Approach to chronic diarrhoea (Yr 4) Flashcards
what defines chronic diarrhoea?
diarrhoea that has been occurring for over 2 weeks
what are some differentials for alimentary disease that may cause diarrhoea?
adverse food reactions
inflammatory bowel disease
antibiotic responsive diarrhoea
lymphangiectasia
lymphoma/tumours
infectious diarrhoea
(partial) obstructions
what is a linear foreign body?
long foreign body such as string (can get stuck in the mouth and then extend into the intestine)
what is haematochezia?
fresh blood in faeces
what does it suggest about the lesion if there is localised blood in the stool?
the lesion must be at the same point (rectal polyp)
what are the features of small intestinal diarrhoea?
increased volume
colour change
normal or slightly increased frequency
(possible weight loss)
(possible flatulence, halitosis, borborygmi)
why does small intestinal diarrhoea have colour changes with increased volume?
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
what do the features of small intestinal diarrhoea relate to?
malabsorption/digestion
what are the features of large intestinal diarrhoea?
decreased volume
increased frequency/urgency
tenesmus
mucus/heamatochezia
dyschezia
variable consistency (constipation)
(no weight loss)
what do the features of large intestinal diarrhoea relate to?
large intestine is mainly for storage of faeces
if melaena is present, where is the bleeding?
before the small intestine (it has been digested) unless there is so much bleeding the digestion is overwhelmed
how do you prepare a patient for a colonoscopy?
starve for 48 hours
laxatives (poly-ethylene glycol)
warm water enemas
is fibre good for small or large intestinal diarrhoea?
large intestinal
what symptomatic treatment may be considered in chronic diarrhoea early in your investigation?
dietary trial
anthelmintic medication
what can you analyse faeces for in chronic diarrhoea cases?
parasites
bacteria
what parasites could you isolate from faeces?
giardia
cryptosporidium
Tritrichomonas foetus (cats)
what are the two most common bacteria causing chronic diarrhoea?
Salmonella
Campylobacter
what cats are usually infected by Tritrichomonus foetus?
young
pedigrees
colonies
(causes large intestinal diarrhoea)
what parasite is a top differential for large intestinal diarrhoea in cats?
Tritrichomonas foetus
what disease does ACTH stimulation test for?
hypoadrenocorticism
what endocrine tests could you run for cases of chronic diarrhoea?
ACTH stimulation test (hypoadrenocorticism)
total thyroxine (hyperthyroidism)
what test is done for exocrine pancreatic insufficiency?
trypsin-like immunoreactivity
what test is done to look for possible pancreatitis?
total lipase or pancreatic lipase
what blood tests can be run to look for malabsorption?
folate and cobalamin
what are folate and cobalamin?
B vitamins (tell us about the intestinal absorption)
where is folate absorbed?
proximal small intestine
where is cobalamin absorbed?
distal small intestine
if the patient has hypocobalaminaemia, what is the likely outcome?
worse (this is a poor prognostic indicator)
what is done if the patient has hypocobalaminaemia?
supplement with cobalamin (SC or oral)
what would be the last diagnostic test to do for chronic diarrhoea?
intestinal biopsy
what is the difference between a sample taken through endoscopy and coeliotomy?
ceoliotomy is full thickness (possibly more representative and diagnostic)
which way would you biopsy a cats intestine?
coeliotomy (they often get hepatitis and pancreatitis at the same time so can assess these at the same time)
