Starting Off Right: A Good Gastrointestinal History

Part 2 of a 3-part series

Dogs and cats commonly present with gastro-intestinal (GI) signs, and gastritis (ie, stomach upset) is the second most common problem identified on pet insurance claims.^1,2 Many signs (eg, vomiting, diarrhea, inappetence) are not specific to GI disease, and the workup and treatment can be frustrating for veterinarians and clients, especially if the patient does not respond to initial therapies. Careful consideration of the signalment and history, combined with a thorough physical examination, are paramount to narrowing the differential list and developing a diagnostic plan.Incorporating a quick, easy, standardized GI history checklist can formalize the medical interview, improve workflow efficiency, and help improve patient care.

With GI patients, the veterinary team must first determine illness chronicity and severity. Signs range from mild and self-limiting to severe and life-threatening; the former may resolve with empiric or symptomatic treatment, whereas the latter may warrant additional diagnostics. To develop a differential diagnosis list, the veterinarian must decide whether clinical signs are caused by primary GI disease or disease secondary to non-GI illness, or if they are a systemic disease manifestation. Clinical signs referable to another body system, including the respiratory tract and the cardiovascular, hepatobiliary, musculoskeletal, or neurologic systems, suggest non-GI illness or systemic disease and can be established by a comprehensive general history combined with a GI-specific history. (See Gastrointestinal History Veterinary Checklist Handout.)

Medical Interview Checklist

A detailed description of the patients specific GI signs is of utmost importance to determine the correct diagnostic path. Following are some examples in which taking time to expand the history would help narrow the differential list and define the actual problem:

• Owners commonly describe regurgitation as vomiting, and failure to differentiate between the two may delay the correct diagnosis, lead to inappropriate treatment, and cause unnecessary client expense and frustration.

• A patients diarrhea may be categorized as small-, large-, or mixed-bowel in origin and differentials considered for each. Whipworms, a common parasite, cause diarrhea of large-bowel origin and a fecal examination would be highly recommended. In comparison, a young German shepherd dog with diarrhea of small-bowel origin, polyphagia, and weight loss has exocrine pancreatic insufficiency highest on the differential list, and a trypsin-like immunoreactivity assay would be prioritized.

Often, a thorough medical interview alone identifies or points to the cause of illness. Common examples include cases like these:

• A young dog with a history of indiscriminate appetite is presented for acute vomiting and a GI foreign body is suspected

• An outdoor cat that was not receiving monthly anthelmintic therapy is presented for chronic vomiting and first worked up for parasitic disease

The importance of using the medical interview to develop a complete and accurate understanding of the clinical signs cannot be over-emphasized. (See Part 1: General History & General History Veterinary Checklist Handout.)

GI History Checklist

Veterinarians commonly see patients with GI signs and a timely, accurate, and complete GI history expedites clinical problem-solving. Finding the time to obtain a complete GI history during a busy practice schedule may be challenging but will pay off in time saved defining the duration and severity of signs, determining the presence of non-GI signs, and providing a detailed description of specific GI signs that can guide the diagnostic plan.

Conclusion

Veterinary practices should use GI history and general history checklists, either separately or combined, to save time and improve efficiency in the workup and standard of care for dogs and cats with GI signs.