Clinical Approach to Chronic Diarrhea

Question 1

What are the 11 aspects of the history that should be obtained for a chronic diarrhea case?

Answer 1

1) duration
2) diet
3) progression
4) appetite
5) weight loss
6) appearance of the feces
7) frequency of defecation
8) presence of vomiting
9) tenesmus
10) the environment in which the animal is kept
11) the animals breed and character.

Question 2

What conditions are GSH dogs most likely to have?

What other breeds are prediposed to chronic diarrhea?

Answer 2

EPI>ARD>IBD

soft coated terriers and basenji

Question 3

What is the clinical association for these physical findings?

Answer 3

Question 4

How does hypoproteinemia present in large vs. small breed dogs?

Answer 4

large: peripheral edema
small: ascites

Question 5

What does a thickened bowerl indicate?

Enlarged mesenteric l.n.?

Answer 5

infiltrative disease

reactive, neoplastic, or infiltrative disease

Question 6

What are the two common causes of chronic anemia?

How can they be differentiated based on cytology?

Answer 6

chronic blood loss in GI or anemia of inflammatory dz

microcytosis w/ chronic blood loss

Question 7

Why would a dog with PLE have hypoCa?

Answer 7

hypoalbuminemia leads to hypoCa

Question 8

Which chemistry values commonly increase with IBD?

Answer 8

ALT & ALP (liver enzymes)

Question 9

When would culturing a fecal sample be beneficial?

Answer 9

with salmonella and campylobacter

Question 10

Which disease can cause lymphopenia associated with chronic diarrhea?

Answer 10

lymphangiectasia

Question 11

What is the clinical association with these biochemical findings?

Answer 11

Question 12

What trypsinogen-like immunoreactivity (TLI) values indicated EPI?

Answer 12

< 2.5 μg/L dog

< 8 μg/L cat

Question 13

How long do you need to run a diet trial to know if the chronic diarrhea is a result of a food responsive disease?

Answer 13

2-6wks

Question 14

In which breed is Abx responsive diarrhea common?

Answer 14

GSH

Question 15

What does it mean if folate is high or low?

Answer 15

high: SIBO/dysbiosis
low: absorbed in proximal SI →malabsorption from SI dz

Question 16

What does it mean if serum cobalamin is low?

Answer 16

severe mucosal dz or SIBO in distal SI (bacteria use cobalamin)

Question 17

What is the important molecule that aids B12 absorption?

What is the difference in location of production in dogs and cats?

Answer 17

intrinsic factor

dog: parietal cells & pancreas
cat: pancreas (more likely to have def)

Question 18

What test is essential for diagnosing IBD, tumors, and mycotic infections in the intestines?

Answer 18

biopsy

Question 19

How can a biopsy be obtained?

Answer 19

endoscopy

laparotomy

laparoscopy

Question 20

What are the common abx used for ARD trials?

Answer 20

tylosin/amoxicillin

severe cases: metronidazole & enrofloxacin

unresponsive: tatracycline

Question 21

DDX for LI disease chronic diarrhea?

Answer 21

Question 22

What parasties are of concern in the LI?

Tx?

Answer 22

trichuris (whipworms) and tritrichomonas

fenbendazole

Question 23

What is the abx of choice for LI diarrhea?

Answer 23

sulfasalazine

(metro/tylosin for clostridium)

Question 24

What is the best way to get a definitive dx for LI diarrhea?

Answer 24

colonoscopy and BIOPSY