chronic vomiting and diarrhoea

RE: chronic vomiting and diarrhoea

Anthony Dennison — Fri, 01 Feb 2019 08:54:15 GMT

[quote user="Claire Godfrey"]I did wonder if she might have had a previously undiagnosed shunt. She is tiny. [/quote]

Could be acquired rather than congenital given her age tbh. Will be interesting to see the BAST results - please let us know!

RE: chronic vomiting and diarrhoea

Claire Godfrey — Thu, 31 Jan 2019 18:29:59 GMT

Thanks all.

Have tried a diet trial. The problem being that the dog eats something and then goes off it. She is currently eating proplan pvd.

Have had back in today as has been quiet and lethargic, however Alt is dropping 512

Temperature today is normal, she is.eating and has gained 150g in a week.

Bile acids sent away today.

I did wonder if she might have had a previously undiagnosed shunt. She is tiny.

Will see what blood results are.

RE: chronic vomiting and diarrhoea

Clive Ansell — Thu, 31 Jan 2019 11:08:46 GMT

[quote user="Liz Barton"]I would be chasing the liver issue in this case - comprehensive liver profile and BAST first.[/quote]

me too, in an ideal world.

If limited by costs then would go down the diet and pred route as already mooted.

Might find the owner is feeding it all sorts of sh1t. I've got a similar case on the go at the moment; elderly SBT owned by a confused elderly gentleman, fed cheap sausages, faggots, pork pies etc. so no compliance with dietary management, so doing well so far on preds., with Metronidazole as needed

RE: chronic vomiting and diarrhoea

Liz Barton — Thu, 31 Jan 2019 10:34:00 GMT

I would be chasing the liver issue in this case - comprehensive liver profile and BAST first. I agree it looks small on the radiograph. Would be concerned about cirrhosis. Hepatopathy would potentially respond to amox, and could be causing the nausea. If possible, an ultrasound guided tract (after checking clotting factors) would be your best bet at getting a minimally invasive diagnosis. You can start a diet trial alongside, but I'd at least want the bloods before starting steroids.

RE: chronic vomiting and diarrhoea

Anthony Todd — Thu, 31 Jan 2019 09:54:13 GMT

[quote user="robloxley"]Agree diet trial needs to be on the cards, but does how ill the pet is not influence how quickly we need to proceed to some medication before waiting for the full results of diet trial[/quote]

A diet trial, should/would have been the first step in an animal that is still eating, IMHO, and, as the animal, I understand, is still eating it probably isn't too unwell.

Dietary intolerance used to be so common, could be difficult to pin down 'cos people don't always tell the truth and they will let the pet out, unsupervised.....

RE: chronic vomiting and diarrhoea

Rob Loxley — Thu, 31 Jan 2019 09:22:44 GMT

[quote user="Thomas Johnson"]I would do a diet trial first, you're right that it may need corticosteroids, but I have fixed a few IBDs with diet alone so would usually try that first before considering medication[/quote]

Agree diet trial needs to be on the cards, but does how ill the pet is not influence how quickly we need to proceed to some medication before waiting for the full results of diet trial

RE: chronic vomiting and diarrhoea

Thomas Johnson — Thu, 31 Jan 2019 08:45:29 GMT

[quote user="David Mills"]

Rather than a diet trial, try a corticosteroid trial. Injectable. It may take 2 or 3 weeks but I suspect this is IBD (or whatever flavour)

[/quote]

I would do a diet trial first, you're right that it may need corticosteroids, but I have fixed a few IBDs with diet alone so would usually try that first before considering medication.

RE: chronic vomiting and diarrhoea

Kara Gibson — Thu, 31 Jan 2019 02:22:39 GMT

Just wondering if you've checked a basal cortisol to rule out Addison's, even if electrolytes normal could fit with this history.

RE: chronic vomiting and diarrhoea

David Mills — Wed, 30 Jan 2019 21:43:19 GMT

Rather than a diet trial, try a corticosteroid trial. Injectable. It may take 2 or 3 weeks but I suspect this is IBD (or whatever flavour)

RE: chronic vomiting and diarrhoea

dred.hall — Wed, 30 Jan 2019 11:18:06 GMT

Whilst a diet trial is a good idea in many chronic GI cases before lots of testing and especially before biopsy, my concern in this case would be the poor appetite (so waiting 4 weeks may adversely affect he patient), and the possibility of primary liver disease (which can cause GI signs). Whilst the raised ALT may be a reaction to primary intestinal disease, it is a it higher than one typically sees, and the apparently small liver might indicate chronic hepatitis/fibrosis. (or she could have a PSS that was never diagnosed)

Antibiotic-responsiveness suggests a bacterial problem and can occur in older dogs seciondary to partial obstruction due to masses. However antibiotics would also affect sins of cholangitis and hepatic encephalopathy.

Doing dynamic bile acid testing next is reasonable, but ultimately this dog may need liver and/or gut biopsies.

RE: chronic vomiting and diarrhoea

Anthony Dennison — Tue, 29 Jan 2019 14:12:10 GMT

Have you done a diet trial yet? I would recommend a hydrolysed diet (RC Anallergenic or Hills z/d), if the owners won't do that I find salmon and potato base diets good for it too. Do for at least 4 weeks.

Could be a chronic IBD type thing, what did the intestines look like on the scan? Normal wall layers, or were some more prominent than others. What was the average intestinal wall thickness? They do look thickened on the radiograph.

If the liver looks small could look at doing a BAST to check dynamic function (after the food trial).

Other possibility is IBS - is it a nervous dog? Psyllium has been shown to help with these, there's a decent amount of it in the protexin pro-fibre pellets. Buscopan or metoclopramide could also help with this sort of spasmodic colic.

Frustratingly a lot of these you'll never find the answer to!