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Intestinal Obstruction Emergency in Dogs and Cats

Description
When a pet eats a foreign object, it may become stuck in the digestive tract. Gastrontestinal obstruction is a surgical emergency. Signs of blockage include repeated vomiting, loss of appetite, dullness, abdominal pain (dogs with belly pain sometimes adopt a bowing posture), and, if the obstruction is near the rectum, straining to pass bowels. If your pet shows these signs, bring him to the veterinary hospital immediately.

Another potential cause is a strangulated gut due to intussusception. This is also life threatening and results when the guts telescope into themselves, resulting in a loss of circulation to the tissues.

Intestines may also become blocked lower down because of obstipation or a build up of a large volume of stool. It can become lodged in the lower bowels or colon, or the rectum, and prevent passage of feces.




To learn more:

  • Intussusception
  • Constipation and obstipation
  • Megacolon





    Intussusception


    What is intussusception?
    Intussusception is the prolapse or falling down of one portion of the gastrointestinal tract into the lumen of an adjoining segment. Intussusception can occur in the esophagus, stomach, or intestines. It results in partial or complete gastrointestinal obstruction, leading to fluid loss and dehydration. German shepherd dogs and Siamese are more likely to develop intussusception. The majority (80%) of affected animals are less than one year of age.

    What causes intussusception?
    Most cases of intussusception are of unknown cause (idiopathic), but uncoordinated movement of the gastrointestinal tract or vigorous contractions of a bowel segment seem to be involved. Other causes include:
  • Viral or bacterial infection of the intestines
  • Foreign body in the gastrointestinal tract
  • Intestinal parasites
  • Previous abdominal surgery
  • Intestinal mass or tumor
  • Enlarged esophagus

    What are the signs of intussusception?
    Signs and the progression of the disease vary greatly, depending upon the location of the intussusception and the completeness of obstruction. Any condition leading to altered movement of the gastrointestinal tract can cause intussusception. Some intussusceptions come and go; therefore, the signs may be intermittent. In general, intussusception of the stomach and esophagus has a more acute (sudden and severe) onset of signs and a more rapid deterioration of the animal than intussusception lower in the gastrointestinal tract.

    Signs of intussusception involving the stomach and esophagus include:
  • Frequent vomiting
  • Spitting up (regurgitation)
  • Blood in the vomited material (hematemesis)
  • Difficulty breathing
  • Abdominal discomfort
  • Collapse

    Signs of intussusception in the intestines:
  • Bloody diarrhea
  • Mucus in the bowel movement
  • Intermittent vomiting
  • Weight loss
  • Straining to have a bowel movement
  • Low intussusception may protrude or prolapse through the rectum and anus, causing an anal "mass"
  • How is intussusception diagnosed?

    How is intussusception diagnosed?
    Intussusception is diagnosed by a thorough physical examination and close monitoring of the animal. Viral intestinal infection usually can be diagnosed with complete blood counts (CBCs) and specific fecal tests. Intestinal parasites are diagnosed by fecal examination. Complete blood counts and blood chemistries can detect blood abnormalities, such as low iron (if bleeding has occurred in the gastrointestinal tract) or high iron concentrations (with dehydration). Foreign bodies and obstructions can be detected by radiographs (X-rays). Contrast studies such as barium enema or upper gastrointestinal (GI) study can differentiate a foreign body from an intussusception. Abdominal ultrasound can be used to identify the intussusception.






    Transverse echographic view of an intussusception in a dog
    Source: soundeklin.com



    Endoscopy (visualization of the esophagus, stomach, or intestines by inserting a lighted scope into the gastrointestinal tract) can identify masses. Erosion, bleeding, or tissue destruction of the lining of the gastrointestinal tract (mucous membranes) can be seen during endoscopy.

    How is intussusception treated?
    Intussusception is a life-threatening condition. The animal is admitted to the hospital for immediate treatment. Food and water are withheld from vomiting animals. Emergency surgery gives the animal the best chance of survival. During surgery, the veterinarian will attempt to manipulate the bowel into normal position. If unsuccessful, the affected area is removed surgically. Fluids are administered intravenously (through the vein). Antibiotics may be given. Anti-ulcer medication or stomach protective medication may be given if ulcers are suspected. The animal is monitored closely for the first 3 to 5 days following surgery. The underlying cause for the intussusception should be identified if possible, and treated appropriately.






    Intra-operative view of an intussusception
    Source: www.acvs.org



    What is the prognosis for animals with intussusception?
    The prognosis (outcome) for animals with intussusception is grave to poor if surgery is not done. Prognosis is poor, even with surgery, if the intussusception is in the stomach or esophagus. Animals with intussusception in the intestines that have appropriate surgery and follow-up care have a better chance of recovery. Intussusceptions can recur. Routine veterinary care of puppies and kittens (vaccinations and treatment of intestinal parasites) will eliminate many of the predisposing factors for intussusception.





    Difficult Defecation (Constipation and Obstipation)


    What are constipation and obstipation?
    Constipation is defined as infrequent, incomplete, or difficult defecation (passage of bowel movement, feces, or stool). Constipation occurs when the movement of feces through the colon (large intestine) is impaired. As the feces sit in the colon, water and salt are reabsorbed back into the body. This results in hard and dry feces that are difficult for the animal to pass. Obstipation describes a state of chronic constipation leading to blockage. Passing of the bowel movement becomes impossible, because the prolonged retention of feces damages the muscular wall of the colon. Severe damage to the large intestine can result in megacolon, in which portions of the colon become distended permanently and are nonfunctional. Constipation or obstipation may be seen in dogs or cats.

    What causes constipation or obstipation?
    Constipation or obstipation may be caused by many conditions, ranging from localized problems within the intestine itself to diseases affecting other body systems.

    Some causes of impaired or obstructed movement of feces include:
  • Diet, such as taking in bones, excess hair, fiber, or other foreign material
  • Drugs, such as administration of antihistamines, antacids, or iron supplements
  • Environmental, such as lack of exercise, dirty litter box, or hospitalization or boarding
  • Mechanical obstruction, such as pelvic fracture or cancer of the colon or prostate
  • Painful defecation, such as caused by bite wounds, trauma, or positioning to defecate with a fractured leg
  • Systemic disease, such as cancer, kidney failure, infection
  • Nervous system disease, such as damage to the nerves of the colon

    What are the signs of constipation or obstipation?
    The clinical signs associated with constipation or obstipation include straining to pass a bowel movement, passage of small amounts of feces or inability to pass feces, loss of appetite (anorexia), occasional vomiting, and depression. The physical examination findings often reveal a lower bowel that is full of hard feces. Other clinical signs may be observed related to the underlying cause of the constipation or obstipation.

    How is constipation or obstipation diagnosed?
    Constipation or obstipation is diagnosed by medical history, physical examination, and rectal examination. Blood, urine, and specific organ function tests can be performed to assess the pet's overall health and aid in determining the specific cause of constipation. Radiographs (X-rays) or a colonoscopy (a technique used to look inside the colon) can be used to visually detect any structural abnormality of the colon and rectum that may impair the passage of feces.

    How is constipation or obstipation treated?
    The treatment of constipation or obstipation involves the removal of bowel movement (feces) from the colon. This can be accomplished by enemas, administration of laxatives, or drug therapy. Severe cases of constipation or obstipation may require manual removal of feces with the patient under general anesthetic. In addition, surgical removal of the damaged portion of the colon (colectomy) may be required in animals with obstipation. A constipated animal usually is dehydrated; thus, fluid therapy often is included in the treatment protocol.

    What is the prognosis for animals with constipation or obstipation?
    The prognosis (outcome) for animals with constipation or obstipation varies, depending on the underlying cause. Often, dietary changes and medication can be used to manage the animal and to prevent recurrent episodes of constipation. An animal with obstipation may have a poor prognosis because of damage to the wall of the colon and the risk of developing megacolon.





    Megacolon


    What is megacolon?
    Megacolon is a condition of persistent constipation and stretching of the colon with hard, concrete-like feces (stool). The condition is most common in cats, but can occur in dogs too.

    What causes megacolon?
    Megacolon can be caused by any condition that results in the blockage of normal passage of feces. Narrowing of the pelvic canal following pelvic fractures is a frequent cause. In other cases it may be due to a weakening of the muscles in, or nerve supply to, the colon. This causes a loss of the normal colon contraction that moves feces along, resulting in retention of feces.

    What are signs of megacolon?
    The major sign of megacolon is chronic constipation with straining unsuccessfully to have a bowel movement. Some cats may also vomit, lose weight, become depressed and develop a scruffy hair coat.

    How is megacolon diagnosed?
    Your veterinarian may diagnose megacolon in your cat from the long-term history of constipation and from the physical examination. Often, X-rays (radiographs) are needed to determine the severity of the colon distension. Blood tests will also be required to assess your pet's overall health prior to deciding on the best treatment.






    X-ray of a dog with a megacolon


    How is megacolon treated?
    Megacolon is initially treated with dietary changes, stool softeners, and enemas (under anesthesia, because of the volume and hard consistency of stool that is removed). Medicine is given to try to strengthen the contraction of the colon. Unfortunately however, these "conservative" approaches are often not very effective in the long-term, and surgical treatment is required. Surgery involves removal of a large portion of the dilated colon ("subtotal colectomy"). Following surgery, the feces will usually be very soft for a while (weeks or months), but will get more normal with the passage of time.

    What is the prognosis for animals with megacolon?
    Medical treatment alone often fails to provide long-term relief for the signs. The prognosis following surgery is good if your pet is otherwise healthy. A small portion of animals that have undergone surgery may have a recurrence of constipation.





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