Chronic Diarrhea

Question 1

Clinical signs of small bowel diarrhea

Answer 1

• large volume of feces
• normal or increased frequency of defecation
• flatulence, steatorrhea
• melena (tarry, black)
• weight loss
• vomiting

Question 2

clinical signs of large bowel diarrhea

Answer 2

• small volume of feces
• increased frequency of defecation
• mucus in the feces
• hematochezia
• Tenesmus
• pain or urgency to defecate

Question 3

Differentials for chronic small bowel diarrhea

Answer 3

1. Primary gastrointestinal:
   - lympahngectasia
   - IBD
   - GI parasites
   - dietary indiscretion
   - histoplasmosis
   - neoplasia
2. Systemic
   - hypoadrenocorticism
   - exocrine pancreatic insufficiency
   - hepatobiliary disease
   - chronic renal failure

Question 4

PLE on blood chemistry

Answer 4

decreased TP, albumin and globulins

Question 5

when should you perform a diet trial in a patient with chronic diarrhea?

Answer 5

Only perform these in stable patients and those willing to eat. We usually don’t perform these in patients with moderate to severe hypoalbuminemia

Question 6

what can you seen on upper GI endoscopy?

Answer 6

esophagus, stomach, duodenum

Question 7

Intestinal Lymphangiestasia

Answer 7

This results from abnormal dilation of lymphatics or lacteals within the small intestine. Lacteal dilation -> rupture and leakage of protein rich fluid into lumen and interstitium -> lymph is a local tissue irritant -> inflammation and granuloma formation

Question 8

secondary intestinal lymphangiestasia

Answer 8

This occurs due to blockage of the lymphatics from neoplasia or inflammation (IBD, parasites, food allergies)

Question 9

Consequences of PLE

Answer 9

1. thromboembolic disease
2. vitamin deficiencies and malnutrition
3. poor oncotic pressure (pleural effusion, pulmonary edema, abdominal effusion, limb edema)

Question 10

Treatment of PRIMARY intestinal lymphangiestasia

Answer 10

strict prescription low fat diet long term +/- prednisone

Question 11

treatment of SECONDARY intestinal lymphangiectasia

Answer 11

treatment of underlying causes with a low fat diet (maybe hypoallergenic diet)

Question 12

Histiocytic ulcerative colitis (young boxers and frenchies)

Answer 12

infiltration of macrophages or histiocytes in the colonic wall

Question 13

Differentials for large bowel diarrhea

Answer 13

1. Histiocytic ulcerative colitis
2. IBD
3. Fiber responsive diarrhea
4. Infectious (C perf, Histo, Trichuris vulpis, giardia, prototheca)
5. IBS
6. Neoplasia