9.5.3: Acute diarrhoea Flashcards by Amelia ...

Causes of acute diarrhoea

Diet: acute gastroenteritis e.g. allergy, intolerance, scavenging, toxins
Drugs: antimicrobials, chemo
Infectious: viral, bacterial, parasitic
Inflammatory disease: CE/IBD, pancreatitis
Metabolic disease: hypoadrenocorticism
Anatomic disease: intussusception / FB
Neoplasia: peracute lymphoma, paraneoplasia
Anomalous: stress/ anxiety - usually mixed/large bowel

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Which animals would you particularly expect infectious diarrhoea in?

Young animals / immunocompromised
Animals in colonies / kennels
Mixed infections e.g. parasites + viruses will be worse. Often worms are the complicating factor and treating worms makes the other disease more manageable.
Seen less in vaccinated, healthy animals

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Viruses that cause acute infectious diarrhoea

Parvovirus
Coronavirus
Adenovirus
FeLV, FIV - chronic enteritis, weight loss, lymphoma in FeLV
Rotavirus
(Norovirus)

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Bacteria that cause acute infectious diarrhoea

Salmonella
Campylobacter
E. coli - ETEC, EHEC, EPEC
Clostridium perfringens, Clostridium difficile
Shigella
Yersinia enterocolitica - rarely reported

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Parasites that cause acute infectious diarrhoea

Helminths
Protozoa e.g. Giardia, Tritrichomonas

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Clinical signs of parvovirus infection

Vomiting
Haemorrhagic diarrhoea: profuse and foetid, with mucosal sloughing
Rapid dehydration
Panleucopaenia
Depression
Anorexia
Pyrexic
Loss of mucosal barrier -> septicaemia / endotoxaemia and shock / DIC
Ileus

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Signalment for parvovirus

Young puppies with low maternal immunity (pre-vaccination)
Older unvaccinated dogs (breed predisposition - black and tan?)

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Causative agent of parvovirus and characteristics

Canine parvovirus 2 (CPV-2)
* Virus stable in environment for years
* Faeco-oral - 3-6 days incubation

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Differential diagnoses for parvovirus

HGE including neoplasia and idiopathic HGE (AHDS)
Salmonella, enteric infection
Intussusception
FB
Hypoadrenocorticism
Acute intoxication: e.g. spoilt food

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AHDS

Acute haemorrhagic diarrhoea syndrome

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Diagnosis of parvovirus

Signalment and clinical signs highly suggestive
Faecal analysis: antigen SNAP - severe necrosis of GIT may lead to false -ves
Haematology and biochemistry - consequences of disease - panleucopaenia; azotaemia, acid-base disturbance, electrolyte disturbances, liver enzymes abnormal, possibly low TP

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Management of parvovirus

Aggressive fluid therapy; assess acid-base status in case severe imbalance - may need to consider colloid/ plasma/ whole blood
Antibiotics: broad spectrum (amox/clav ± quinolone), take care re age of patient; gram -ve coverage difficult in young animals
Anti-emetics (aggressively!!) e.g. maropitant, metoclopramide due to marked nausea
Pro-motility medications e.g. metoclopramide as enteritis decreases motility
Antacids and ulcer coating medication - severe gastritis can develop along with reflux oesophagitis and strictures
Begin oral fluid/ nutients ASAP; may require assistance e.g. NO tube

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Prevention of parvovirus

Vaccination + do not take puppies out too early!
Cleaning and disinfection: bleach/ Virkon

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Pathogenesis, signalment and clinical signs of haemorrhagic gastroenteritis

Syndrome of acute haemorrhagic diarrhoea (AHDS)
* Idiopathic in most cases; may be Type I hypersensitivity reaction or C. perfringens enterotoxin production
* Usually small breed dogs

Clinical signs
* Vomiting ± blood
* Foetid diarrhoea including protein loss - brown water
* Depression, anorexia - very ill
* Haemoconcentration (fluid shift into GIT means hypovolaemia before clinical dehydration apparent)

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Differential diagnoses for haemorrhagic gastroenteritis and how you could differentiate between them

Ddx for HGE:
* Parvoviral enteritis - HGE will not show leucopaenia but parvo will
* Intussusception
* Pancreatitis

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Treatment and prognosis of HGE

Treatment
* Aggressive fluid therapy - same as parvo; colloid/ plasma/ whole blood depends on degree of haemorrhage and complications
* Antimicrobial - only if signs of sepsis: amox/clav + metronidazole + fluoroquinolone

Prognosis
* Good in most cases
* If TP low and systemic inflammatory response = guarded

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Pathogenesis of feline panleucopaenia

Feline panleucopaenia virus (basically feline parvo; cats can also be infected by canine parvovirus)
Kittens/ colonies often affected, virus widespread in feral cats
Transmission and signs the same as canine parvovirus
Also: repro failure / cerebellar hypoplasia (infections in utero)

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Signalment, clinical signs and treatment of coronavirus infection in dogs

Signalment
* Young dogs (pos age-related immunity)
* Highly contagious

Clinical signs
Mild villus destruction - enterocytes at tips
* Usually subclinical but strain-related and co-infection can worsen disease
* Predominantly small bowel diarrhoea
* If severe, may see vomiting and watery/ mucoid diarrhoea

Treatment
* Supportive IVFT
* Nutritional support for GIT

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Importance of feline enteric coronavirus in cats

FECV can mutate into FIP-causing coronavirus
More a problem in multi-cat households

Diagnosis and treatment of bacterial enteritis

Diagnosis - difficult! Must correlate the bacteria found with clinical signs; don’t treat bacteria just because you find them, they might be commensals.

Treatment
* Manage the presenting situation e.g. if immunocompromised owner
* Consider campylobacter and risk factors e.g. home, kennel environment etc.
* Need multiple samples as microbiome fluid in some patients, static in other
* Boxers with large intestinal signs - treat for E. coli

Clinical signs of Campylobacter jejuni, Campylobacter upsaliensis

Commensal in dogs - potential long-term zoonosis. Clinical signs ususally in immunocompromised animals and those with additional infectious agents (giardia, parvo)

Clinical signs
* Acute enterocolitis NOT chronic low grade diarrhoea
* Diarrhoea ± blood and mucus
* Vomiting
* Straining - large intestinal type diarrhoea
* Pyrexia
* Abdominal pain
* Can become enteroinvasive due to host stress

Diagnosis and treatment of Campylobacter

Diagnosis
* Faecal stain / culture - need fresh faeces
* PCR

Treatment
* Treat underlying disease if present e.g. CIBD
* Treatment most frequently with fluoroquinolones, can use erythromycin but this can lead to vomiting

Signalment for Salmonella

Mainly young and immunocompromised animals
Commensal in many dogs
More common if fed raw
Significant risk to owners

Clinical signs of Salmonella

4 scenarios after infection: transient asymptomatic disease, acute gastroenteritis, carrier state, bacteraemia.

Clinical signs
* Mild or severe
* Haemorrhagic diarrhoea
* Pyrexia
* Sepsis due to translocation across gut wall

Treatment and prognosis of *Salmonella*

Treatment * Only treat if severe sepsis and shock + culture results * Do not treat if mild disease - like *Campylobacter* ; if disease is mild, likely not significant findings Negative prognostic indicators: * Hypoglycaemia * Pyrexia >40C * SIRS and DIC Presentation in cats * Cats - usually mild but if songbird fever (ingest migrating birds) can lead to acute febrile illness with diarrhoea

Presentation and treatment of Clostridial enteritis

Presentation * *C. perfringens, C. difficile* part of normal anaerobic flora * Diarrhoea due to enterotoxin production * History of trigger: diet change, hospitalisation, kennels * Large intestinal type diarrhoea / HGE / AHDS Treatment * **Metronidazole** (alternatives: ampicillin, tylosin) * Manage complications * Environmental spores very resistant - use **hypochlorite** to disinfect, care re fomites * Unclear zoonotic risk

Presentation, diagnosis, and treatment of *E. coli* enteritis

Presentation * Common gut commensal and faecal isolate * Various strains present - try to identify if possible * EHEC = shigatoxin, secretory diarrhoea * EPEC * EHEC = possible reverse zoonosis DIagnosis * In Boxers, need biopsy to identify histiocytic ulcerative colitis Treatment * Metronidazole / fluoroquinolones

1-5

6-8

9-17

18-20

Signalment and clinical signs of ascarid infections

Signalment * Puppies/ kittens Clinical signs * Failure to gain weight * Pot-bellied appearance * Vomiting and small bowel diarrhoea * Obstruction of GIT if large burdens along with respiratory disease when migration

Signalment and clinical signs of hookworms

Signalment * Kennelled dogs Clinical signs * Diarrhoea * Weight loss * Anaemia with *Ancyclostoma* * Interdigital dermatitis / perineal irritation

Signalment and clinical signs of cestodes

Signalment * Kennelled and farm dogs most at risk Clinical signs * Signs rare in adults * Zoonotic risk necessitates control

Diagnosis and treatment of helminth parasites

Diagnosis * Clinical signs and history * Faecal exam Treatment * Heavy importance due to public health considerations (VLM, OLM) * Treatment does not remove encysted larvae * Occult parasite infestation should be considered in animals being treated for IBD

Signalment and clinical signs of coccidiosis

Signalment * *Isospora canis* - dog * *Isospora felis, isospora revolta* - cat * When seen in puppies/kittens, animals in poor condition -> leads to most severe signs Clinical signs * Small intestinal location but mixed bowel signs often seen * May see chronic intermittent shedding by carriers during stress / concomittant disease * Can be severe and mortality can occur

Diagnosis and treatment of coccidiosis

Diagnosis - faecal exam - direct or flotation for oocysts Treatment * Mild disease is self-limiting * TMPS, toltrazuril, diclazuril if needed * Shedding can reoccur after treatment

Presentation and diagnosis of *Cryptosporidium*

Presentation * Dogs and cats infected by host-specific crypto * Seen in puppies, kittens, poor conditions -> need to steam clean environment to control * Many animals infected but a few develop diarrhoea * = malabsorptive and secretory diarrhoea * Co-infection with giardia or tritrichomonas increases severity of signs Diagnosis * Faecal smear * IFA * PCR

Treatment of *Crytosporidium*

Treatment * Often self limiting unless there is an underlying cause * Determine underlying cause if present * Consider dietary manipulation and neutraceuticals * Antibiotics of limited benefit - could consider tylosin, azithromycin and paromomycin * Zoonotic potential!

Clinical signs and diagnosis of *Giardia* infection

Clinical signs * Acute to chronic, usually mild diarrhoea - soft wateru with mucus (mixed bowel) * Can result in severe chronic disease with weight loss (due to toxin liberation, induction of IBD, dysmotility, inhibition of enterocyte function) Diagnosis * Faecal smear evaluation (Direct smear of flotation techniques) * SNAP test (ELISA)

Treatment of *Giardia*

* Fenbendazole 3-5 days (licensed) * Metronidazole may help * Fibre may help * Unclear benefit of neutraceuticals

Presentation, diagnosis and treatment of *Tritrichomonas foetus*

Presentation * Strictly large intestinal parasite * Affects cats and rarely dogs * Affects colonies/ breeders * Causes large bowel diarrhoea * Often presents as secondary pathogen Diagnosis * Microscopy * Culture * PCR Treatment * Difficult to treat - ronidazole

Key history questions to ask in the case of acute diarrhoea?

* Vaccination and worming status? * Scavenging, diet? * On any drugs? * Contact wtih other animals? * Environment/ travel? * Health of owners - consider zoonoses * Any previous illnesses/ surgeries? * Are any other body systems involved?

Examples of adsorbants and why you might use them

Examples: koalin, pectin, chalk, bismuth subsalicylate, magnesium aluminium silicate, activated charcoal Why to use: * Alter intestinal flora / bind flora * Coat or protect mucosa * Absorb toxins * Bind water; possibly antisecretory

**True/false:** probiotics are useful in managing acute diarrhoea.

**True** We should be using these often.

What are some examples of prokinetics? How often would we use these in acute diarrhoea?

Examples: * Metoclopramide (upper GIT) * Erythromycin (encourages gastric emptying) * Ranitidine - not very widely available * Lidocaine (small intestinal motility) These are rarely indicated in acute diarrhoea. They might be used when a disease process has led to ileus.