Clinical Reasoning in Veterinary Practice

When the problem is diarrhoea, we define the location first, as this helps us to confirm the affected body system. Colin has semi‐formed to liquid faeces, increased frequency of defaecation, small faecal volume, tenesmus, mucus and blood. These are all seen with large bowel diarrhoea.

Colin has large bowel diarrhoea with no signs of small bowel diarrhoea (e.g. weight loss, appetite changes). It is therefore very likely that Colin has a primary GI cause of his diarrhoea.

Large bowel diarrhoea in young cats is most commonly caused by parasitic or protozoal infection. Feline infectious peritonitis and food‐responsive enteropathy are other possible differentials in this age group. Neoplasia is less likely, although lymphoma can sometimes affect cats under a year of age.

Colin’s diarrhoea did not improve during a properly performed diet trial of a ‘novel’ protein‐source diet. His owners had a limited budget and were keen to perform a step‐by‐step investigation of his diarrhoea. Faecal testing was performed initially due to the increased chance of infectious diarrhoea at his age and also with the knowledge that he was originally from a multi‐cat household where other cats have had diarrhoea in the past.

Faecal parasitology, Zn sulphate flotation for Giardia cysts and Tritrichomonas PCR were performed. Only the Tritrichomonas PCR was positive.

Treatment was discussed with Colin’s owners. Some cats with Tritrichomonas infection do not require treatment if their diarrhoea is relatively mild as the disease usually resolves over time. However, resolution may take many months, and cats may continue to excrete the organism even once diarrhoea has resolved. Colin’s owners were keen to treat him, and he was given ronidazole at a dose of 25 mg/kg once daily for 2 weeks. His diarrhoea resolved and did not recur.

Ronidazole should be used with caution and with informed owner consent as it may cause neurological and GI side effects. It is not licensed in most small animal markets and may not be readily available in formulations suitable for cats without the use of a licensed compounding pharmacy.

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