Category: gastrointestinal-disease-cats

Vomiting and diarrhoea

Vomiting and diarrhoea are common in cats. Both are symptoms of other conditions rather than diseases in their own right and there is a vast range of cat diseases in which diarrhoea and/or vomiting may occur. In many cases the problem may be successfully treated without ever pinpointing the actual cause. However, the information that you give your vet may be vital in deciding whether the case is serious enough to need further detailed investigations.

Diarrhoea occurs when the normal functioning of the large bowel (intestine) is disturbed. The large bowel is responsible for absorbing water from the gut and if it does not do this properly, very liquid faeces (droppings) are produced.

Vomiting occurs when stomach juices are expelled from the mouth. It is important to distinguish vomiting from regurgitation. Regurgitation only occurs after a meal and the material will have visible lumps of undigested food which are often eaten again.

The causes of both diarrhoea and vomiting include viral, bacterial or parasitic infections; changes in diet, stress or excitement, poisonous drugs or chemicals, blockages or damage to the digestive system or other body organs.

It is often difficult to know that your cat has diarrhoea if it goes to the toilet outside the house and immediately covers up the faeces (droppings) with soil. But the problem becomes obvious if it uses a litter tray, if it has an accident indoors or in long haired cats whose back ends can become soiled with diarrhoea. A cat will readily vomit indoors.

Both diarrhoea and vomiting occur as short lived (acute) conditions lasting 1-2 days which will often clear up on their own, and as long-term (chronic) problems which are usually more serious. If your cat does not appear to be in distress or be losing weight, all you may need to do is to withhold all food for a day and then give your cat small amounts of cooked fish, chicken or some other food which is easily digested. Make sure clean fresh water is available but do not give milk.

If vomiting or diarrhoea is continuous for more than 24 hours, despite starvation, your cat could become dangerously dehydrated and should be taken to your vet.

Contact your vet sooner if a kitten is ill (because they get dehydrated more quickly than adults), if there is blood in the vomit or diarrhoea, if the faeces (droppings) are of a black and tarry appearance.

Never treat your cat yourself with drugs from your own medicine cabinet because some human drugs are poisonous to cats.

Your vet will manage acute diarrhoea or vomiting by starvation unless your cat is dehydrated then it may be given fluids and essential minerals by mouth or injection. Your vet may not give antibiotics because bacterial infections are one of the rarer causes of these problems and because ‘good’ bacteria are always present in a normal gut, antibiotics (which kill these too) could actually make the problem worse.

Your vet will ask you questions about your cat, such as:

  • Is your cat ill or depressed?
  • Has your cat eaten any unusual foods?
  • Is there anything unusual about the colour and smell of the your cat’s faeces or vomit?
  • When and how often is your cat being sick or having diarrhoea?
  • Are there other cats in the household and have these also been affected?
  • Has your cat been hunting or scavenging left over human food?
  • Has your cat been given any medical treatment or been exposed to any potential poisons?
  • Think about these questions before going to your vet and see if you can identify any possible reason why your cat may be ill.

If the illness continues for more than a couple of days it may be necessary for your vet to carry out a range of tests to find out the cause of the problem. A small sample of your cat’s faeces will be examined for bacterial infections or parasites in the gut. Blood tests may also be taken to check for infection, kidney or liver disorders.

An x-ray may be needed to see if there is anything abnormal in the gut. Sometimes your vet will put an endoscope into your cat’s stomach and intestine to try and see the cause of the problem, and a small biopsy sample of intestine may be removed for examination.

Digestive upsets are unpleasant for you and your cat but in most cases your cat will be better within 1-2 days. If your cat is not improving after 24 hours make an appointment with your vet for further advice.


Pancreatitis is a condition which ranges in severity from almost no clinical signs to severe abdominal upset and even death. It can therefore be very difficult to know if your cat is suffering from pancreatitis Your vet is best placed to advise you on any illness in your pet so if you are worried about your pet’s health a visit to the vet’s surgery for a check over is always warranted.

The pancreas is a small organ located close to the stomach. It has an important role in the digestion of food and produces large volumes of digestive enzymes after each meal which are released into the gut to help digest food as it leaves the stomach. These enzymes are normally stored in specialised storage granules in the pancreas until they are needed.

Quite simply, pancreatitis is inflammation of the pancreas. Once the pancreas is damaged the digestive enzymes are released from the specialised storage granules into the pancreas itself and can start the process of self digestion. If large amounts are released the enzymes can start to affect other parts of the body.

The pancreas also has a second, and completely separate function, which is to produce the hormone insulin which helps to control levels of blood sugar.

There are a number of suspected causes of pancreatitis although in a number of cats no reason is found for pancreatitis to develop. In many cases pancreatitis is associated with inflammatory bowel disease and inflammatory liver disease (IBD) in cats. The combination of three concurrent problems is termed ‘triaditis’. The signs of IBD and pancreatitis can be very similar and so it can be difficult to know which changes are caused by which disease.

Some medications can cause pancreatitis in people and dogs (although there is no evidence that this occurs in the cat) so if you are worried about your cat in anyway always remind your vet what medications your cat is taking – even if you think the vet may know already.

As stated above the amount of pancreatic enzyme released determines the severity of disease resulting in a range of different clinical presentations ranging from mild to severe. Cats with pancreatitis are usually very miserable and don’t want to eat. Some cats with pancreatitis develop jaundice and you may notice a yellowish tinge to the whites of the eyes, skin or roof of the mouth.

Cats tend to develop the less severe grumbly form of the disease (often termed chronic). Patients may present with vague signs such as lethargy and poor appetite; in some cases vomiting and mild abdominal discomfort may be present. The more severe forms of the disease (also termed acute or necrotising pancreatitis) are less common in the cat. These patients may exhibit severe pain, jaundice, frequent vomiting. Other signs include diarrhoea and fever but these signs often look just like any other tummy upset. In the severe form of the disease affected cats may have difficulty breathing and can start to bleed from multiple sites in the body.

Many cats with pancreatitis go on to develop hepatic lipidosis if they do not eat for a period of time. This is a complex disease in which excessive fat is deposited in the liver causing liver damage and ultimately failure. The risk of lipidosis developing starts to increase after 3 days of anorexia.

Ideally treatment begins with resolving the underlying cause of the disease – for example in cases of triaditis management of the liver and intestinal disease will help resolve the pancreatitis. Mild cases of pancreas may recover without any treatment over a few days. Often cats with pancreatitis will not want to eat. Food intake should be monitored due to the risk of lipidosis (see above). Drugs may be given to reduce nausea and vomiting if this is present.

Cats may need to be admitted to a veterinary hospital. Intravenous fluids can be given through a drip to support the cat whilst it is not eating and, if anorexia is prolonged, it may be necessary to administer food by an alternative route eg placement of a feeding tube to ensure that nutritional intake is maintained. Pain relief is important in speeding recovery. Since, in cats, pancreatitis is most often associated with IBD then treatment of this condition is indicated.

In very severe cases cats become extremely unwell and need intensive care or maybe even an operation. When pancreatitis is severe there can be serious effects on other organs in the body and intensive care including blood transfusions may be required.

Most cats with pancreatitis get better within a few days to a week. Your vet will advise you on longterm care of your pet after an episode of pancreatitis which will depend on individual cases and whether any reason for the pancreatitis was found. Often cats that have had one episode will be more likely to have repeated bouts later in life and these may need to monitored more carefully.

In cats that have been severely affected there may be long term consequences of the disease. Damage to the pancreas can result in failure of its other functions. Loss of large amounts of pancreas can mean that the cat is no longer able to produce sufficient quantities of insulin (thus becoming diabetic) or not producing enough digestive enzymes (resulting in poor digestion of food and weight loss).

Unfortunately some cats with the severe form of pancreatitis will die despite all treatment.

If you have any concerns about our cat contact your own vet for further advice.

Liver problems in your cat

Liver disease is quite common in cats and can occur at any age, from kittens to old age. Usually the signs of liver disease, like many diseases in cats, are a bit vague; affected cats are often just quiet, have reduced appetite and lose weight. Jaundice is quite often seen and if your cat has this you may notice yellowness in the eyes, mouth or skin or the urine being darker than usual.

The liver is a large organ found at the front of the abdomen. It has many roles but generally they are connected to metabolism – the making of substances useful around the body and the processing and safe removal of many waste products and toxins.

The liver can be affected by many diseases and each individual condition has its own causes. Animals with porto-systemic shunts have an abnormal blood supply to the liver. This is a genetic condition and is more commonly seen in Persians and related breeds and Cornish and Devon Rexes. Signs are usually seen in kittens and young adults.

Young cats may be affected by the terrible virus causing Feline Infectious Peritonitis (FIP). Cats with FIP can suffer from liver disease as well as disease in other body areas.

Cysts can be seen in the livers of some cats, especially Persians and related breeds. These cysts cause more problems in the kidneys (polycystic kidney disease – PKD) and there is a genetic test as well as an ultrasound examination programme available. Breeders are currently trying to eliminate this condition.

Toxins and damage from septicaemia sometimes cause liver disease and this can occur at any age. Some cats with Feline Immunodeficiency Virus (FIV) also develop liver disease.

The most common liver diseases are those seen usually in middle-aged and older cats – inflammatory diseases such as cholangiohepatitis and lymphocytic cholangitis, hepatid lipidosis (fatty liver) which happens when the liver function shuts down due to another serious illness such as diabetes (or anything that cause the cat to stop eating); and cancers such as lymphoma or adenocarcinoma. It is not clear why particular cats are affected but being overweight will predispose a cat to fatty liver and being exposed to the Feline Leukaemia Virus (FeLV) increases a cat’s risk of developing lymphomas.

Evidence of liver damage is usually seen in the blood test results of cats with two other common diseases – diabetes mellitus and hyperthyroidism. In both of these diseases the changes should resolve once the underlying condition is controlled and liver damage does not require specific investigation or treatment.

Cats with liver disease can show a variety of signs. Often signs are vague and are easily confused with signs of disease in other organs – heart failure, kidney failure, inflammatory diseases of the intestine or cancers. Cats will tend to have a reduced appetite and to lose weight; they may just seem quiet and withdrawn from their usual behaviours. You may see some vomiting and sometimes diarrhoea – usually larger quantities of liquid faeces.

Cats with portosystemic shunts may show signs of abnormal brain function – odd behaviour and seizures, failure to grow properly or weight loss.

A swollen abdomen is seen with some sorts of liver disease, usually because of fluid accumulating, sometimes from enlargement of the liver itself. Again, there are many other causes of fluid accumulation in the abdomen besides liver disease.

Jaundice is quite often seen when cats have more serious liver disease and owners sometimes notice this. You may see a yellow tinge to the skin where your cat’s skin is visible – between the eyes and ears, on the ears themselves and the lips or nose, you may also notice it in the eyes or mouth or that urine is darker than usual. Jaundice can be caused by problems other than liver disease, especially when red blood cells have been broken down rapidly (for example in cats affected by Feline Infectious Anaemia (FIA)). Pancreatitis (inflammation of the pancreas) is another cause but cats with pancreatitis often also have secondary liver damage.

It should be clear from the last paragraph that it’s not possible to even diagnose whether liver disease is present over the phone. It is certainly not possible to establish its cause. Your vet will need to examine your cat to make the diagnosis and often further tests are needed.

Routine blood tests run on sick cats may indicate that liver damage is happening. A further blood test called a bile acid stimulation test is used to check whether the liver is working normally. Further laboratory tests are used to help diagnose FIP, FeLV, FIV, FIA and to investigate other causes of abdominal fluid accumulation. Scanning the liver with ultrasound is now commonly used and will assist your vet to find cancers and cysts.

Most liver diseases are caused by inflammation and cancer and these can only be diagnosed by getting a tissue sample – either via a small needle or by taking a piece of tissue either using ultrasound guidance or during surgery.

Some liver diseases are treated effectively with drugs – the common inflammatory diseases usually respond to drug treatments and they often need to be given for weeks, months or even for life. The prognosis is often good. Special diets often can be helpful.

There are some liver diseases that require surgery, although this is uncommon; biliary tract stones causing an obstruction require emergency surgery. Individual cancers and cysts sometimes are removable.

Unfortunately, some liver diseases do not respond well to treatment – FIP, FIV and polycystic diseases do not have good treatments. Lymphoma of the liver is a common cancer, chemotherapy may have an effect but good responses are not usual.

Cats can live quite a long time with liver cancer, even if these are malignant – depending, of course, just how ill they are when the disease is found and that any pain can be controlled.

This all depends on the cause of the problem. Mild liver problems may well not be noticed in most cats so any problem that is bad enough to show obvious signs at home probably will not get better by itself. Sometimes evidence of liver damage is found in blood tests from a cat being examined for another reason and if there is not an obvious problem with the liver then just monitoring may be appropriate. However, your vet may want to perform other tests such as the bile acid stimulation test and an ultrasound examination to provide further information.

There are several predispositions to liver diseases to bear in mind. Avoiding FIP is difficult but there are some breeders claiming to produce kittens free of Coronavirus (the causal virus). Vaccination is available to prevent infection from FeLV and is advised for cats with outdoor access. The main avoidable risk factor for liver disease must be obesity and its link to hepatic lipidosis so regular weighing and feeding an appropriate diet to maintain your cat’s body condition in the normal range is very much recommended.

Liver disease is always serious and usually requires considerable veterinary input: firstly to diagnose liver disease, then to establish the exact type and cause of the pathology and its prognosis and then to guide treatment. Treatment can also be complicated and expensive, often including prolonged drug treatment and supportive care with hospitalization.

Forced feeding using tubes is often very important. Maintaining the cat’s nutrition is vital in maximizing the number of cats surviving the common treatable liver diseases.

Making the diagnosis first is important as it’s not right to provide all this veterinary care for a cat when the underlying disease has a hopeless prognosis and there are cats for whom euthanasia at the appropriate time is the kindest option.

Exocrine pancreatic insufficiency (EPI)

Almost all cats will suffer from diarrhoea at some point in their lives. In most cases this lasts no more than a few days and cats generally get better without any treatment. However, in a few cases the diarrhoea is due to a more serious underlying cause and does not resolve. EPI, although uncommon in the cat, is a condition that can cause chronic diarrhoea.

EPI results in a reduced ability to digest food this means that an affected pet will suffer from chronic diarrhoea and be significantly underweight. Cats with EPI have a good appetite but despite consuming lots of food they are literally starving.

The pancreas is a small organ located close to the stomach. It has an important role in the digestion of food and produces large volumes of digestive enzymes after each meal, which are released into the gut to help digest food as it leaves the stomach. These enzymes are normally stored in specialised storage granules in the pancreas until they are needed.

In EPI the pancreas is not able to produce sufficient quantities of these enzymes and so food is poorly digested. The undigested food cannot be absorbed into the body and passes through the gut resulting in the production of smelly greasy faeces. Despite consuming plenty of calories the cat is only able to use a small fraction of these and the rest pass out unused in the faeces.

In most affected cats EPI develops as a consequence of long term pancreas damage due to chronic pancreatitis, or a tumour of the pancreas or the bowel.

The most obvious sign of EPI is weight loss over several months despite a normal or ravenous appetite. Some cats are so hungry they start to steal food. Faeces are bulky and they may be greasy or smelly and diarrhoea is common. In most cases affected cats appear to be well in themselves although the haircoat may be greasy and unkempt in appearance. In some animals there is a history of previous pancreatitis (abdominal pain, vomiting and diarrhoea).

Your vet may suspect that your dog has EPI from the clinical signs. However, there are lots of other diseases that cause weight loss and diarrhoea and many investigations may be necessary. Diagnosis can be confirmed by blood tests.

Fortunately the management of EPI is relatively straightforward (at least in theory). If the disease is the consequence of an insufficient production of digestive enzymes then the treatment should be to supplement these enzymes.

Dietary changes may be necessary to provide a good quality energy dense diet. Improvements in consistency of faeces should be seen within a few days of treatment although it may take several months for weight and appetite to return to normal.

Cats with EPI are unable to absorb the vitamin B12, therefore regular injections are needed once or twice a month.

In some cases short courses of antibiotics are also required to stabilise the bacterial population in the bowel which may flourish before the enzyme supplementation starts. Many cats with EPI may have other diseases at the same time such as small bowel disease, liver disease and even diabetes mellitus.

In most cats it is possible to manage the signs of EPI to allow cats to maintain their body weight (and maybe even put on some weight), occasionally patients will not respond to therapy and your vet may need to perform investigations to ensure this is not as a consequence of concurrent disease. However, the underlying problem will never go away and if diagnosed your pet will require treatment for the rest of its life. It is important to consider the cost implications of this when embarking on treatment initially.

If you have any concerns about your cat contact your own vet for further advice.

Constipation in your cat

Cats are often secretive about their bowel habits and it can be difficult for owners to notice problems. However, if you suspect that your cat is having difficulty toileting or shows a reluctance to go to the litter tray you should make an appointment with your veterinary surgeon. Simple constipation can sometimes be easily treated but it is common for constipated cats to be distressed, significantly ill and permanent damage to the bowel occurs easily. Constipation should always be taken seriously. Also, very similar signs can be seen in cats suffering from lower urinary tract disease which itself is distressing and potentially very dangerous.

To understand constipation it is important to understand how the large intestine normally works. Food passes through the small intestine where it is digested and nutrients are absorbed. The remaining undigested material plus bacteria and some tissue from the gut lining forms the stool.

The stool enters the large intestine where water is removed and it is stored for a few hours before contractions of the intestine push the stool through the pelvic canal and out of the anus.

Constipation occurs if the stool spends too long in the large intestine, too much water is removed, and the stool becomes dry and hard. These hard pellets can be difficult for the gut to move and can soon build up to a concreted mass too large to pass through the pelvis.

There are many causes of constipation, examples are:

  • Management issues: the cat is inhibited from passing faeces because it is being boarded in a cattery, is in pain from arthritis or after a surgery or is being bullied by another cat at home. Some cats will refuse to use a dirty tray.
  • Dehydration: many cats that eat dry food do not take in enough water. Kidney failure is another important cause of dehydration in older cats.
  • Obstruction to passage of stools: especially damage to the pelvis after a road accident or the presence of a growth in, or near, the colon or rectum.
  • Poor function of the colon: due to nerve or muscle damage.
  • Some medical conditions and hormonal conditions.
  • Foreign material in the stool: hair from the cat, especially long-haired cats and cats that are overgrooming because of stress or skin disease; hair, feathers and bone from prey.
  • Obesity and inactivity make constipation more likely.
  • Idiopathic megacolon: this is when the colon becomes weak and ineffective for a reason that is poorly understood. This is common.

Unfortunately there is a cycle of deterioration. When defaecation is painful the cat becomes less inclined to defaecate and can also stop eating and become dehydrated. The stools become harder and drier and more unpleasant to pass and the problem escalates.

When faeces build up in the colon the intestinal walls can become stretched, damaged and eventually are unable to contract at all which will mean that the affected cat will never pass faeces normally again. This is called “megacolon.”

The most common sign associated with constipation is straining to pass a motion. If your cat has a litter tray in the house then you may notice her straining or crying in the tray but only passing small hard faeces. Sometimes a small amount of liquid faeces may be squeezed past the obstruction and it may look like the cat has diarrhoea.

Cats may go to the litter tray frequently or refuse to go at all. They may lick around their bottom more than usual. If the constipation is more severe she may become unwell and be unwilling to eat. Vomiting may occur. Cats with diarrhoea or urinary tract problems will show similar signs.

Your vet may suspect that your cat has constipation from the history you describe. They will want to examine your cat and may be able to feel the hard lumps of faeces inside the colon. However, constipation is just a sign of disease and so your vet will need to do other tests to try to find out what is causing the problem.

X-rays will show any abnormal pelvis. In rescued cats owners may not know about an accident that occurred when they were young. Masses or strictures narrowing the colon or rectum can be detected by digital rectal examination (under anaesthetic), endoscopy or barium-contrast x-rays.

Blood and urine tests will be needed to rule out underlying problems like renal failure, low potassium and high calcium levels. Your vet will want to ensure that your cat is not suffering from urinary tract disease (FLUTD) before treatment for constipation is started.

Your vet may prescribe some laxatives or an enema to soften the stool and make it easier to pass. If your cat is dehydrated your vet may give subcutaneous or intravenous fluids to rehydrate her and soften the faeces.

Often it may be necessary for your vet to take your cat into hospital to remove the blockage. This may be done with the use of enemas and digital manipulation under anaeasthetic. In some cases surgery may be required to remove faeces and in these cats part of the colon is often removed (colonectomy) when it has become stretched and non-functional.

It is important that cats pass a regular motion to keep the bowel healthy and functioning normally. Cats that have had constipation are prone to a recurrence and they are often required to have long-term treatment to attempt prevention and to avoid a major surgery.

Ensure that they have access to a clean litter tray or the outside. In multi-cat households cats may be deterred from using the litter tray if there is competition for it so ensure that there are more litter trays than cats in the household.

Long haired cats should be brushed regularly. Encouraging your cat to exercise – regular play time with an indoor cat can help to keep them fit and active and will ward off many potential health problems.

Since dehydration is a common cause of constipation it is important to encourage your cat to drink as much as possible. Many cats will drink more from a water fountain. Dietary issues can also have an influence on stool quality but there is a lot of variation between individual cats. Adding certain fibre to the food can help in cats that are well hydrated and with mild problems – take your vet’s advice about this. Other cats are usually better on low fibre, low residue diets. Cats are likely to be better hydrated if they avoid dry foods.

Drugs may help cats that are prone to constipation. Laxatives can be given in the long term. Some will stimulate the colon to secrete fluid, others lubricate the stool directly. Cats will often take these in their food. There are also drugs that stimulate contractions in the large bowel but these are tablets that require long-term pill giving.