Vomiting and Diarrhoea
What is it?
Vomiting occurs when the stomach contents are forcefully ejected via the mouth. It is important that we distinguish vomiting from regurgitation; regurgitation is a passive process whereby undigested food is brought back up, usually very soon after a meal.
Diarrhoea occurs as a result of a disturbance to the normal function of the intestines, it is usually a problem with the large intestine. The large intestines main job is to reabsorb water so if it is not working properly then faeces become more fluid = diarrhoea.
Both vomiting and diarrhoea are common in dogs occurring as a sign of an underlying condition rather than a specific disease itself. The causes can include changes in diet, stress or excitement, toxins (poisons or chemicals), infection (bacteria, parasite or virus), blockages or damage to the digestive tract or other body organs.
If you suspect your pet has been poisoned, you can call the Animal Poison Line on 01202 509000. The service offers advice for pet owners and the charge is £30 per case.
What do I need to do?
Short term (acute) conditions lasting 1-2 days usually resolve on their own without the need for any treatment or veterinary care. A longer term problem is usually more serious.
Initially, starve your dog for 24 hours, feeding them nothing but leaving plenty of fresh water available and then give them small amounts of cooked chicken or fish with rice. If the problem persists for more than 24 hours, despite fasting, then take your dog to the vet.; there is a risk that they could become dehydrated.
Contact the vet sooner if there is blood in the vomit/diarrhoea or if the faeces are black and tarry (a sign of internal bleeding) and for puppies they become dehydrated very quickly and should not be starved.
Never treat your dog with human medicines - some drugs are poisonous!
What does the vet need to know?
It is important that any questions asked by the vet are answered to the best of your knowledge so they have the best chance of making your dog better.
Some important questions the vet will likely ask you :
- When did the problem start and when was the dog last normal?
- Has your dog eaten any different foods? Do they scavenge for food?
- Is your dog a chewer, i.e. do they chew toys/sticks/bones and are there any missing?
- Is he or she dull or depressed?
- What is the appearance of the vomit/diarrhoea; colour, smell, consistency?
- Are any other dogs in the household affected?
- Has the dog been given any medication or had access to any sort of toxic substance?
What will the vet do?
The vet will take a thorough history and then perform a clinical examination of your dog.
Initial treatment usually involves 24 hours of fasting, unless your dog is dehydrated in which case they will be given fluids and essential electrolytes by mouth or directly into the vein. The vet may prescribe medication to help settle their stomach and protect it. In some cases antibiotics will be given, but not all; antibiotics kill both the good and bad bacteria so can do more harm than good in some cases.
If the problem persists for more than a couple of days then the vet may perform further tests. These can include:
Faecal samples: To check for bacterial and parasite infections.
Blood tests: To check for infection, pancreatic, liver or kidney disorders.
X-rays: To look for any abnormalities within the guts.
Ultrasound scan: This can show the finer details of each organ in the abdomen (compared to x-rays).
Endoscopy: Camera passed into the stomach and intestines to look for any abnormalities and take biopsy samples of the intestine for examination.
Surgery: Sometimes it is necessary to perform surgery to assess the abdominal organs and remove or sample anything abnormal.
Digestive upsets are unpleasant for you and your dog but most cases will be better within 1-2 days. If your dog is not improving after 24 hours, or you are at all worried, make an appointment with your vet.
Hyperadrenocorticism ‘Cushings’ Syndrome
Hyperadrenocorticism (HAC) or Cushings syndrome is one of the most common hormonal disorders diagnosed in dogs. Cushing’s syndrome is more commonly seen in older dogs.
There are two types of Cushings:
Pituitary-dependent Cushings: This is the most common form of the disease (80% - 85% of spontaneous cases), and is often caused as a result of benign tumour of the pituitary gland. This tumour causes the pituitary gland to produce large amounts of a hormone called ‘ACTH’ which stimulates the adrenal gland to produce excessive amounts of cortisol.
Adrenal-dependent Cushings: This form is less common and occurs when a tumour develops on one or both adrenal glands and produces excessive amounts of cortisol.
The symptoms of Cushings syndrome develop when excessive amounts of cortisol are circulating around the body. Cortisol is a hormone produced by the a part of the adrenal gland called the cortex. Cortisol plays an important role in the normal body function including the following:
- Mobilising nutrients
- Aiding the body’s response to inflammation
- Activating the liver to raise blood sugar levels
- Help control the amount of water in the body
Symptoms of Cushings Syndrome
However, excessive levels of cortisol in the body can cause numerous symptoms including most commonly:
- Increased drinking
- Increased urination
- Increased appetite
- Pot belly due to muscles becoming thinner
- Hair loss, which is often symmetrical
- Recurrent skin infections
- Excessive panting
Cushing’s is diagnosed by measuring the level of cortisol in the body. There are several tests which your vet may recommend if they are suspicious your pet has Cushing’s syndrome.
- ACTH Stimulation test
- Low-Dose Dexamethasone Suppression Test
- Urinary Cortisol: Creatinine Ratio
If the symptoms are being caused by a tumour on the adrenal gland, it can be managed surgically. However, a tumour on the pituitary gland is often impossible to treat surgically and needs to be managed medically.
Medical management involves administering your pet a tablet called ‘Vetoryl’ which contains the active ingredient Trilostane. Trilostane blocks the excessive production of cortisol. It is important to note that your the aim of treatment is to manage the condition successfully, which will enhance your pets’ quality of life.
Your pet will have to have regular bloods tests to monitor there cortisol levels as it is important that levels are not overly suppressed by the medical treatment. The efficacy of treatment is also assessed by monitoring changes in clinical symptoms, and monitoring electrolytes, urea and creatinine levels. At the start of treatment blood tests will be done at 2 weeks, 4 weeks and 12 weeks after starting therapy and thereafter every 3 months.
What is chronic kidney disease or failure?
Kidney disease develops when there is an abnormality present in the structure or function of one or both kidneys. Clinical symptoms of kidney disease develop when kidney function has deteriorated a significant amount (up to 75%), as a result it can progress for some time without being noticed. Blood and urine tests are used to detect kidney disease.
What are the functions of the kidney?
- To filter and eliminate waste products from the blood
- Produce hormones
- Control of red blood cell production
- Maintain hydration through water and electrolyte balance
What are the types of kidney disease?
Acute: Sudden onset and develops over a few days. In some cases can be reversible.
Chronic: Insidious onset, may be present for months to years and is irreversible. Treatment of chronic kidney disease is aimed at slowing down the progression of the disease. It is also important to note that the underlying cause of chronic renal disease is often unknown as the disease tends to be present for some time before diagnosis.
What are the symptoms of chronic renal disease?
Symptoms of kidney disease result partially from the inability of the kidneys to concentrate urine. As kidney function declines further the ability of the kidney to elimate waste products from the body declines and these start to build up in the body – this is called uraemia and the toxins are referred to as uraemic toxins. This helps us to understand the variety of clinical symptoms that develop which are listed below:
- Increased thirst
- Increased urine volume
- Weight loss
- Poor hair coat
- Reduced/selective appetite
- Loss of appetite
- Bad breath
- Mouth ulcers
What test are performed?
Urinalysis: This will let the vet know how well the kidneys are concentrating the urine. As kidney disease progresses urine becomes more dilute. Any signs of a urinary tract infection can also be detected. Urine protein levels may be checked also, levels increase as disease progresses.
Biochemistry: Allows the vet to check the levels of urea and creatinine which are two waste products produced by the body that the kidneys should eliminate. The levels of urea and creatinine increase as kidney disease progresses.
Haematology: Assess degress of anaemia. The kidney produces a hormone called erythropoetin which is involved in red blood cell production. As kidney function declines, hormone production and red blood cell levels also decline.
Phosphorus, potassium and calcium: Levels of all three are monitored as they can change.
Blood pressure measurement: High blood pressure can lead to further decline in kidney function.
Ultrasound and x-ray: May be done to evaluate the structure of the kidneys.
Further tests may be performed to evaluate kidney function further, which your vet will discuss with you if they think they are necessary. This include blood urea nitrogen and creatinine concentrations.
Treatment of kidney disease
Treatment of kidney disease depends on the severity of the condition at the time of diagnosis.
- Diet: low in protein, phosphorus and salt (these diets help to reduce clinical symptoms and delay progression of the disease)
- Good hydration
- Manage blood pressure, anaemia, electrolytes imbalances if present with oral treatments
- Intravenous fluid therapy: Often required to treat the uraemia (the build up of toxins in the system)
What is Diabetes Mellitus (DM)?
DM occurs when the pancreas fails to produce or respond to the hormone insulin. Insulin is required by the body to efficiently use sugars, fats and proteins from the diet.
What causes diabetes mellitus?
DM may occur spontaneously for no obvious reason, however certain factors can increase its incidence:
- Age: Diabetes is more often seen in middle aged to older dogs and cats
- Gender: Female dogs appear to be more predisposed than males
- Hormones: It is not uncommon for female dogs to become transiently diabetic during a season
- Obesity: Animals that are overweight will be predisposed to developing diabetes mellitus
- Drugs: Certain drugs such as corticosteroids can trigger DM, usually following long term use
What are the signs of Diabetes Mellitus?
Without insulin, sugars from the diet accumulate in the blood and spill into the urine. This is often reflected in the clinical signs we recognise in our pets.
Excessive thirst: Sugar in the urine causes the pet to drink lots of water, and pass large amounts of urine.
Increased appetite and weight loss: Appetite is controlled by levels of sugar in the brain. If the brain becomes deprived of sugar our animal may seem constantly hungry, yet may lose weight due to improper use of nutrients from the diet.
Untreated diabetic pets are more likely to develop infections and commonly get bladder, kidney, or skin infections.
Rapid onset cataract formation are commonly seen in diabetic dogs, and rarely cats.
Less common signs of diabetes are weakness or abnormal gait due to nerve or muscle dysfunction.
How is it diagnosed?
DM is usually diagnosed by first examining a urine sample to determine if there is glucose in the urine (glucosuria or glycosuria) and/or a urinary tract infection. A simple in house blood sample can then be taken to determine the glucose (sugar concentration) in your pets blood.
How is DM treated?
There are two different types of DM:
Type 1: Seen in nearly all dogs and some cats. This is “classic” diabetes where the pancreas stops producing insulin. Treatment involves supplementing the animal with insulin by daily injections. The dose required to control each animal can vary enormously and so the initial stabilisation phase can be quite time consuming while a correct regime is established.
Type 2: Seen less frequently, and is more common in cats compared with dogs. This type of diabetes is where the animal is producing insulin normally, but the cells in the body stop responding to the hormone. This is usually treated with a combination of diet, weight loss and insulin.
What happens once my pet has been diagnosed?
When your pet is diagnosed with DM we will book you in for an extended consultation with one of our nurses. During these consults they will explain various aspects of diabetic pet care, including feeding, correct storage of your insulin, and what to do if your pets glucose drops too low. We will also give you a teaching session on how to measure insulin dosages correctly and how to inject the insulin safely, with minimal discomfort to your pet.
It is also an opportunity for you to ask any questions you might have.
A common concern is that clients may not recognise if there pet is having a hypo/episode of low blood sugar.
If this does happen your pet may become weak and wobbly, and become quite vacant and stare into space. If blood sugar drops very low they may collapse.
What to do if your pet does have low blood sugar episodes
If your pet is showing signs of having a hypo it is important to rub a sugary substance such as honey or jam on their gums. If they are conscious and able to swollow some sugar water can be poured directly into their mouth. It is always advisable to seek veterinary advice if there are any concerns of a hypo occurring.
What is the pancreas?
The pancreas is a small glandular organ which is located next to the stomach and the first part of the small intestine. The pancreas has two roles:
1. Production of digestive enzymes that go into the small intestine and help break down food into smaller components so that the gut can absorb them. These enzymes are packaged into a single unit and only release the enzymes once they are in the intestines. The lining of the gut is protected from digestion by a thick mucus lining, this ensures that the enzymes only work on the food present.
2. It produces the hormone insulin which regulates blood sugar in the body.
What is pancreatitis and what are the symptoms?
Pancreatitis means inflammation of the pancreas and can be caused by a variety of factors, however the cause of it can also be unknown (idiopathic pancreatitis). Any of the causes listed below lead to damage and inflammation of the pancreas:
- Recent ingestion of a fatty meal
- Infection, which can ascend from the small intestine via a duct to the pancreas
- Pancreatic tumour
Any of the above lead to the enzymes that the pancreas produces being prematurely released into the pancreas itself. This results in digestion of the pancreas, pain and inflammation. All three of which can be very severe.
The symptoms of pancreatitis are very variable and may include one or more of the following:
- High temperature
- Sudden onset diabetes
- Abdominal pain (may see your pet in a stretching ‘prayer position’)
How is pancreatitis diagnosed?
Diagnosis is based on history taking, clinical examination and laboratory tests.
Haematology: Assess for signs of infection and dehydration.
Blood Amylase and Lipase are measured: These are two enzymes that the pancreas produces and there levels increase.
Canine/Feline specific pancreatic lipase snap test: This is a highly sensitive test that provides information on pancreatic function and can be run in-house.
Canine/Feline pancreatic trypsin-like immunoreactivity: This is a very sensitive test that determines if the pancreas is not working properly or if there is pancreatic damage present. This test is performed at an external lab.
Imaging of the pancreas may be advised, but is not always warranted.
Treatment of pancreatitis
Treatment needs to be instigated immediately and generally quite aggressive as the condition can progress quickly. Treatment includes some or all of the following:
- Intravenous fluid therapy
- Intravenous antibiotics
- Anti-vomiting medications
- Pain relief (modality is dependant on severity of pain)
- Nil by mouth for a short period of time may be recommended to try and reduce the production of enzymes by the pancreas.
Your vet may recommend repeat blood tests to monitor response to treatment.
Prognosis for pancreatitis
Prognosis for pancreatitis is dependent on the underlying cause, age and severity of the condition at the time of presentation. Mild cases are more likely to respond to treatment, however severe cases with a severe underlying problem carry a very guarded prognosis and are associated with higher fatality rates due to secondary complications including organ failure and septic shock.
Long term treatment of patient that have had or suffer from pancreatitis flare-ups. Animals that have had pancreatitis in the past are considered at risk of future pancreatitis episodes. They are also at greater risk of developing diabetes. Management of diet, weight, lifestyle and medication can help reduce the risk of further attacks, which need also need prompt veterinary attention if they do occur.
Cruciate Ligament Disease
The stifle/knee joint is a hinge joint, involving the femur which articulates with tibia and fibula below it. Between the femur and tibia/fibula there are two cartilagenous structures called menisci that act as shock absorbers when stress is applied to the joint. The entire joint is held together by ligaments, which help it move in the correct direction smoothly.
What are cruciate ligaments?
There are two cruciate ligaments, they are called the cranial and caudal cruciate ligaments and they prevent inappropriate forward and backward movement of the femur in relation to the tibia. The collateral ligaments prevent any unwanted side to side movement of the bones relative to each other.
What is cruciate ligament disease?
This is the term used to describe damage or injury to the cruciate ligaments, and damage can be either a partial tear or a complete tear/rupture. It tends to affect the cranial cruciate ligament. Injury to the cruciate ligament leads to instability in the joint, allowing the femur to move forwards over the surface of tibia leading to pain, discomfort and inflammation. The constant movement and trauma to the cartilage surface of the bone and menisci leads to lameness, which is often non-weight bearing in the dog.
How does cruciate ligament injury develop?
Generally it is associated with some sort of trauma such as slipping on a floor, jumping over a fence, falling from a height, jumping off a sofa. In older dogs it may be naturally weakened and more prone to damage. Larger, overweight and older breed dogs tend to be affected, but it also seen in smaller breed dogs.
What are the signs of cruciate ligament disease?
In sudden on set cases, the dog tends to become suddenly lame on a back leg and is reluctant to put full weight on the leg. This is often referred to as ‘toe-touching’. Chronic cases tend be associated with a gradual onset of lameness and change in gait. Heat and swelling may also be associated with the joint.
How is cruciate ligament disease diagnosed?
Initial diagnosis is made based on history and clinical examination. If the vet is concerned that your pet has damaged a cruciate ligament further tests will be advised, including assessment of joint stability under sedation or general anaesthetic and imaging (x-rays) of the affected joint. X-rays are important as they allow the vet to assess if there is any evidence of arthritis in the joint, which may affect the long-term prognosis and approach to management of the case.
Treatment and management of cruciate ligament disease
Mild cases and small breed dogs may be able to be managed conservatively and may include one or all of the following - anti-inflammatory medication, controlled exercise program, body weight management and physiotherapy/hydrotherapy. However, if the cruciate disease is determined to be severe then a variety of different surgical options are available which your vet will discuss with you.
1. The lateral suture
This is were a prosthetic ligament is placed around the outside of the stifle joint. It therefore stabilises the joint and allow normal movement to occur again. Return to normal movement can take an averagy time of 2-3 months, and it may take several weeks before your dog will want to put weight on their limb. All animals go home with pain killer, an exercise program and are advised to start supplement such as glucosamine and chondroitin sulphate. Hydrotherapy is also highly recommend to aid recovery.
2. Tibial Tuberosity Advancement (TTA) or Tibial Plateau Leveling Osteotomy
These are complex procedures which involve altering the geometry of the joint so that movement of the femur down the tibia is limited and the cruciate ligament is no longer required. Return to normal walking tends to be quicker with this surgery and anti-inflammatories, a controlled exercise program and physiotherapy/hydrotherapy will also be advised.
Possible post operative problems
As with any surgery success is not guaranteed and complications may be develop. The factors outlined below increase the risk of a problem post-operatively.
- Degree of damage to the menisci (associated with residual pain)
- Degree of arthritis already present
- Age of dog (older dogs at greater risk of arthritis)
- Obesity (increased pressure on joint and surgery site)
- Temperament (rest post-operatively is encouraged and this can be difficult in very active/bouncy dogs)
It is important to note that dogs with cruciate ligament disease often have arthritis already present and may require a long term management plan.
What is Pyometra?
Pyometra is an infection of the uterus and is a common condition in female dogs that have not been neutered. It is more commonly found in older females but can present in younger dogs also. Cats can also develop a pyometra but is not as common as in dogs.
Why does pyometra develop?
Female dogs have a season approximately every 6 months, and during this period she will have all the hormonal changes associated with normal pregnancy. This occurs regardless if she is pregnant or not. The risk of pyometra developing becomes greater with each season that your bitch has. Pyometra tends to develop anywhere from 4-12 weeks post season. Certain injections used to stop a season or prevent an unwanted pregnancy can also increase the risk of pyometra developing.
What are the signs of Pyometra?
- Licking at vulva/back end
- Increased drinking
- Reduced appetite
- Discharge from vulva (yellow/brown creamy discharge)
If any of these signs are present please make sure to contact your veterinary practice to make an appointment to have your dog assessed. A dog with pyometra will continue to deteriorate if left untreated.
Your vet will take a full history and give your pet a full clinical examination. An abdominal ultrasound will be recommended to confirm a pyometra. Bloods tests will also be advised which will not only provide information on the presence of infection but will also provide essential information regarding over all health - including kidney and liver function. The combination of a clinical examination and blood tests will allow the vet to judge if your dog is a suitable candidate for surgery.
The treatment of choice is surgery to remove the infected uterus. If the uterus is not removed the infection will get worse and your pet will deteriorate further. During surgery your pet will have intravenous fluid therapy, pain relief and antibiotics. This surgery is essentially the same as a routine spey, however it carries much higher risk of complications - these will be discussed at the time of surgery.
Prognosis and prevention
Prognosis depends on how ill your pet is on presentation. If presented and treated early most dogs will make a full recovery from a pyometra. Speying your dog is the only way to prevent pyometra from occurring.