Approach to chronic diarrhoea (Yr 4) Flashcards

1
Q

what defines chronic diarrhoea?

A

diarrhoea that has been occurring for over 2 weeks

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2
Q

what are some differentials for alimentary disease that may cause diarrhoea?

A

adverse food reactions
inflammatory bowel disease
antibiotic responsive diarrhoea
lymphangiectasia
lymphoma/tumours
infectious diarrhoea
(partial) obstructions

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3
Q

what is a linear foreign body?

A

long foreign body such as string (can get stuck in the mouth and then extend into the intestine)

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4
Q

what is haematochezia?

A

fresh blood in faeces

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5
Q

what does it suggest about the lesion if there is localised blood in the stool?

A

the lesion must be at the same point (rectal polyp)

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6
Q

what are the features of small intestinal diarrhoea?

A

increased volume
colour change
normal or slightly increased frequency
(possible weight loss)
(possible flatulence, halitosis, borborygmi)

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7
Q

why does small intestinal diarrhoea have colour changes with increased volume?

A

most of the digestion occurs in SI if, if food isn’t being digested properly water is held in the lumen meaning an increased volume of faeces

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8
Q

what do the features of small intestinal diarrhoea relate to?

A

malabsorption/digestion

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9
Q

what are the features of large intestinal diarrhoea?

A

decreased volume
increased frequency/urgency
tenesmus
mucus/heamatochezia
dyschezia
variable consistency (constipation)
(no weight loss)

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10
Q

what do the features of large intestinal diarrhoea relate to?

A

large intestine is mainly for storage of faeces

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11
Q

if melaena is present, where is the bleeding?

A

before the small intestine (it has been digested) unless there is so much bleeding the digestion is overwhelmed

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12
Q

how do you prepare a patient for a colonoscopy?

A

starve for 48 hours
laxatives (poly-ethylene glycol)
warm water enemas

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13
Q

is fibre good for small or large intestinal diarrhoea?

A

large intestinal

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14
Q

what symptomatic treatment may be considered in chronic diarrhoea early in your investigation?

A

dietary trial
anthelmintic medication

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15
Q

what can you analyse faeces for in chronic diarrhoea cases?

A

parasites
bacteria

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16
Q

what parasites could you isolate from faeces?

A

giardia
cryptosporidium
Tritrichomonas foetus (cats)

17
Q

what are the two most common bacteria causing chronic diarrhoea?

A

Salmonella
Campylobacter

18
Q

what cats are usually infected by Tritrichomonus foetus?

A

young
pedigrees
colonies
(causes large intestinal diarrhoea)

19
Q

what parasite is a top differential for large intestinal diarrhoea in cats?

A

Tritrichomonas foetus

20
Q

what disease does ACTH stimulation test for?

A

hypoadrenocorticism

21
Q

what endocrine tests could you run for cases of chronic diarrhoea?

A

ACTH stimulation test (hypoadrenocorticism)
total thyroxine (hyperthyroidism)

22
Q

what test is done for exocrine pancreatic insufficiency?

A

trypsin-like immunoreactivity

23
Q

what test is done to look for possible pancreatitis?

A

total lipase or pancreatic lipase

24
Q

what blood tests can be run to look for malabsorption?

A

folate and cobalamin

25
Q

what are folate and cobalamin?

A

B vitamins (tell us about the intestinal absorption)

26
Q

where is folate absorbed?

A

proximal small intestine

27
Q

where is cobalamin absorbed?

A

distal small intestine

28
Q

if the patient has hypocobalaminaemia, what is the likely outcome?

A

worse (this is a poor prognostic indicator)

29
Q

what is done if the patient has hypocobalaminaemia?

A

supplement with cobalamin (SC or oral)

30
Q

what would be the last diagnostic test to do for chronic diarrhoea?

A

intestinal biopsy

31
Q

what is the difference between a sample taken through endoscopy and coeliotomy?

A

ceoliotomy is full thickness (possibly more representative and diagnostic)

32
Q

which way would you biopsy a cats intestine?

A

coeliotomy (they often get hepatitis and pancreatitis at the same time so can assess these at the same time)