How can this puzzling case of unremitting gastrointestinal problems be resolved? Explore the diagnostic process and management in this article brought to you by Clinician’s Brief and WSAVA. A 4.5-year-old intact female shar-pei was presented for chronic recurrent diarrhea, which was either watery or mucoid, of more than a year’s duration. Vomiting and hyporexia developed the month before presentation and was associated with mild weight loss. The dog was the only pet in the household and was up-to-date on vaccinations and flea/tick preventives; heartworm prevention was unnecessary, as there is no heartworm disease in Sweden or northern Europe, where this dog lives.
The patient had to be sedated for physical examination due to temperament. BCS was 4/9, with a muscle condition score showing mild muscle atrophy and a dull hair coat. Despite chronic diarrhea, no signs of dehydration were observed. All other vital parameters were within normal limits. Rectal palpation was painful despite sedation.
Several therapeutic diets labeled intestinal, including a high-fiber diet, had been tried throughout the last year without clinical improvement. The protein sources of those diets included chicken, egg, and turkey, and the owners sometimes gave treats such as cold cuts and table scraps. Water intake remained the same throughout the year. Metronidazole had been prescribed on several occasions; diarrhea would cease with metronidazole but would recur each time after discontinuation of therapy.
Diagnostics included screening for intestinal parasites, CBC, serum chemistry profile, urinalysis, and a GI panel, including trypsin-like immunoreactivity, cobalamin, and folate. No intestinal parasites were detected. Subnormal serum concentrations of folate, cobalamin, and cholesterol were detected. CBC and serum chemistry profile were otherwise unremarkable.
Endoscopy of the stomach and small and large intestine were performed. Histopathology of biopsies of the small and large intestine revealed a moderate lymphocytic-plasmacytic enteritis, with a moderate degree of villous atrophy, and moderate lymphocytic-plasmacytic colitis.
Linda Toresson, DVM, Evidensia Specialist Animal Hospital, Helsingborg, Sweden
Gregg K. Takashima, DVM, WSAVA Global Nutrition Committee Series Editor
Kara M. Burns, MS, MEd, LVT, VTS (Nutrition), VTS-H (Internal Medicine, Dentistry), Academy of Veterinary Nutrition Technicians
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