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SMALL ANIMAL > 9.5.3: Acute diarrhoea > Flashcards

9.5.3: Acute diarrhoea Flashcards

1
Q

Causes of acute diarrhoea

A
  • 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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2
Q

Which animals would you particularly expect infectious diarrhoea in?

A
  • 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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3
Q

Viruses that cause acute infectious diarrhoea

A
  • Parvovirus
  • Coronavirus
  • Adenovirus
  • FeLV, FIV - chronic enteritis, weight loss, lymphoma in FeLV
  • Rotavirus
  • (Norovirus)
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4
Q

Bacteria that cause acute infectious diarrhoea

A
  • Salmonella
  • Campylobacter
  • E. coli - ETEC, EHEC, EPEC
  • Clostridium perfringens, Clostridium difficile
  • Shigella
  • Yersinia enterocolitica - rarely reported
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5
Q

Parasites that cause acute infectious diarrhoea

A
  • Helminths
  • Protozoa e.g. Giardia, Tritrichomonas
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6
Q

Clinical signs of parvovirus infection

A
  • 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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7
Q

Signalment for parvovirus

A
  • Young puppies with low maternal immunity (pre-vaccination)
  • Older unvaccinated dogs (breed predisposition - black and tan?)
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8
Q

Causative agent of parvovirus and characteristics

A

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

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9
Q

Differential diagnoses for parvovirus

A
  • HGE including neoplasia and idiopathic HGE (AHDS)
  • Salmonella, enteric infection
  • Intussusception
  • FB
  • Hypoadrenocorticism
  • Acute intoxication: e.g. spoilt food
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10
Q

AHDS

A

Acute haemorrhagic diarrhoea syndrome

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11
Q

Diagnosis of parvovirus

A
  • 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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12
Q

Management of parvovirus

A
  • 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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13
Q

Prevention of parvovirus

A
  • Vaccination + do not take puppies out too early!
  • Cleaning and disinfection: bleach/ Virkon
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14
Q

Pathogenesis, signalment and clinical signs of haemorrhagic gastroenteritis

A

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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15
Q

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

A

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

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16
Q

Treatment and prognosis of HGE

A

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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17
Q

Pathogenesis of feline panleucopaenia

A
  • 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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18
Q

Signalment, clinical signs and treatment of coronavirus infection in dogs

A

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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19
Q

Importance of feline enteric coronavirus in cats

A
  • FECV can mutate into FIP-causing coronavirus
  • More a problem in multi-cat households
20
Q

Diagnosis and treatment of bacterial enteritis

A

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

21
Q

Clinical signs of Campylobacter jejuni, Campylobacter upsaliensis

A

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

22
Q

Diagnosis and treatment of Campylobacter

A

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

23
Q

Signalment for Salmonella

A
  • Mainly young and immunocompromised animals
  • Commensal in many dogs
  • More common if fed raw
  • Significant risk to owners
24
Q

Clinical signs of Salmonella

A

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

25
Q

Treatment and prognosis of Salmonella

A

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

26
Q

Presentation and treatment of Clostridial enteritis

A

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

27
Q

Presentation, diagnosis, and treatment of E. coli enteritis

A

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

28
Q

1-5

A
29
Q

6-8

A
30
Q

9-17

A
31
Q

18-20

A
32
Q

Signalment and clinical signs of ascarid infections

A

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

33
Q

Signalment and clinical signs of hookworms

A

Signalment
* Kennelled dogs

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

34
Q

Signalment and clinical signs of cestodes

A

Signalment
* Kennelled and farm dogs most at risk

Clinical signs
* Signs rare in adults
* Zoonotic risk necessitates control

35
Q

Diagnosis and treatment of helminth parasites

A

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

36
Q

Signalment and clinical signs of coccidiosis

A

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

37
Q

Diagnosis and treatment of coccidiosis

A

Diagnosis - faecal exam - direct or flotation for oocysts

Treatment
* Mild disease is self-limiting
* TMPS, toltrazuril, diclazuril if needed
* Shedding can reoccur after treatment

38
Q

Presentation and diagnosis of Cryptosporidium

A

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

39
Q

Treatment of Crytosporidium

A

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!

40
Q

Clinical signs and diagnosis of Giardia infection

A

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)

41
Q

Treatment of Giardia

A
  • Fenbendazole 3-5 days (licensed)
  • Metronidazole may help
  • Fibre may help
  • Unclear benefit of neutraceuticals
42
Q

Presentation, diagnosis and treatment of Tritrichomonas foetus

A

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

43
Q

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

A
  • 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?
44
Q

Examples of adsorbants and why you might use them

A

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

45
Q

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

A

True
We should be using these often.

46
Q

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

A

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.

SMALL ANIMAL (90 decks)

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