Unexplained weight loss is frustrating for owners and veterinarians alike, in addition to being life-threatening for the patients it affects. Recently, two middle-aged pot-bellied pigs from the same herd were presented to the clinic for severe weight loss that had been happening for about two months, despite proper deworming and increased feed rations.
Weight loss can be the result of many different causes so it is absolutely crucial to perform a thorough work-up with these cases. Initial causes of weight loss that I decided to explore included dental problems, infectious disease, musculoskeletal pain, a foreign body, liver disease or cancer. Therefore, I needed various diagnostic techniques to direct my treatment plan and rule out my differential diagnoses.
The pigs had normal temperatures, pulse rates, and respiratory rates and their physical exams did not reveal any abnormalities. An oral/dental exam did not reveal anything that would prevent proper chewing and swallowing of food. When I observed the pigs eating, they did not drop food or have any issues consuming food. The animals were passing normal feces and did not have diarrhea. Nevertheless, I collected a fecal sample to test for parasites, coccidia and bacterial causes of malabsorption such as Lawsonia intracellularis. Parasitology and bacterial analyses came back negative, ruling out my initial array of potential infectious causes. When the pigs were evaluated for pain or musculoskeletal abnormalities that may prevent them from eating or accessing their food, they were found to be comfortable. Abdominal radiographs and an abdominal ultrasound were performed to look for foreign bodies, abdominal masses or hepatic abnormalities. The gastrointestinal tract appeared multifocally thickened on ultrasound, but no masses or foreign bodies were identified. A blood sample was collected, but all parameters on the complete blood count and serum chemistry were within normal limits. The exceptions were an elevated creatinine kinase, which could be explained by the severe muscle atrophy the pigs showed and an elevated GGT, which was likely a response to the pigs being fasted prior to presentation to the clinic in anticipation of them requiring sedation for parts of their examinations.
In the end, since we could not arrive at a clear answer to explain their clinical signs, we decided to help to reduce inflammation within the GI tract which was likely accounting for the thickening observed on ultrasound. We placed the animals on a course of steroids to treat what seemed to be inflammatory bowel disease. Both of them began to gain weight and their clinical signs started to improve.
Unfortunately, our running diagnosis had to be a diagnosis of exclusion as we had ruled out most other possibilities. These cases taught me so much along the way, though, because sometimes medicine doesn’t have a neat, clear answer and you need to make an educated guess about the situation and do what is best for the patient with the information you have. I learned the value of a comprehensive work-up and the power of thinking outside the box. Despite the frustration that weight loss can present, a systematic and thorough investigation has the power to improve the quality of life of an animal in your care and at the end of the day, that’s all that really matters.