• Excessive hepatic copper, recurrent pancreatitis, IBD, or biliary issues serve as cause
• Liver histopathology shows degeneration, inflammation, necrosis, and fibrosis

Clinical signs:

• Anorexia
• Lethargy
• Vomiting
• Weight loss
• Jaundice
• PU/PD
• Ascites
• Behavioral changes

Treatment:

• The treatment is based on biopsy results and includes immunosuppressives, anti-fibrotics, copper chelation, antioxidants, and choleretics

Supportive therapies:

• IV fluids, electrolytes, antiemetics, gastric protectants
• Lactulose, low protein diet, and antibiotics help with HE
• Mannitol may be given to reduce brain edema
• Vitamin K can help if there is coagulopathy

Acute Hepatitis

• It is often caused by infections like leptospirosis, or canine infectious hepatitis

Clinical signs:

• Lethargy, vomiting, diarrhea, abdominal pain, PU/PD, dehydration, and jaundice

Treatment:

• It involves supportive care with fluids/electrolytes, antiemetics and gastroprotectants
• Plus antibiotics like doxycycline or ampicillin

Copper Storage Disease

• Seen in Bedlington terriers, Dalmatians, and Labs
• Copper build-up is caused either by genetics (Bedlingtons), high copper diets, or cholestasis-associated chronic hepatitis

Clinical signs:

• GI issues, PU/PD, pale/jaundiced mucus membranes
• Followed by lethargy, appetite loss, and pigmenturia

Treatment:

• A supportive low copper, high zinc diet can help
• Copper chelators (D-penicillamine/trientine) and ursodiol may also be indicated

Other treatment options:

• Immunosuppressants like prednisolone, SAMe, and vitamin E supplements

Gallbladder Mucocele

• It is more common in cats
• The mucus-secreting glands dysfunction and proliferate, which leads to the bile accumulation

Clinical signs:

• The disease is usually silent, diagnosed via ultrasound
• Other possible signs are lethargy, vomiting, icterus, rupture leading to peritonitis or septicemia
• Increased liver enzymes, cholesterol, and WBC may occur

Treatment:

• Surgery
• Internal medicine

Portosystemic Shunts (PSS)

• Shunts are characterized by vascular anomalies connecting the portal vein to the systemic circulation, thus bypassing the liver.
• Shunts are typically caused by failure of ductus venosus closure (3-10 days post birth)

Outcomes of blood bypassing the liver:

• Poor liver development, protein deficiency, altered fat metabolism, and liver atrophy occur following blood bypassing the liver

Types of PSS:

• Intrahepatic PSS usually affects large breed dogs; extrahepatic PSS is common in small breeds

Clinical signs:

• Hepatic encephalopathy signs like ataxia, circling, seizures, or coma
• GI signs of vomiting, diarrhea, or anorexia
• Urinary signs: hematuria, stranguria, pollakiuria, urethral obstruction

Other possible signs:

• Delayed growth and cryptorchidism.

Diagnosis:

• Look for fasting and measure 2-hour postprandial bile acids
• Ammonia testing can rule things out

Treatment:

• Medication only addresses HE signs
• Surgery may be performed

Nutritional Considerations

• High value protein, digestible carbs, and commercial hepatic diets
• Lactulose usage keeps the pH low, retaining the ammonia

Other treatment options:

• Metronidazole to kill the gut flora and omeprazole to heal ulcerations

Emergency care:

• IV fluids and electrolytes

Feline Lipidosis

• Lipidosis is due to fasting promoting lipolysis and fatty acid delivery to the liver

Primary Lipidosis

• Obese cats accumulate fat in hepatocytes which results in liver cell function loss
• This fat accumulation is from high peripheral fat release, reduced liver protein, and poor fat metabolism

Secondary Lipidosis

• Lipidosis mirrors primary symptoms, but has more nervous system involvement than in primary cases
• Any concurrent pancreatitis, IBD, or neoplasia issues can make the condition worse

Clinical signs:

• Vomiting, anorexia, weakness, weight loss, hypersalivation, depression, jaundice, and hepatomegaly

Treatment:

• Vigorous feeding with high protein diets
• Treat underlying causes if present
• Provide fluid and replace electrolytes
• Antiemetics, prokinetics, antioxidants, and Vitamin K may also be administered

Neutrophilic Cholangitis (Suppurative)

• Ascending bacterial infection originates in the small intestine.
• The ascending bacterial infection infiltrates the bile duct

Clinical signs:

• Include lethargy, vomiting, weight loss, pyrexia, and jaundice

Treatment:

• Manage it with antibiotics per culture and sensitivity tests, plus ursodiol
• Amoxicillin and Ursodeoxycholic acid are given

Lymphocytic Cholangitis (Non-Suppurative)

• A slow illness with portal tracts infiltrating small lymphocytes and plasmacytes

Clinical signs:

• Waxing/waning grades, vomiting, diarrhoea, no appetite, weight loss, jaundice, liver enlargement/swelling
• A FIP-like illness

Treatment:

• Do antibiotics, antioxidants, ursodiol and GI diets

Oral Cavity and Esophagus Issues

• Periodontal disease, sialocele, and chronic gingivostomatitis may appear

Chronic gingivostomatitis

• It is a result of an inappropriate immune response to oral bacteria as a stimulation
• It is triggered by feline calicivirus, FeLV, FIV

Clinical signs:

• Weight loss
• Reluctance to eat
• Dropping food, vocalizing when eating, hypersalivation and foul breath

Treatment:

• Partial or complete tooth extraction

Feline Eosinophilic Granuloma Complex

• It is an allergic reaction with certain genetic traits

Clinical signs:

• Ulcers on the upper lip, eosinophilic plaques, as well as collagenolytic granulomas

Treatment:

• Broad-spectrum antibiotics like doxycycline or amoxicillin
• Food trials
• Systemic glucocorticoids like prednisolone, antiparasitics

Other Issues

• Neoplasms, motility disturbance disorders, megaesophagus, hiatal hernias and diverticula, obstructions

Types of obstructions:

• Vascular ring anomalies, persistent right aortic arch, foreign bodies, and strictures

The Stomach

• Esophagitis and gastroesophageal reflux, airway esophageal fistula, gastritis can appear in the stomach

Acute Gastritis

• Acute gastritis usually stems from a gastric mucosal insult
• Dietary indiscretion, foreign bodies, intoxication, systemic illness, parasites, and viruses usually serve as insult

Treatment:

• Fluid, food restrictions, protectants and adsorbents ( Bismuth subsalicylate, Kaolin-pectin, Sucralfate or Activated charcoal are used)

Chronic Gastritis

• It is usually categorized as being mild to moderate
• It is a superficial lymphoplasmacytic type, marked by follicle contamination

Clinical signs:

• Vomiting of food and bile

Treatment:

• Diet change, steroids, and chlorambucil
• Antacids like bismuth subsalicylate and prokinetics such as metoclopramide

Helicobacter-Induced Gastritis

• This condition is marked by high urease levels, which produces ammonia and bicarbonate
• High levels result in a pH rise in the stomach

Treatment:

• Metronidazole, amoxicillin, famotidine, and PPIs such as omeprazole

Other Intestinal Diseases

• Pyloric stenosis, ulcerations/erosions, GD/GDV, motility disorders, neoplasia

The Intestines

• Acute enteritis, bacterial, and protozoan diseases may develop

Acute Enteritis

• Acute enteritis stems from bacteria, viruses, parasites, protozoa, fungi, or food

Clinical signs:

• Diarrhea, vomiting, dehydration, fever, appetite loss, depression, and pain

Treatment:

• Providing fluid, reversing symptoms, antiemetics, food restrictions, and antibiotics depending on whether a fever or neutropenia exists are used as treatment

Maldigestive and Malabsorptive Diseases

• Antibiotic-responsive enteropathy/diarrhea and SIBO are subtypes Abnormal bacteria in the SI gut reduces the Gl tract's protection mechanisms

Clinical signs:

• Young animals with diarrhea, appetite loss, weight loss and vomiting

Treatment:

• Oxytetracycline, low fat diets, fructo-oligosaccharides, probiotics, cobalamin, and steroids
• Avoid SIBO

Protein-Losing Enteropathy

• Occurs where intestinal disease triggers inflammation, infiltration, congestion, or bleeding, leading to albumin loss
• IBD and lymphoma trigger it in adults; hookworms and intussusception trigger it in younger dogs

Clinical signs:

• Signs of weight loss, diarrhea, vomiting, anorexia, ascites, and edema

Treatment:

• The treatment focuses on fluids, antiemetics, high-quality protein, and the use of hetastarch or dextran to maintain oncotic pressure, as well as plasma transfusion

Other intestinal diseases:

• Lymphangiectasia, colitis, lymphocytic-plasmacytic colitis, obstructions

Pancreatitis (Acute)

• The condition is marked by vomiting, appetite loss, abdominal pain with a praying position

Clinical signs:

• Dehydration and potential collapse come next

Cats

• They register milder symptoms than the dogs
• Low to no appetite, less activity, and pain and vomiting are common

Treatment

• Fluid support with ringer's solution, managing the pain will come next

Pancreatitis (Chronic and Autoimmune)

• It involves prolonged inflammation that destroys the cells

Clinical signs:

• The disorder occurs in middle-aged or older animals, specifically English cocker spaniels and comes alongside diabetes
• Concurrent keratoconjunctivitis sicca and glomerulonephritis may also come alongside it

Dogs

• Milder GI symptoms such as hematochezia and appetite loss may appear

Cats

• It is much more difficult to specify symptoms because they are more subtle

Diagnosis:

• cPLI tests, biopsies and B12 measures help to diagnose

Exocrine Pancreatic Insufficiency

• It is a syndrome that reduces enzyme production from the exocrine pancreas

Causes:

• Total acinar cell loss from chronic pancreatitis
• Acinar atrophy or depletion

Clinical signs:

• Preserved appetite, diarrhea, oily skin; can be diagnosed from measuring TLI

Treatment:

• Replace enzymes from pork or ox

Others:

• H2 receptor antagonists, antibiotic to manage other infections and injections for B12
• Focus on low fat foods with very little fiber
• Diet

Lab Tests

• High ALP in cats means liver damage