Vomiting, Diarrhea, and Table Scraps for the Holidays

During the holiday season, you may find that one or more of your pets has an upset stomach. Vomiting and diarrhea are common reactions to stress from traveling or new visitors in the home and dietary changes from table scraps or trash can diving after holiday meals. In many cases, the upset stomach will resolve on its own without requiring a trip to see your veterinarian, but if it does not, you may find yourself discussing pancreatitis. The following will help you as a pet owner understand this disease and what you should expect when working with your veterinarian to treat it.

Pancreatitis, or inflammation of the pancreas, is a common reason for pets to present to their veterinarian or to an emergency clinic. The pancreas is an organ that lies near the stomach and intestines and produces enzymes that aid in digestion and utilization of nutrients from the diet, like lipase and insulin. Pancreatitis is the most common pancreatic disease in small animal patients. While it is much more prevalent in dogs, it can occur in cats as well. There are two types of pancreatitis: acute (arising suddenly) and chronic (persisting over a long period of time). However, both types are diagnosed and treated similarly.

There are a myriad of causes of pancreatitis, and most cases are considered idiopathic—meaning that the cause is never identified. Dietary indiscretion, or “garbage can gut,” is one of the most common identified causes. Table scraps rich in fat like cheese, gristle, turkey carcasses, and pork, can trigger a bout of pancreatitis. Blunt trauma, like falling from a high place or being hit by a car, has also been associated with pancreatitis.  Certain types of bacterial, parasitic, or viral infections are also associated with pancreatitis. A very small number of pets may react unfavorably to certain classes of drugs and develop pancreatitis secondary to administration of those drugs.

When the pancreas becomes inflamed, it leaks digestive enzymes into the surrounding tissue. These enzymes break down healthy tissues and cause more inflammation. This process can be very painful, and pets with pancreatitis often present with profound abdominal discomfort and pain. Vomiting, diarrhea, dehydration, lethargy, weakness, and loss of appetite are also common presentations of pancreatitis. The severity of signs is often directly correlated with the degree of inflammation in the pancreas, ergo less severe cases will present with less severe clinical signs.

Coming to a diagnosis of pancreatitis often involves careful investigation of your pet’s history, physical examination, lab work, and imaging findings. It is important to rule out other causes of vomiting and diarrhea, like foreign body obstruction, so your veterinarian may recommend x-rays of your pet’s abdomen. A CBC (complete blood count) and blood chemistry panel will allow your veterinarian to examine the function of your pet’s organs, like the kidneys and the liver. Tests looking for pancreatic lipase (PLi- an enzyme secreted by the pancreas) in the blood can help support a diagnosis of pancreatitis, but the most definitive diagnosis can be made after examining your pet’s abdomen via ultrasound and noting inflammation in the pancreas.

When treating pancreatitis, your veterinarian will likely recommend hospitalizing your pet. This allows your pet to receive intravenous fluids, pain medications, anti-nausea medications, and other supportive care measures. There is no medication to “cure” pancreatitis. Pets usually recover with supportive in-hospital care and time to allow the inflammation to resolve. The severity of inflammation and thus severity of signs will determine how long and how aggressive the supportive care will need to be. Having pancreatitis once makes a pet predisposed to developing it again at some point in their life, so it is important to follow your veterinarian’s diet recommendations once your pet is discharged from the hospital.

Liver Disease in Pets

The liver is one of the body’s greatest multi-taskers; it commands the majority of metabolic functions in the body, manufactures proteins and glucose, metabolizes waste products in the blood, and produces the contents of the gall bladder to aid in digestion. With such a critical role in maintaining health and well-being, it is no surprise that when the liver is injured, the results can be serious and far-reaching.

Acute and chronic liver diseases are commonly encountered in veterinary medicine. Acute liver disease is usually the result of ingesting toxins (certain species of mushrooms, xylitol, Sago palm– for a full list of household and environmental toxins please visit ASPCA’s website: https://www.aspca.org/pet-care/animal-poison-control), drug reactions, or infectious diseases. These conditions can present as general illness with relatively non-specific signs like vomiting, fever, lethargy, loss of appetite, diarrhea, or neurological problems like stumbling and loss of balance. Your veterinarian can run a blood panel to check for elevation in liver enzymes and determine if your pet’s signs are a result of liver injury. As soon as liver injury has been identified supportive care will be started. In most cases the severity of injury will dictate the aggressiveness of the treatment. The liver has a tremendous capacity for regeneration, but time is needed for it to recover so acute liver injury often involves lengthy hospital stays, serial blood testing, intravenous fluids, medications, and special feeding procedures.

Chronic liver disease is becoming more common as the life span of the pet population increases. Signs of chronic liver disease are similar to acute liver disease but are slower in onset and may appear gradually over the period of several months; weight loss, increased thirst, and increased urination may also indicate chronic liver problems. Identifying chronic liver disease often entails a full work-up including blood and urine testing, abdominal ultrasound, and even liver biopsies and culture, in some cases. Treatment for chronic disease focuses on supporting the liver with antioxidants like milk thistle extract, vitamin E, and SAMe. Because many chronic liver diseases have a strong immune-mediated component treatment may require immunosuppressive drugs, like cyclosporine or prednisone. Your veterinarian may also recommend special prescription diets that are lower in protein and copper than commercial dog food, which lessens the metabolic burden on the liver and reduces the amount of waste products in the bloodstream.

Since organ transplants are not commonly performed in veterinary patients, early diagnosis and liver specific supportive care makes the largest impact on extending these patients lives. The veterinary community will continue to pursue new and innovative treatment options for patients with liver disease. Currently, there is research being conducted on the efficacy of stem cells in treating chronic liver disease, and we are interested to see the results. If your pet is suspected of having liver disease or has been diagnosed with liver disease our internal medicine and emergency medicine team at Pet Specialists of Monterey is here to help.