Turtle has been having diarrhea on and off for the last three months. She has been treated several times with various medications at least some of which, according to Anne, were antibiotics. The medications have had varying degrees of success in lessening the diarrhea, none have completely eliminated it. Turtle is a 10-year-old tabby kitty.
Anne reports that Turtle seems to eat well though none of the various diets she has tried have helped in with the diarrhea. Anne is frustrated and a bit worried at this point and suspects that Turtle is less than thrilled with the situation as well. She seems to be spending much more time in the litter box though, thankfully from Anne’s perspective, Turtle always makes it to the litter box in time – so far.
Obviously, Turtle’s diarrhea is not a straightforward and simple case. The first step is to return to Turtle’s veterinarian. Turtle will need some diagnostic testing, which in should include blood work and radiology to examine her digestive tract.
High on my list of possible causes for Turtle’s diarrhea is a disease called inflammatory bowel disease, IBD. This is caused by the immune system reacting against “something” in the digestive tract, causing an inflammatory response within the wall of the digestive system. This most commonly occurs in the stomach and/or the small intestine. This inflammation then decreases the ability of the digestive tract to do its job, therefore causing less than thorough digestion of food leading to diarrhea. Affected cats can sometimes vomit as well because of stomach involvement in the process. Turtle was not reported to be vomiting.
Inflammatory bowel disease can show on a radiograph as thickening of the small intestinal wall. This thickening of the wall is not, however, definitively diagnostic for IBD. There are other diseases that can cause this radiographic sign one of which is a type of cancer within the bowel wall called intestinal lymphosarcoma. There is no way to distinguish these two diseases by radiography.
If Turtle’s radiographs do demonstrate small bowel wall thickening and I think they will, it likely will be necessary to biopsy her bowel. This can sometimes be accomplished with a endoscopic technique under anesthesia. A special flexible scope with camera and channels for special instruments is introduced down the cat’s esophagus through the stomach and into the earliest section of small bowel.
Unfortunately with cats, it is difficult to advance the scope much farther. It is for that reason that, in cats, I usually recommend using a laparotomy technique to obtain biopsy samples. This is a surgical technique similar to a spay surgery in its approach and allows the surgeon to visualize the cat’s entire digestive system from the outside in, so to speak. It also allows visualization of the lymph nodes in the abdomen associated with the small intestine. Biopsy samples can be obtained from theses nodes along with sample of the small bowl wall allowing for the best chance to obtain that definitive diagnosis we need.
Armed with the answer to the underlying cause for Turtle’s chronic diarrhea, we can hopefully formulate a treatment plan to bring her back to normal digestive function.
Jeff Kahler is a veterinarian in Modesto. Questions can be submitted to Your Pet in care of LifeStyles, The Modesto Bee, P.O. Box 5256, Modesto 95352.