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Module 16 > Diagnosis and Management of Large Intestinal Disease in Dog and Cat > Flashcards

Diagnosis and Management of Large Intestinal Disease in Dog and Cat Flashcards

1
Q

what are the clinical manifestations of large intestinal disease

A
  1. fecal tenesmus: straining to defecate
  2. dyschezia: difficult or painful defecation
  3. diarrhea: large intestinal characteristics
  4. hematochezia: passage of fresh blood on feces
  5. constipation: infrequent, difficult passage of feces
  6. fecal incontinence: involuntary passage of feces
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2
Q

What are categories of causes of tenesmus and dyschezia (5)

A
  1. colorectal diseases
  2. prostatic diseases
  3. perianal and perineal diseases
  4. urogenital disease
  5. miscellaneous
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3
Q

what are colorectal diseases that cause tenesmus and dyschezia (8)

A
  1. parasitic colitis
  2. infectious colitis
  3. inflammatory bowel disesase
  4. fibre responsive diarrhea
  5. neoplasia or rectal polyp
  6. colorectal stricture
  7. constipation
  8. impaction and foreign material
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4
Q

hat are causes of parasitic colitis (3)

A
  1. Giardia
  2. Trichuris (c)
  3. Tritrichomonas fetus (f)
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5
Q

wjat are causes of infectious colitis (3)

A
  1. clostridium
  2. histoplasma (USA)
  3. prototheca (rare)
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6
Q

what are the types of inflammatory bowel disease (2)

A
  1. idiopathic
  2. granulomatous
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7
Q

What prostatic diseases can cause tenesmus and dyschezia (3)

A
  1. benign prostatic hyperplasia
  2. prostatitis
  3. prostatic neoplasia
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8
Q

what are urogenital diseases that cause tenesmus and dyschezia (3)

A
  1. cystitis, urethritis, vaginitis
  2. urolithiasis
  3. urinary tract neoplasia
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9
Q

what perianal and perineal diseases can cause tenesmus and dyschezia (3)

A
  1. anal sacculitis, impaction, abscess, neoplasia
  2. anal furnuculosis/perianal fistula
  3. perineal hernia
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10
Q

what are miscellaneous causes of tenesmus and dyschezia (2)

A
  1. caudal abdominal or pelvic mass
  2. pelvic fracture
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11
Q

what is tenesmus

A

spurious feeling of the need to evacuate the bowels, with little or no stool passed

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12
Q

what is dyschezia

A

constipation associated with a defective reflex for defecation.

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13
Q

how would you investigate a patient with tenesmus/dyschezia as well as diarrhea (5)

A
  1. fecal parasitology (giardia, trichuris. ancylostoma, tritrichomonas in cats)
  2. fecal culture
  3. rectal cytology: may identify infectious agents (ex. fungal)
  4. diagnostic imaging: rule out extraluminal disease, intussusception, lymphadenopathy, bowel thickening
  5. colonoscopy and mucosal biopsy
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14
Q

what is idiopathic colitis

A

idiopathic inflammation of the colon

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15
Q

how is idiopathic colitis diagnosed

A

diagnosis of exclusion plus compatible histopathological changes

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16
Q

how is idiopathic colitis managed (4)

A
  1. dietary modification
  2. antibiotics
  3. anti-inflammatory drugs
  4. immunosuppressive therapy
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17
Q

what diet would be suitable to manage diopathic colitis

A

hydrolyzed protein diets or supplemental fibre

butyrate levels in the colon can reduce the level of inflammation

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18
Q

what antibiotic is used to manage diopathic colitis

A

metronidazole to reduce the clinical signs

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19
Q

what anti inflammatory drugs can be used to manage idiopathic colitis

A

sulfasalazine (5-ASA)

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20
Q

what immunosuppressive drugs are used to manage idiopathic colitis (4)

A

prednisolone (1st line)

azathioprine (2nd line in dogs)

cyclosporine (2nd line in dogs)

chlorambucil (2nd line in cats)

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21
Q

what is granulomatous colitis

A

segmental, thickened, partially obstructed segment of bowel (ileum and colon most commonly) characterized by macrophages and bacterial invasion of the intestinal wall

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22
Q

what breed is granulomatous colitis typically seen in

A

boxers

french bulldogs

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23
Q

how is granulomatous colitis managed

A

Current treatment recommendations for GC require antimicrobials effective against E coli and that penetrate intracellularly, such as enrofloxacin (10–15mg/kg, PO, daily), with reassessment every 2 weeks and total treatment duration of 8 weeks.

fluroquinolones

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24
Q

at what age is idiopathic large intestinal diarrhea in dogs commonly reported

A

median age of 6 years old

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25
Q

what are the clinical signs of idiopathic large intestinal diarrhea in dogs

A

intermittent diarrhea characterized by increasing frequency, fecal mucus, hematochezia, and tenesmus +/- concurrent vomiting

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26
Q

how is idiopathic large intestinal diarrhea in dogs diagnosed

A

CBC, serum biochem, fecal parasitology NAD

colonic mucosa often normal during colonoscopy but decreased numners of lymphoid follicles

histopathological evaluation = WNL

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27
Q

how is idiopathic large intestinal diarrhea in dogs managed

A

respond to increased dietary fibre (psyllium)

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28
Q

what does tritrichomonas fetus infection cause

A

colitis in cats

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29
Q

what are the signs of tritrichomonas fetus infection

A

causes a mild to moderate lymphoplasmacytic and neutrophilic colitis

asymptomatic to signs of large intestinal inflammation

fecal incontinance

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30
Q

at what age is tritrichomonas fetus infection commonly

A

in cats <1 year

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31
Q

what breeds is tritrichomonas fetus infection more common in

A

common in pedigrees

bengal

siamese

maine coon

and multicat households/resuce centres

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32
Q

how is tritrichomonas fetus infection diagnosed

A

PCR for tritrichomonas DNA is highest sensitivity

in pouch culture ~65% sensitivity

fecal we prep sensitvitiy <20%

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33
Q

what organisms are in a fecal PCR panel in cats for enteropathogens (8)

A
  1. tritrichomonas fetus
  2. giardia spp
  3. cryptosporidium spp
  4. toxoplasma gondii
  5. salmonella spp
  6. clostridium perfringens enterotoxin A gene
  7. feline coronavirus (FeCoV)
  8. feline panleukopenia virus
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34
Q

how is tritrichomonas fetus infection managed (4)

A
  1. high fibre diet
  2. ronidazole (antiparasitic)
  3. probiotics
  4. treatment of concurrent infections?
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35
Q

how would your investigation differ when fecal tenesmus is associated with constipation rather than diarrhea

A

less infectious causes of constipation

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36
Q

what are causes of constipation (6)

A
  1. mechanical obstruction
  2. neuromuscular dysfunction
  3. metabolic/endocrine disease
  4. inflammation
  5. environmental
  6. pharmacological/drug induced
37
Q

what mechanical obstructions can cause constipation (3)

A
  1. intraluminal
  2. intramural
  3. extramural
38
Q

what are intraluminal causes of constipation (3)

A

impaction with

  1. bones/hair
  2. rectal stricture
  3. perineal hernia (diverticulum)
39
Q

what are intramural causes of obstruction

40
Q

what are extramural causes of obstruction

A
  1. pelvic fractures/stenosis
  2. neoplasia
  3. prostatic disease
41
Q

what neuromuscular dysfunction can cause constipation (3)

A
  1. lumbosacral disease
  2. hypogastric or pelvic nerve disorders
  3. colonic smooth muscle dysfunction
42
Q

What are metabolic/endocrine diseases that can cause constipation (5)

A
  1. dehydration
  2. hypokalemia
  3. hypercalcemia
  4. hypothyroidism
  5. obesity
43
Q

what inflammatory diseases can cause constipation (2)

A
  1. anal sac disease
  2. anal furunculosis/perianal fistula
44
Q

what are environmental causes that can lead to constipation (2)

A
  1. soiled litter tray
  2. inactivity/hospitalization
45
Q

what neuromuscular dysfunction can cause constipation (3)

A
  1. lumbosacral disease
  2. hypogastric or pelvic nerve disorders
  3. colonic smooth muscle dysfunction
46
Q

What lumbosacral diseases can cause constipation (2)

A
  1. cauda equina syndrome
  2. sacral spinal cord deformaties
47
Q

what hypogastric or pelvic nerve disorders can cause constipation

A

dysautonomia

48
Q

what drugs can cause constipation (3)

A
  1. opioids
  2. anticholinergics
  3. diuretics
49
Q

how would you investigate tenesmus/dychezia with constipation (6)

A
  1. rectal examination
  2. neurological assessment
  3. serum biochemistry
  4. thyroid function tests (T4:TSH)
  5. abdominal radiography +/- ultrasonography
  6. colonoscopy (or barium-contrast enema)
50
Q

what is a common large intestinal disorder that is particularily in the male cat

A

feline constipation, obstipation, megacolon

51
Q

what is obstipation

A

severe or complete constipation

52
Q

what would be the presentation usually of feline constipation, obstipation and megacolon (7)

A
  1. typically there is a chronic history of reduced production of feces +/- fecal tenesmus and dyschezia
  2. intermittent hematochezia and mucoid diarrhea
  3. systemic signs of inappetance
  4. malaise
  5. vomiting
  6. weight loss
  7. may be a history of RTA/pelvic trauma
53
Q

what can be found on physical exam with feline constipation

A

distended colon

54
Q

what is the pathway that leads to megacolon

A

constipation –> obstipation –> dilative megacolon or hypertrophic megacolon

55
Q

what is the rad showing

56
Q

how do you diagnose feline constipation, obstipation, megacolon (4)

A

exclusion of other causes

  1. serum biochem
  2. T4 (juvenile-onset hypothyroidism)
  3. abdominal radiography +/- ultrasonography
  4. colonoscopy (or barium-contrast enema) to rule out inflammatory lesions, strictures, etc
57
Q

what is the most common cause of obstipation in cats

A

idiopathic megacolon (62%)

pelvic canal stenosis (23%)

nerve injury (6%) or sacral deformity (5%)

58
Q

what are the aims of therapy of feline constipation, obstipation and megacolon (4)

A
  1. achieve normal hydration
  2. remove impacted feces
  3. increase dietary fibre
  4. pharmacologic manipulation of colonic function (laxatives, prokinetics)
59
Q

how can feline constipation, obstipation and megacolon be managed (4)

A
  1. removal of impacted feces
  2. diet
  3. laxatives
  4. colonic prokinetics agents
60
Q

how can removal of feces in feline constipation, obstipation and megacolon be done (2)

A
  1. enemas
  2. manual evacuation
61
Q

how can diet manage feline constipation, obstipation and megacolon (2)

A
  1. high fibre for mild constipation
  2. low residue diets for obstipation/megacolon
62
Q

what laxatives can be used to manage feline constipation, obstipation and megacolon (4)

A
  1. dietary fibre supplements
  2. lubricant laxatives
  3. hyperosmotic laxatives
  4. stimulant laxatives
63
Q

what colonic prokinetic agents can be used to manage feline constipation, obstipation and megacolon (3)

A
  1. 5HT4 serotonergic agnoists
  2. H2 receptor antagonists
  3. ? prostaglandin analogues
64
Q

what is used to perform enemas

A

microlax

lactulose

65
Q

what are examples of colonic prokinetic agents (2)

A
  1. cisapride
  2. ranitidine
66
Q

what are examples of laxatives

A
  1. psyllium
  2. lactulose
67
Q

what are the consequences of feline constipation, obstipation and megacolon (2)

A
  1. mucosal ulceration and inflammation
  2. colonic perofration
68
Q

what can be done if there is recurring feline constipation, obstipation and megacolon

A

(sub-total) colectomy +/- pelvic osteotomy (if megacolon is secondary to pelvic canal stenosis)

69
Q

what is anal furunculosis/perianal fistula

A

chronic inflammatory disease resulting in ulceration and fistulous tracts in the anal and perianal areas

70
Q

what breeds are predisposed to anal furunculosis/perianal fistula

A

GSDs predisposed (middle aged dogs)

71
Q

what may concurrently occur with idiopathic colitis

A

anal furunculosis/perianal fistula

72
Q

what are the clinical signs of anal furunculosis/perianal fistula (2)

A
  1. inflammation and pain associated with lesions
  2. anal stricture may develop or fecal incontinence
73
Q

how are anal furunculosis/perianal fistulas treated (4)

A
  1. cleaning to reduce contamination
  2. antibiotics to treat secondary infection (metronidazole/clindamycin)
  3. analgesia
  4. stool softeners
74
Q

what immunosuppressive therapy can be used to manage anal furunculosis/perianal fistula (2)

A
  1. ciclosporin (oral) (+/- ketoconazole)
  2. tacrolimus (topical)
75
Q

what is a common cause of straining

A

perineal hernia

76
Q

what causes perineal hernias

A

loss of lateral support to rectum

deviation of rectum into subcutaneous hernia

77
Q

what are the signs of perineal hernias

A

pernieal swelling

78
Q

what is the signalment commonly of perineal hernias

A

older entire male dogs

79
Q

how do you treat perineal hernias

A

surgical repair

80
Q

what causes decreased or absent anal tone

A

lower motor neuron dysfunction

81
Q

what diseases cause decreased or absent anal tone (3)

A
  1. lumbosarcal disease
  2. caudal equina syndrome
  3. degenerative myelopathy (GSDs and other breeds)
82
Q

with upper motor neuron dysfunction are the anal tone and reflexes normal

83
Q

what are the disease that upper motor neuron dysfunction cause (3)

A
  1. thoracic, cervical or central lesions
  2. arachnoid cysts
  3. IVDD, FCE, neoplasia
84
Q

what is sphincter incontinence caused by (4)

A
  1. neurological dysfunction
  2. trauma to external anal sphincter
  3. aging (geriatric dogs)
  4. behavioural disorders
85
Q

what is reservoir incontinence caused by

A

failure of the large bowel to accommodate the colorectal content

86
Q

what is reservoir incontinence due to (3)

A
  1. colorectal irritability
  2. reduced capacity/compliance
  3. increased volume of feces
  4. acute or chronic proctitis
  5. rectoanal neoplasia
  6. diffuse colitis
  7. diarrhea
87
Q

how is sphincter incontinence managed

A

usually permanent and untreatable

loperamide may be useful in the management of mild fecal incontinence (increases the anal canal pressure and attenuates the rectosphincter relaxation reflex)

88
Q

how is reservoir incontinence treated

A

identify and treat the underlying disorders

Module 16 (26 decks)

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