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Y4 SA - Internal medicine > Approach to chronic diarrhoea and constipation > Flashcards

Approach to chronic diarrhoea and constipation Flashcards

1
Q

List the 6 steps in the approach to diarrhoea

A
  1. History & physical examination
  2. Symptomatic therapy
  3. Laboratory investigations
  4. Diagnostic imaging
  5. Gastrointestinal biopsy
  6. Therapeutic trials
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2
Q

List the DDx for alimentary diseases that cause diarrhoea

A
  • Adverse reactions to food: allergy, poisoning
  • Inflammatory bowel disease
  • Antibiotic responsive diarrhoea
  • Lymphangiectasia
  • Lymphoma/tumours
  • Infectious diarrhoea
  • Obstructions
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3
Q

What is Lymphangiectasia?

A

Lymphatic system within the SI is obstructed -> dilation of the lacteal
Diarrhoea due to protein loss into the intestine

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4
Q

List the DDx for systemic causes of diarrhoea

A

Liver disease
Renal disease
Pancreatic disease
Endocrine disease
- Addison’s disease
- Diabetes mellitus
- Hyperthyroidism

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5
Q

Describe the information which should be gathered when you are presented with a dog with diarrhoea

A

Gastrointestinal signs
Systemic signs
Diet history
Vaccine history etc
Verify vomiting vs regurgitation
Classify the diarrhoea - SI vs LI
Grade the severity of signs

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6
Q

Why should you check the tongue in the physical exam?

A

To check for a linear foreign body

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7
Q

Define haematochezia

A

Fresh blood in the stool

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8
Q

Why is it important to classify diarrhoea? How is this done?

A
  • Helps with localisation
  • Ask owner to bring in a sample of faeces
  • Photo of the faeces
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9
Q

Describe the features of diarrhoea and clinical signs that enable it to be localised to the small intestine

A
  • Increased volume
  • Colour change
  • Normal to slight increase in frequency
    ± Weight loss
    ± Flatulence, borborygmi, halitosis
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10
Q

Describe the features of diarrhoea and clinical signs that enable it to be localised to the large intestine

A
  • Decreased volume
  • Increased frequency
  • Urgency & tenesmus
  • Mucus & haematochezia
  • Dyschezia: pain on defaecation
  • Constipation ± variable consistency
  • No weight loss?
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11
Q

What is the main function of the LI?

A

To act as a storage organ for appropriate defaecation, enabling the individual to make a conscious decision on when to defecate

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12
Q

Describe diffuse diarrhoea

A

Watery with some solid components
Fresh blood

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13
Q

Melaena is a sign of…?

A

Upper GI disease
Blood loss from stomach or SI -> blood gets digested
Dark stool – tar/black

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14
Q

Fibre supplementation is used for diarrhoea localised where?

A

Large intestine

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15
Q

How should a patient be managed/prepared before a colonoscopy?

A

Starve 48 hours
Poly-ethylene glycol:
- 3 doses, 4h apart
- Use Stomach tube
Followed by 2x warm water enemas

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16
Q

Which laboratory test is carried out first in diarrhoea cases?

A

Faecal analysis

17
Q

What is being assessed on faecal analysis?

A

Parasites
Bacteria

18
Q

Name 3 parasites which may be seen on a faecal analysis

A
  • Giardia
  • Cryptosporidia
  • Tritrichomonas foetus (cats)
19
Q

Describe the disease caused by Tritrichomonas foetus

A
  • Poor bodily condition
  • Chronic diarrhoea
  • Most commonly affects pedigree cats and cats in colonies
  • Causes SI diarrhoea in cats and LI diarrhoea in dogs
20
Q

How is Tritrichomonas foetus diagnosed?

A

Faecal preparation in saline
Culture
Polymerase chain reaction

21
Q

Describe the stage 2 laboratory tests carried out for diarrhoea cases

A

Haematology
Serum biochemistry
Urinalysis
Mainly used to rule out systemic diseases - Liver disease, Kidney disease, etc

22
Q

Describe the endocrine tests used in diarrhoea cases

A

ACTH stim test/ Basal cortisol - hypoadrenocorticism
Total thyroxine - hyperthyroidism

23
Q

What is the trypsin-like immunoreactivity test used for?

A

Exocrine pancreatic insufficiency

24
Q

Which test could you carry out to diagnose pancreatitis?

A

Total lipase or pancreatic lipase

25
Q

Folate and cobalamin tests are used to assess?

A

Malabsorption

26
Q

What does a hypocobalaminaemia result indicate?

A

A negative prognostic indicator
If present treat with cobalamin

27
Q

In cases of diarrhoea when is radiography useful?

A

Radiography is good for:
- Foreign bodies
- Masses
- Obstructions

28
Q

In cases of diarrhoea when is ultrasound useful?

A

Can identify intestinal masses and lymph nodes

29
Q

Describe how endoscopy is used in diarrhoea cases

A

Minimally invasive and direct examination
Requires equipment and expertise
Small superficial samples from a limited region
Harder to find a focal lesion
Smaller biopsy samples

30
Q

Describe how a coeliotomy is used in diarrhoea cases

A

Can get multiple full-thickness biopsies
Surgical risk
Best for cats

31
Q

A non-specific normal /mild inflammation result from a biopsy indicates what possible causes?

A

Adverse reaction to food
Antibiotic-responsive diarrhoea etc
IBD ~ “chronic enteropathy”

32
Q

A moderate-severe inflammation result from a biopsy indicates what cause?

A

IBD ~ “chronic enteropathy”

33
Q

Which two specific severe conditions can also be diagnosed from a biopsy?

A

Lymphoma
Lacteal dilation - Lymphangiectasia

34
Q

What information would you ask owners to record in a diary?

A

Frequency of diarrhoea
Other signs – vomiting / pain
Appetite and demeanour
Compliance with treatment

35
Q

Define constipation

A

Difficult, incomplete, or infrequent evacuation of dry hardened faeces from the bowels

36
Q

List the possible causes of constipation

A
  • Dietary
  • Neuromuscular: idiopathic megacolon
  • Obesity
  • Hospitalisation
  • Change in routine
  • Inactivity
  • Colonic obstruction: stricture, pelvic trauma, neoplasia
  • Dehydration
  • Drug-induced
37
Q

How is constipation treated?

A
  • Remove underlying cause if possible
  • Oral laxatives i.e. lactulose
  • Enemas
  • Oral polyethylene glycol
  • Gentle manual evacuation under anaesthetic
  • Surgery (if megacolon)
  • Dietary management: High fibre diet

Y4 SA - Internal medicine (7 decks)

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