De-frustrating diarrhea in cats and kittens

Diarrhea is the most common sign associated with intestinal disease in the cat. Other signs of intestinal disease include anorexia, weight loss, abdominal discomfort, and vomiting. Common intestinal causes of diarrhea include infectious diseases (Table 1), food allergy/intolerance, inflammatory bowel disease, and lymphoma. It is important to remember that diarrhea can also be a result of non-intestinal problems such as cholangitis, pancreatitis, hyperthyroidism, and systemic infections. Important information to capture in the medical history includes the duration and frequency of diarrhea. Small bowel diarrhea should be distinguished from large bowel diarrhea in order to prioritize differential diagnoses (Table 2). Questions should also be asked about other clinical signs, medications and supplements, and access to outdoors. A complete nutritional assessment and history should be taken. The diagnostic plan can be divided into initial and advanced diagnostics: Initial diagnostics: a) FeLV/FIV serology b) Direct fecal smears c) Rectal cytology (large bowel diarrhea) d) Fecal flotation-centrifugation e) Giardia fecal antigen f) T. foetus testing (large bowel diarrhea) g) Molecular-based testing for enteropathogens h) +/Fecal culture i) Response to treatment with a broad spectrum dewormer such as fenbendazole j) Chronic diarrhea: CBC, chemistry panel, total T4, urinalysis Advanced diagnostics: a) fTLI, fPLI, cobalamin, folate b) Imaging: ultrasonography +/biopsy, radiology (best for foreign body, intussusception) c) Laparotomy or laparoscopy and biopsy