17. Diagnostic approach of diarrhoea. Principles of treatment Flashcards
definition of diarrhoea
increase in fecal fluidity
4 different pathomenchanisms of diarrhoea
osmotic diarrhoea
secretory diarrhoea
exudative diarrhoea
dysmobility
how can diarrhoea be clinically categorised
temporally : acute / chronic
aetiologically : intestinal / extraintestinal
anatomically : small / large bowel
Severity : acute - self limiting / acute life threatening
extraintestinal causes of diarrhoea
Diseases of non GI digestive organs
Toxic effect
Metabolic Derangements
Systemic Failure
Circulatory failure
Disorders affecting peristalsis
Metastatic Tumour
What metastatic tumour can cause diarrhoea
haemagiosarcoma
what non gi digestive organ diseases can cause diarrhoea
Pancreatitis
EPI
Cholestasis
PSS
What toxic and metabolic derangements can cause diarrhoea
liver failure
kidney failure
endotoxaemia
addison’s
NSAIDS, AB, heavy metals
What systemic infections can cause diarrhoea
distemper
leptospirosis
FIP
FeLV
FIV
What circulatory diseases can cause diarrhoea
RS- HF
PSS
IMHA
What disorders can affect peristalsis
peritonitis
pancreatitis
hyperthyroidism
history of diarrhoea patients
Young animal —- infectious
Older — Neoplsatic
symptoms, duration
environment, diet,
Previous therapies
Primary clinical signs of diarrhoea
diarrhoea
secondary clinical signs of diarrhoea
vomitting
anorexia
hypovolemic shock
abdo discomfort
abdo pain
hypothermia
pain
dehydration
hypovolemia
polyphagis
weight loss
Faeces of small bowel diarrhoea
Large watery stool volume
rarely mucus
Melena
Sometimes fat / undigested food
Faeces of Large Bowel diarrhoea
Small dense stool volume
mucus is common
fresh blood
no fat / undigested foor
Defecation of small bowel diarrhoea
rarely tenesmus
no urgency
normal frequency
Defecation of large bowel disease
Tenesmus is common
Urgency is common
Increased frequency
Is vomitting more common in large or small bowel diarrhoea
Small > large
Is gas more common in large or small diarrhoea
small
Is weight loss more common in small or large bowel diarrhoea
small
Why use Lab D in diarrhoea patietns
to rule out extraintestinal causes
Lab D of diarrhoea
Serum Albumin <20mg/l –> PLE
Lipase
TLI
ACTH
T4
FeLV
FIV
If PLE is present then you need to excluse
renal & hepatic causes
If PLE is not present, you need to excluse
EPI
Causes of decreased cobalmin
EPI
distal SID
dysbiosis
SIBO
Causes of decreased folate
Proximal SID
causes of increased folate
dysbiosis
faecal analysis
flotation - parasites
direct smear & cytology
fresh - protozoa, para eggs
bacterial culture - campylobacter, salmonella, c
Faecal antigen testing
Inflammatory markers
Faecal Antigen testing for viruses
Parvo - ELISA
Cornoa - PCR
Faecal Antigen testing for bacteria
Campylobacter - PCR
Cl. - ELISA
Faecal Antigen testing for protozoa
Giardia - ELISA
Tritrichomonas - PCR
what inflammatory markers do you check for in faecal sampling
calmprotectin
Faecal s100a12
lactoferrin
diagnostic imaging of diarrhoea
contrast radiography
abdominal US
endoscopy
ex. lap
intestinal biopsy
what can an abdo US show
ileus, sub sileus
intussusception
inspection of the gi layers
abdo viscera
FNA, cytology, abdocentesis
when do you use endoscopy for diarrhoea examination
in chronic intestinal disorders & sampling
can check mucosa - friability, granularity, erosion, masses, lymphatic dilation
