Chronic Dairrhea Flashcards
If a patient presented to you with the following symptoms, what type of diarrhea would you determine this to be?
increased amount of feces
normal frequency of defecation
flatulence
melena
weight loss
vomiting
small bowel diarrhea
If a patient presented to you with the following symptoms, what type of diarrhea would you determine this to be?
small amount of feces
increased frequency of defecation
mucus in feces
hematochezia
tenesmus
pain and urgency to defecate
large bowel diarrhea
what are primary GI differentials for chronic SMALL BOWEL diarrhea?
- lymphangiectasia (primary or secondary)
- inflammatory bowel disease (SR, FR, or AR/dysbiosis)
- GI parasites
- dietary indiscretion
- histoplasmosis
- neoplasia
T/F: anything that can cause an inflammatory cellular infiltrate can cause obstruction of the lacteals and lead to lymphangiectasia
true
what are 4 systemic (extra-GI) differentials for chronic SMALL BOWEL diarrhea?
- hypoadrenocorticism
- exocrine pancreatic insufficiency
- hepatobiliary disease
- chronic renal failure
You perform a Chemistry on a patient with chronic small bowel diarrhea, why are the proteins ALL low?
protein losing enteropathy
You perform a Chemistry on a patient with chronic small bowel diarrhea, if the liver enzymes/ glucose/ BUN/ cholesterol/ bilirubin were abnormal, what test could you run to rule out liver dysfunction?
bile acids.
you run a chemistry on a patient with chronic diarrhea who has lost weight and has muscle wasting from the chronicity of the disease. Why would the creatinine be low?
muscle wasting
creatinine is a muscle biproduct.
T/F: antibiotic-responsive inflammatory bowel disease patients typically do not have albumin abnormalities on blood work
true
You have a patient with chronic small bowel diarrhea. You need to rule out extra-GI causes such as addisons, EPI, as well as parasites and histoplasmosis. What tests can you run to rule these causes out?
- basal cortisol (if >2, r/o addisons; if <2 perform an ACTH stim)
- Trypsin-like immunoreactivity test
- dewormer trial
- urine antigen test (histo)
If you have a patient that has chronic small bowel diarrhea and you have ruled out the following: addisons, EPI, parasites, histoplasmosis, hepatobiliary disease, kidney disease, and dietary indiscretion; what diagnostics would you perform next to definitively diagnose this patient with a cause for the chronic diarrhea?
- could consider a diet trial with a low fat hydrolyzed diet for 3 weeks to see if its food intolerance or lymphangiectasia (only do this if the patient does NOT have mod-severe hypoalbuminemia and is stable)
- consider abdominal imaging to check for masses in the GI tract
- gastrointestinal biopsy (sx vs endoscopic) to see if the cause is lymphangiectasia or others.
what would you expect to see on GI endoscopy and histopath in a patient with lymphangiectasia?
lacteal dilation and mucosal inflammation (lymphoplasmacytic)
why does lymphangiectasia cause inflammation and hypoproteinemia ?
the lacteals become dialted and rupture leaking protein-rich fluid into the lumen and interstitium.
Lymph is a local tissue irritant and causes inflammation and granuloma formation.
what breeds have a genetic predisposition for primary intestinal lymphangiectasia?
- soft coated wheaten terrier
- norweighian lundehund
- yorkie
- maltese
- shar-pei
what causes SECONDARY intestinal lymphangiectasia?
it occurs due to blockage of the lymphatics
1. neoplasia
2. inflammation (IBD, parasites, food allergies)
