Clinical Approach to Chronic Diarrhea Flashcards

1
Q

What are the 11 aspects of a history to consider in a patient with chronic diarrhea?

A
  • 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)
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2
Q

what are the characteristics of the feces in small bowel diarrhea?

A
  • normal or increased volume
  • mucus rare
  • melena (rare)
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3
Q

what are the characteristics of the feces in large bowel diarrhea?

A
  • normal or decreased volume
  • mucus common
  • hematochezia
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4
Q

what are the characteristics of defecation in small bowel diarrhea?

A
  • not usually urgent
  • absent tenesmus
  • absent dyschezia
  • increased frequency (2-3x)
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5
Q

what are the characteristics of defecation in large bowel diarrhea?

A
  • commonly urgent
  • tenesmus common
  • moderate to severely increased frequency (>3x)
  • occasional dyschezia
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6
Q

what are some other characteristics of small bowel diarrhea besides those of feces and defecation?

A
  • weight loss common
  • vomiting, flatulence, and halitosis can occur
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7
Q

what are some other characteristics of large bowel diarrhea besides those of feces and defecation?

A
  • weight loss rare
  • vomiting uncommon
  • flatulence and halitosis absent
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8
Q

what tests are involved in a complete fecal exam?

A
  • 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
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9
Q

where is folic acid absorbed and what do tests for it indicate?

A

absorbed in SI, high levels suggest antibiotic responsive diarrhea

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10
Q

where is cobalamin absorbed and what do tests for it indicate?

A
  • 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
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11
Q

what are the steps involved in diagnosing chronic diarrhea?

A
  • complete fecal exam
  • cobalamin/folate
  • imaging
  • biopsy
  • diet trial
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