Gastroenteritis: What to Do When Food Won’t Stay Down

One of the most common reasons that pets end up in the veterinary hospital or ER is due to vomiting and diarrhea, known medically as gastroenteritis. While trauma and poisonings are common and more dramatic, this sometimes simple, sometimes complex condition accounts for a big percentage of veterinary visits. In some cases, the cause can be serious, elude diagnostics tests, or require hospitalization or surgery. Luckily for many cases, the cause and treatment are simple, and management can be completed at home. Your vet can help guide you through the steps needed to determine the cause and the best course of action, and some of the information here will help you decide what's best for your pet before a visit.

Gastroenteritis is not a disease or a diagnosis - it's just a medically descriptive term for inflammation of the stomach and intestinal tract that tells us something's up with the tummy. It can be caused by many things, such as:

Viruses: Most feared among them is parvovirus
Dietary indiscretion: Eating spoiled food, too much people food, or garbage
Blockage: A foreign body causing an intestinal blockage
Pancreatitis: Inflammation of the pancreas
Medical conditions: kidney disease, liver disease, inflammatory bowel disease, etc.
Cancer
Pain, fear, nervousness

What to watch for & what to do:

If your otherwise healthy pet vomits once, you don't always need to head to the vet right away. If the vomiting continues and you see any of these other symptoms, go to the vet within the next 24 hours.

Diarrhea accompanying the vomiting, but not bloody or severe
Lack of appetite for less than 24 hours
Only 1-2 episodes of vomiting in 24 hours
Normal activity level
No significant medical history

If any of the following signs develop, however, you should seek immediate medical advice, day or night, especially if you have a young, unvaccinated puppy.

Sudden abdominal distension - a sign of gastric dilatation-volvulus, or 'bloat,' a surgical emergency
Bloody, severe, or uncontrollable diarrhea
Lethargy, lack of responsiveness, inability to walk
Abdominal pain
Difficulty breathing
Straining to use the bathroom
History of serious medical conditions like diabetes, kidney disease, or heart disease
Epilepsy and inability to keep down anti-seizure medication
Vomiting for more than 24 hours or more than 2 episodes in 24 hours
Episodes of non-productive vomiting or retching that are repeated, another sign of 'bloat'

For mild cases where there are none of the warning signs described above, some patients will respond to stopping food and water for a few hours, then slowly reintroducing small amounts of water first. For bigger dogs and most cats, no food for 12-24 hours is safe and effective in letting the stomach calm down. Toy breeds like Yorkies and puppies less than 4 months of any breed can't go that long without food. Have their diet and food withholding time directed by a veterinarian.

Once your pet can hold down water for a few hours without vomiting, you can feed small amounts of an easily digested bland diet. Use one selection from the protein column below and one from the starch column.

PROTEIN STARCH

Cottage cheese
Plain white cooked rice
Boiled lean hamburger
Plain cooked potatoes
Lean deli meat
Plain cooked pasta
Cooked chicken breast
Plain bread
Scrambled egg white
Rice flake baby cereal (good for cats)
Meat baby food - beef, chicken, turkey (good for cats)

Dogs should be fed in small, frequent meals every 6 hours or so using the feeding guide below. Feed the bland diet for 2-3 days or as directed by your veterinarian.

Dogs under 5 lbs - - teaspoonful, 4 times per day
Dogs 5-10 lbs and all cats - 1 tablespoonful, 4 times per day
Dogs 10-15 lbs - 2 tablespoons, 4 times per day
Dogs 15-25 lbs - 1/2 cup, 4 times per day
Dogs 25-40 lbs - 2/3 cup, 4 times per day
Dogs 40-60 lbs - 3/4 cup, 4 times per day
Dogs 60-90 lbs - - cup, 4 times per day
Dogs over 90 lbs - 1 1/2 cups, 4 times per day

After 2-3 days of feeding the bland diet, gradually transition back to normal diet unless another one has been prescribed by mixing in increasing amounts of normal food over another 2-3 days.

Tests

For dogs and cats that need medical attention, some testing is usually in order to determine the cause of the vomiting and/or diarrhea. While sometimes it may be okay to treat the symptoms and ask your vet to administer an anti-nausea medication, most patients benefit from an X-ray and/or some lab tests. These can help make sure surgery isn't needed for a blockage or that some other serious medical issue isn't causing the symptoms. Blood and urine tests can show several important things, even if they don't determine the cause. They may put your mind at ease that certain serious disorders such as diabetes or kidney failure aren't the cause, and they may help your vet gauge the degree of dehydration and better plan a treatment.

Not all causes of gastroenteritis will show up on the first round of tests. In some cases, the diagnosis is elusive and may require either repeated testing or more advanced tests like ultrasound, endoscopy, or surgery to explore the abdomen and take biopsies. Many foreign objects like rubber, cloth, or plastic don't show up on standard X-rays, so sometimes repeated X-rays are needed to look for abnormal accumulations of gas or other indications of an obstruction.

For some cases, if the cause is not found on several rounds of testing and the patient is still showing symptoms, an exploratory surgery is needed. While it may seem odd to go to the extreme of surgery without knowing what's going on, exploratory surgery itself is a form of diagnostic test. Samples for biopsy can be taken from organs, and feeding tubes can be placed to provide nutrition for patients who can't or won't eat. In about 2/3 of cases, the cause for vomiting is found in exploratory surgery, while for the remaining third, the hope is that biopsies will provide the answer. In a few cases, the cause remains elusive despite tests, surgery, and everyone's best intentions.

Costs

Treatment strategies for gastroenteritis can vary widely. Some may be simple as outlined above, or some may only require a day or two of anti-nausea medication administered at home. Others will require treatment in the hospital due to prolonged vomiting, dehydration, surgery, or treatment for the underlying cause. IV fluids are needed in many cases for patients that can't or won't drink, and anti-nausea medications, antacids, pain medication, and several other kinds of therapies may be needed. In general, initial testing can cost anywhere from $200 to $600, and hospitalization can cost in the range of $100 to $500 per day, depending on what treatment is needed. If surgery is needed, costs can be expected to be anywhere in the range of $300 or $400 for simple procedures performed by non-specialists with no complications on up to $10,000-plus for severe complications and long hospital stays.

For patients who are unable to eat, larger hospitals, universities, and referral institutions with specialists can often provide intravenous feeding when needed. IV fluids provide no nutrition, just water and electrolytes. IV nutrition, known as parenteral nutrition, takes specialized training and ICU level care in most cases and can cost $200-300 per day alone. Tube feeding can be done at most practices, and involves feeding a liquid diet through a small, rubber tube that enters the stomach through the nose.

Force feeding only stresses the pet out further, and risks causing food aversion and should never be performed. It also risks getting the handler bitten and causing food to enter the lungs during the struggle, causing pneumonia.

Summary

While most cases are simple and respond to simple measures, in some cases advanced testing or treatment may be needed. Your veterinarian can help you decide on the best course of testing and treatment and get your pet back on the path to better health quickly.

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