Acute Diarrhea Clinical Approach

Question 1

what are the 4 classifications of acute diarrhea?

Answer 1

self-resolving small bowel

life-threatening small bowel

self-resolving large bowel

life-threatening large bowel (rare)

Question 2

what should you always do diagnostically in acute diarrhea cases?

Answer 2

fecal

Question 3

what are the causes of acute diarrhea?

Answer 3

• infectious: very common, whipworms, tritrichomonas, hookworms, salmonella and campylobacter (not common in SA)
• hemorrhagic gastroenteritis
• obstruction
• toxins and drugs
• diet
• extraintestinal

Question 4

describe the pathogenesis of canine parvovirus

Answer 4

• epitheliotropic enterovirus, attacks rapidly dividing cells, wipes out villi and lose absorption ability, may get sub-clinical infections with shedding but no signs
• attack on crypts -> necrosis of epithelial cells -> enteritis/diarrhea -> sepsis, DIC, death possible

Question 5

what are the two types of parvovirus and what signs do they cause?

Answer 5

type 1: abortion

type 2: severe enteritis, related to FPV, 4 subtypes evolving

Question 6

epidemiology of parvo

Answer 6

fecal-oral transmission

incubation period 3-7 days

virus shed in feces

morbidity 20-90%

mortality 0-50%

Doberman/Rottweilers/black and tan breeds predisposed

Question 7

when does fecal shedding hit its maximum?

Answer 7

4 days, one day before clinical signs show (day 5)

Question 8

what are the clinical signs of parvo?

Answer 8

diarrhea, vomiting, fever, abdominal pain, anorexia, lethargy, leukopenia, dehydration, PCV <55%

Question 9

how is parvo diagnosed?

Answer 9

EM of fresh feces, histopath of intestine, tissue immunofluorescence, fecal ELISA (viral load may be too low by time clinical signs show up and owner brings them in, false positives in recently vaccinated patients with MLV)

Question 10

how is parvo treated?

Answer 10

• isolation
• replacement fluid therapy!!!
• blood component therapy
• parenteral abx
• antiemetics
• tamiflu
• nursing care and time is most important
• NPO until zero puke for 24 hr
• give liquid diet during vomiting/diarrhea

Question 11

what are the prophylactic/preventive measure for parvo?

Answer 11

immunity after infection for anywhere from 20 months to possibly life

vaccination

Question 12

what are the clinical signs of Hemorrhagic Gastroenteritis?

Answer 12

• can affect all ages but tends to be 2-4 years
• mini/toy breeds
• depression
• vomiting +/- blood
• diarrhea -> dysentery
• varying severity
• dehydrated, tachycardia, acute loss = skin turgor may be normal
• hallmark: severely increased PCV >60% but a normal TP, thrombocytopenia, metabolic acidosis
• usually a one-time episode

Question 13

how is Hemorrhagic Gastroenteritis treated?

Answer 13

• fluids and electrolytes!!
• antiemetics
• antibiotics are questionable
• stop food and water
• feed 12-24 hours after getting better
• get over it in 1-2 days