A few cases of chronic diarrhea may warrant an exploratory laparotomy, such as cats with mass lesions or those in which jejunal
disease or submucosal pathology is suspected. When compared with an endoscopic examination, a surgical approach provides some
advantages, including therapeutic mass removal, collection of full-thickness biopsy samples, and examination of the liver,
pancreas, and abdominal lymph nodes. However, patient discomfort and recovery time are increased with surgery, and the risk-benefit
ratio of surgery vs. endoscopy should be carefully evaluated in each patient. If surgery is performed, it is essential to
evaluate the entire abdominal cavity. Even if focal disease is identified, it is often worthwhile to take full-thickness biopsy
samples from each area of the GI tract, even if it looks and feels grossly normal.
Accurate and thorough diagnostic testing is often crucial in determining the underlying cause of chronic diarrhea. Even with
the most sensitive tests, the disease process leading to chronic diarrhea can be painstakingly elusive. Ultimately, test results
partnered with response to therapy may be the only way to definitively diagnose the cause of chronic diarrhea in many of our
feline patients. See the second part of this article for details on treatment.
Sally Purcell, DVM
Audrey K. Cook, BVM&S, MRCVS, DACVIM, DECVIM-CA
Department of Small Animal Clinical Sciences
College of Veterinary Medicine
Texas A&M University College Station, TX 77843-4474
1. Bowman DD. Georgis' parasitology for veterinarians. 9th ed. St. Louis, Mo.: Saunders Elsevier, 2009;295-371.
2. Gates MC, Nolan TJ. Comparison of passive fecal flotation run by veterinary students to zinc-sulfate centrifugation flotation
run in a diagnostic parasitology laboratory. J Parasitol 2009;95(5):1213-1214.
3. Mekaru SR, Marks SL, Felley AJ, et al. Comparison of direct immunofluorescence, immunoassays, and fecal flotation for detection
of Cryptosporidium spp. and Giardia spp. in naturally exposed cats in 4 Northern California animal shelters. J Vet Intern Med 2007;21(5):959-965.
4. Rossi M, Hänninen ML, Revez J, et al. Occurrence and species level diagnostics of Campylobacter spp., enteric Helicobacter spp. and Anaerobiospirillum spp. in healthy and diarrheic dogs and cats. Vet Microbiol 2008;129(3-4):304-314.
5. Gookin JL, Stebbins ME, Hunt E, et al. Prevalence of and risk factors for Tritrichomonas foetus and Giardia infection. J Clin Microbiol 2004;42(6):2707-2710.
6. Lubbs DC, Vester BM, Fastinger ND, et al. Dietary protein concentration affects intestinal microbiota of adult cats: a study
using DGGE and qPCR to evaluate differences in microbial populations in the feline gastrointestinal tract. J Anim Physiol Anim Nutr (Berl) 2009;93(1):113-121.
7. Marks SL, Melli A, Kass PH, et al. Evaluation of methods to diagnose Clostridium perfringens-associated diarrhea in dogs. J Am Vet Med Assoc 1999;214(3):357-360.
8. Marks SL, Kather EJ. Clostridium perfringens-associated diarrhea. In: Greene CE, ed. Infectious diseases of the dog and cat. 3rd ed. St. Louis, Mo.: Saunders Elsevier, 2006;364-366.
9. Gabor LJ, Canfield PJ, Malik R. Haematological and biochemical findings in cats in Australia with lymphosarcoma. Aust Vet J 2000;78(7):456-461.
10. Suchodolski JS, Steiner JM. Laboratory assessment of gastrointestinal function. Clin Tech Small Anim Pract 2003;18(4):203-210.
11. Steiner JM, Williams DA. Serum feline trypsin-like immunoreactivity in cats with exocrine pancreatic insufficiency. J Vet Intern Med 2000;14(6):627-629.
12. Forman MA, Marks SL, De Cock HEV, et al. Evaluation of serum feline pancreatic lipase immunoreactivity and helical computed
tomography versus conventional testing for the diagnosis of feline pancreatitis. J Vet Intern Med 2004;18(6):807-815.
13. Baez JL, Hendrick MJ, Walker LM, et al. Radiographic, ultrasonographic, and endoscopic findings in cats with inflammatory
bowel disease of the stomach and small intestine: 33 cases (1990-1997). J Am Vet Med Assoc 1999;215 (3):349-354.
14. Willard MD, Mansell J, Fosgate GT, et al. Effect of sample quality on the sensitivity of endoscopic biopsy for detecting gastric
and duodenal lesions in dogs and cats. J Vet Intern Med 2008;22(5):1084-1089.