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Y4 - Small Animals > Approach to chronic diarrhoea and constipation > Flashcards

Approach to chronic diarrhoea and constipation Flashcards

1
Q

What would be your 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

What are alimentary disease differential diagnoses for constipation / diarrhoea?

A
  • Adverse reactions to food
  • Inflammatory bowel disease
  • Antibiotic-responsive diarrhoea
  • Lymphangiectasia
  • Lymphoma/tumours
  • Infectious diarrhoea
  • (Partial) obstructions
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3
Q

What are systemic disease differential diagnoses for constipation / diarrhoea?

A
  • Liver disease
  • Renal disease
  • Pancreatic disease
  • Endocrine disease
    -Addison’s disease
    -Diabetes mellitus
    -Hyperthyroidism
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4
Q

What history should be asked?

A
  • Gastrointestinal signs
  • Systemic signs
  • Diet history
  • Vaccine history
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5
Q

What should physical examination include?

A
  • Oral cavity - check base of tongue for foreign body
  • Abdominal palpation
  • Rectal examination
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6
Q

What is haematochezia?

A
  • Blood coming from anus
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7
Q

What the difference between true vomiting and false vomiting?

A
  • False vomiting = regurgitation
  • True vomiting = heaving before hand
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8
Q

How can you classify diarrhoea?

A
  • Colour
  • Consistency
  • Frequency
  • Volume
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9
Q

SI vs LI diarrhoea?

A

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

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10
Q

How would you prepare for a colonoscopy?

A
  • Starve for 48hours
  • Poly-ethylene glycol laxative 3 doses 4h apart
  • 2x war, water enemas
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11
Q

Where is sulfasalzine active?

A
  • Only activated in LI - not used for SI problems
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12
Q

What can be used for symptomatic therapy?

A
  • Dietary trial
  • Anthelmintic medications
  • Other
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13
Q

What is stage 1 of laboratory tests?

A
  • Faecal analysis
  • parasites - giardia, cryptosporidia, tritrichomonas foetus
  • Bacteria (unlikely to cause chronic problem) - salmonella, campylobacter
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14
Q

What is stage 2 of laboratory tests?

A
  • Haematology
  • Serum biochemistry
  • Urinalysis

*rule out kidney + liver disease

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15
Q

What is Stage 3 of lab tests?

A
  • Endocrine tests
  • ACTH stim test / basal cortisol - hypoadrenocorticism
  • Total thyroxine - hyperthyroidism
  • Trypsin-like immunoreactivity - EPI
  • Total lipase / pancreatic lipase - pancreatitis
  • Folate + cobalamin - malabsorption
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16
Q

What does hypocobolaminaemia tell us?

A
  • Negative prognostic indicator
  • If present treat with cobalamin - SC injection
17
Q

What is stage 4 or lab tests?

A
  • Imaging
  • radiographs - foreign bodies, masses, obstruction
  • US - identify masses + lymph nodes
18
Q

What is stage 5 of lab tests?

A
  • 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)
19
Q

What are biopsy diagnoses?

A

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

20
Q

What are different causes of constipation?

A
  • 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
21
Q

How can you treat constipation?

A
  • Remove underlying cause
  • Oral laxative - lactulose
  • Enemas
  • Oral polyethylene glycol
  • Manual evacuation under GA
  • Surgery
  • Dietary management
22
Q

How would you treat giardia + toxoplasma together in a dog?

A
  • Fenbendazole
23
Q

How would you treat protein losing enteropathy?

A
  • Prednisolone - reduce over 2-3 months to q48h
  • Cytotoxins - chlorambucil

Y4 - Small Animals (105 decks)

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