Clinical Approach to Chronic Diarrhea Flashcards
What are the 11 aspects of a history to consider in a patient with chronic diarrhea?
- duration
- diet
- progression
- appetite (increased, ravenous, pica?)
- weight loss (SI)
- appearance of feces
- frequency of defecation
- presence of vomiting
- tenesmus
- environment where animal is kept (exposure, parasites, work, indoors/outdoors, recent change, boarding, travel)
- breed and character (GSD and EPI)
what are the characteristics of the feces in small bowel diarrhea?
- normal or increased volume
- mucus rare
- melena (rare)
what are the characteristics of the feces in large bowel diarrhea?
- normal or decreased volume
- mucus common
- hematochezia
what are the characteristics of defecation in small bowel diarrhea?
- not usually urgent
- absent tenesmus
- absent dyschezia
- increased frequency (2-3x)
what are the characteristics of defecation in large bowel diarrhea?
- commonly urgent
- tenesmus common
- moderate to severely increased frequency (>3x)
- occasional dyschezia
what are some other characteristics of small bowel diarrhea besides those of feces and defecation?
- weight loss common
- vomiting, flatulence, and halitosis can occur
what are some other characteristics of large bowel diarrhea besides those of feces and defecation?
- weight loss rare
- vomiting uncommon
- flatulence and halitosis absent
what tests are involved in a complete fecal exam?
- macro and microscopic
- centrifugation
- saline smear (for motile organisms)
- cytology
- culture (not great)
- check for C. perfringens (can be normal)
- Giardia and Tritrichomonas (use ELISA! hard to see)
- IDEXX PCR panel
where is folic acid absorbed and what do tests for it indicate?
absorbed in SI, high levels suggest antibiotic responsive diarrhea
where is cobalamin absorbed and what do tests for it indicate?
- absorbed in distal SI (impaired with intestinal disease), low serum concentrations suggest either severe mucosal disease or distal intestinal bacterial overgrowth or a combo of both
what are the steps involved in diagnosing chronic diarrhea?
- complete fecal exam
- cobalamin/folate
- imaging
- biopsy
- diet trial