Approach to chronic diarrhoea and constipation Flashcards
What would be your approach to diarrhoea?
- History & physical examination
- Symptomatic therapy
- Laboratory investigations
- Diagnostic imaging
- Gastrointestinal biopsy
- Therapeutic trials
What are alimentary disease differential diagnoses for constipation / diarrhoea?
- Adverse reactions to food
- Inflammatory bowel disease
- Antibiotic-responsive diarrhoea
- Lymphangiectasia
- Lymphoma/tumours
- Infectious diarrhoea
- (Partial) obstructions
What are systemic disease differential diagnoses for constipation / diarrhoea?
- Liver disease
- Renal disease
- Pancreatic disease
- Endocrine disease
-Addison’s disease
-Diabetes mellitus
-Hyperthyroidism
What history should be asked?
- Gastrointestinal signs
- Systemic signs
- Diet history
- Vaccine history
What should physical examination include?
- Oral cavity - check base of tongue for foreign body
- Abdominal palpation
- Rectal examination
What is haematochezia?
- Blood coming from anus
What the difference between true vomiting and false vomiting?
- False vomiting = regurgitation
- True vomiting = heaving before hand
How can you classify diarrhoea?
- Colour
- Consistency
- Frequency
- Volume
SI vs LI diarrhoea?
SI diarrhoea =
* Increased volume
* Pale brown
* Normal / increased frequency
* +/- weight loss
* +/- flatulence, borborygmi, halitosis
LI diarrhoea =
* Decreased volume
* Increased frequency
* Urgency + tenesmus
* Mucus + haematochezia
* Dyschezia
* Constipation + variable consistency
* No weight loss
How would you prepare for a colonoscopy?
- Starve for 48hours
- Poly-ethylene glycol laxative 3 doses 4h apart
- 2x war, water enemas
Where is sulfasalzine active?
- Only activated in LI - not used for SI problems
What can be used for symptomatic therapy?
- Dietary trial
- Anthelmintic medications
- Other
What is stage 1 of laboratory tests?
- Faecal analysis
- parasites - giardia, cryptosporidia, tritrichomonas foetus
- Bacteria (unlikely to cause chronic problem) - salmonella, campylobacter
What is stage 2 of laboratory tests?
- Haematology
- Serum biochemistry
- Urinalysis
*rule out kidney + liver disease
What is Stage 3 of lab tests?
- Endocrine tests
- ACTH stim test / basal cortisol - hypoadrenocorticism
- Total thyroxine - hyperthyroidism
- Trypsin-like immunoreactivity - EPI
- Total lipase / pancreatic lipase - pancreatitis
- Folate + cobalamin - malabsorption
What does hypocobolaminaemia tell us?
- Negative prognostic indicator
- If present treat with cobalamin - SC injection
What is stage 4 or lab tests?
- Imaging
- radiographs - foreign bodies, masses, obstruction
- US - identify masses + lymph nodes
What is stage 5 of lab tests?
- Intestinal Biopsy
-endoscopy = minimally invasive + direct examination, small sample in limited region - coeliotomy - can get multiple full-thickness biopsies, surgical risk (Used more in cats)
What are biopsy diagnoses?
Non-specific: normal /mild inflammation
* Adverse reaction to food
* Antibiotic-responsive diarrhoea etc - occurs in GSD
* IBD ~ “chronic enteropathy”
Moderate-severe inflammation
* IBD ~ “chronic enteropathy”
Lymphoma
Lacteal dilation
* Lymphangiectasia (if severe, dogs)
* Secondary to another disease
What are different causes of constipation?
- Dietary - ingested foreign material, low residue diet
- Neuromuscular - idiopathic megacolon, spinal cord disease
- Environmental - obesity, inactivity, change in routine
- Colonic obstruction - stricture, pelvic trauma, neoplasia
- Electrolyte imbalance - dehydration, hypokalaemia
- Drug-induced - opiates, phenothiazines
How can you treat constipation?
- Remove underlying cause
- Oral laxative - lactulose
- Enemas
- Oral polyethylene glycol
- Manual evacuation under GA
- Surgery
- Dietary management
How would you treat giardia + toxoplasma together in a dog?
- Fenbendazole
How would you treat protein losing enteropathy?
- Prednisolone - reduce over 2-3 months to q48h
- Cytotoxins - chlorambucil
