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Small Animal Medicine II > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

What is diarrhea? What are the 4 major mechanisms?

A

excess fecal water increases fluidity, frequency, and volume of feces

  1. osmotic
  2. secretory
  3. increased mucosal permeability
  4. dysmotility
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2
Q

What is the difference between acute and chronic diarrhea?

A

ACUTE = <14 days

CHRONIC = >14 days or intermittent over weeks to months

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3
Q

What different approaches are used for self-limiting (mild) and life-threatening (severe) diarrhea?

A

little diagnostics and/or supportive treatment –> deworm, dietary modification

more diagnostics and supportive care needed –> HGE, Parvovirus

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4
Q

What are the 6 major differentials for acute diarrhea?

A
  1. diet - indiscretion, poor quality, intolerance, change (most common cause!)
  2. parasites - Giardia, Coccidiosis, Whipworms, Hookworms, Roundworms (more commonly large bowel)
  3. stress
  4. infectious - Parvo, feline panleukopenia virus, coronavirus, FeLV/FIV, Clostridium perfringens, Campylobacter
  5. hemorrhagic gastroenteritis (HGE)
  6. drugs/toxins - antibiotics, antineoplastics, anti-inflammatories
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5
Q

What history is especially important to gather when diagnosing acute diarrhea?

A
  • diarrhea as a major or minor component - primary GI vs. systemic
  • if it’s a new problem
  • characteristic of diarrhea - melena, hematochezia, mucus, tenesmus, amount, frequency
  • deworming and vaccination history
  • exposure to other animals
  • known dietary indiscretion - diet change, table scraps, garbage, FB
  • other signs - vomiting, appetite
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6
Q

What are 4 important aspects of the physical exam in patients with diarrhea?

A
  1. assess hydration
  2. abdominal palpation - pain, mass, FB
  3. temperature - fever associated with Parvo
  4. rectal exam - mass, thickened colon, FB, strictures, visual inspection of feces (blood, mucus, color, consistency)
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7
Q

Diarrhea scores:

A
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8
Q

What diagnostics are performed in self-limiting and life-threatening diarrhea?

A

SELF-LIMITING - PCV/TS, fecal (float, Giardia ELISA, cytology, saline examination)

LIFE-THREATENING - CBC/chem/UA, fecal, abdominal radiographs or U/S (usually low yield), fecal parvovirus ELISA, fecal bacterial culture

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9
Q

The cause of hemorrhagic gastroenteritis is unknown. What is thought to be associated? What breeds most commonly present with this problem?

A

Clostridium perfringens - rarely need antibiotics for improvement

small-breeds - Mini Schnauzers, Yorkies, Dachshunds

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10
Q

What are the most common signs of hemorrhagic gastroenteritis? What 2 things are seen on CBC/chem?

A
  • severe hemorrhagic diarrhea - “raspberry jam” with fetid odor
  • severe dehydration
  • hypovolemic shock
  • abdominal pain/discomfort
  1. increased PCV > 60% - hemoconcentration
  2. low or normal albumin - loss from intestines
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11
Q

What treatment is needed for HGE? What improvement is expected?

A

SUPPORTIVE - aggressive fluid therapy, bland diet once eating for 3-5 days +/- antibiotics

improvement typically seen within 1-2 days, diarrhea may take several days to resolve –> recurrence possible

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12
Q

How is Giardia transmitted? What clinical signs are associated?

A

fecal-oral

  • mild, self-limiting or severe, acute diarrhea
  • chronic small bowel diarrhea
  • weight loss
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13
Q

How is Giardia diagnosed? What treatment is recommended?

A

zinc sulfate float, Giardia ELISA, direct saline smear for mobile trophozoites –> ELISA typically remains positive for a long time

Fenbendazole or Metronidazole (can combine) + decontamination (bath, clean environment)

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14
Q

What should be done if a fecal floatation in a patient with diarrhea is negative?

A

does NOT exclude parasites –> use broad-spectrum dewormer (Fenbendazole, SID for 3-5 days)

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15
Q

What are the most common signs of Clostridium perfringens diarrhea? What diagnostics are recommended?

A

acute or chronic, large bowel diarrhea that can be hemorrhagic

no perfect test - enterotoxin ELISA, PCR, spores on rectal smear (safety pins, tennis rackets)

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16
Q

How is Clostridial diarrhea treated?

A

Amoxicillin + Metronidazole + Tylosin

  • most commonly done in chronic cases
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17
Q

What kind of diarrhea results from stress? When is this most common?

A

self-limiting large bowel diarrhea +/- hemorrhagic, tenesmus

stressful events or anxiety - changes in environment, separation anxiety

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18
Q

What are the 6 major parts of acute diarrhea management?

A
  1. nutrition - bland diet
  2. deworming
  3. probiotics
  4. antibiotics (?) - may not be needed, recommended if infectious cause is proven, risk for dysbiosis
  5. fluid therapy
  6. antidiarrheal - Loperamide (opioid), may not want to mask signs, though –> most commonly used in patients on chemotherapy

only for symptomatic relief from intractable diarrhea

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19
Q

What diet is recommended in patients with diarrhea? What is added for large bowel diarrhea?

A

highly digestible, low fat - commercial or boiled chicken and rice

fiber

slowly transition back to normal diet after 3-5 days once signs have improved and remained so

20
Q

What is the difference between small and large bowel diarrhea?

A

SMALL - normal to slightly increased frequency, increased fecal volume, melena, vomiting, weight loss

LARGE - increased frequency and urgency, decreased fecal volume, mucus, frank blood (hematochezia), tenesmus/dyschezia

(MIXED = signs of both)

21
Q

What are the 8 major differentials for small bowel diarrhea?

A
  1. IBD
  2. food hypersensitivity
  3. intestinal neoplasia
  4. lymphangiectasia
  5. SIBO, ARD
  6. Giardia
  7. Histoplasmosis
  8. EPI
22
Q

What are the 10 major differentials for large bowel diarrhea?

A
  1. food hypersensitivity
  2. fiber responsive
  3. IBD
  4. histiocytic ulcerative colitis
  5. irritable bowel syndrome
  6. colonic neoplasia
  7. Clostridium
  8. Tritrichomonas
  9. Histoplasmosis
  10. Whipworms
23
Q

What are 4 systemic causes of chronic diarrhea?

A
  1. hyperthyroidism - can look like IBD in cats (weight loss, good appetite, diarrhea)
  2. liver disease
  3. kidney disease
  4. hypoadrenocorticism

diarrhea usually isn’t the main feature of illness (except with atypical Addison’s)

24
Q

What are the 4 major diagnostics used for chronic diarrhea?

A
  1. fecal - float (ZnSO4), direct smear, cytology
  2. CBC/chem/UA +/- T4, cortisol
  3. therapeutic trials - diet, deworming, antibiotics
  4. GI panel - TLI, PLI, cobalamine (decreased), folate (increased) –> best for EPI and assessing cobalamine deficiencies
25
Q

What imaging is recommended in some cases of chronic diarrhea? When is a surgical procedure needed?

A
  • AUS - palpable abdominal abnormalities, assess intestinal thickness or enlarged LN, FNA
  • endoscopy - stomach, duodenum, colon +/- ileum mucosal biopsies –> IBD, lymphoma, lymphagiectasia

celiotomy - full thickness GI biopsies of the entire tract

26
Q

What are the 3 most common causes of malabsorptive diarrhea?

A
  1. intestinal disease - IBD, lymphoma –> nutrients unable to be absorbed across enterocytes
  2. pancreatic disease - EPI –> lose enzymes responsible for digestion
  3. endocrine disease - hyperthyroidism, diabetes –> catabolic state, decreased glucose utilization
27
Q

What is IBD? What signs are most common?

A

steroid responsive enteropathy that leads to lymphoplasmacytic (+/- eosinophilic) enteritis

  • chronic small bowel diarrhea
  • weight loss
  • variable appetite
  • vomiting (cats!)
28
Q

What diagnostics are recommended for IBD? What treatment is done?

A
  • AUS - intestinal thickening, lymphadenopathy, can be normal!
  • biopsies - definitive

Prednisone +/- other immunosuppressives (Budesonide is not systemically absorbed and goes right to the SI)

29
Q

What is the most common cause of chronic diarrhea in dogs? What treatment is recommended?

A

food hypersensitivity (responsive) enteropathy

many respond to diet alone –> 2 week minimum trial with hypoallergenic novel or hydrolyzed protein diets

30
Q

What are the 3 most common intestinal neoplasias? What signs are associated?

A
  1. lymphoma (small cell in cats)
  2. adenocarcinoma
  3. MCT
  • chronic small bowel to mixed diarrhea
  • weight loss
  • variable appetite
31
Q

How is intestinal neoplasia diagnosed? Treated?

A

biopsy

  • SMALL CELL (cats) - prednisolone, chlorambucil; good prognosis!
  • LARGE CELL (dogs, cats) - chemotherapy; poor prognosis
32
Q

What signs are associated with lymphangiectasia? What is seen on bloodwork?

A
  • chronic small bowel diarrhea
  • vomiting
  • weight loss
  • some dogs show no GI signs

protein-losing enteropathy - hypoalbuminemia +/- hypoglobulinemia, hypercholesterolemia, lymphopenia

33
Q

What diagnostics are used for lymphangiectasia? How is it treated?

A
  • AUS - speckling of GIT, thickening
  • endoscopy - visualize rice granule-like dilated lacteals

treat underlying disease + low fat diet (prednisone + low fat diet if idiopathic)

34
Q

What sign is associated with SIBO and ARD? Why is it difficult to diagnose?

A

chronic small bowel diarrhea

  • cobalamine and folate levels are questionable
  • may respond to antibiotics - Metronidazole, Tylosin, Amoxicillin, Tetracyclines
35
Q

What is exocrine pancreatic insufficiency?

A

acinar atrophy of the pancreas results in loss of enzymes responsible for digesting starch, protein, and fat –> draws fluid into GIT

  • may be autoimmune, but does not respond to steroids
36
Q

What are the 2 most common signs of EPI? What dogs are most commonly affected?

A
  1. weight loss with ravenous appetite - may be coprophagic
  2. voluminous pulpy feces with an orange to yellow color

young to middle-aged GSD and Collies

37
Q

How is EPI diagnosed? What treatment is recommended?

A

low TLI (<2.5) +/- low cobalamine (pancreas produces intrinsic factor responsible for absorption)

pancreatic enzymes + cobalamine supplementation

38
Q

What is the most common sign of Clostridium diarrhea? What treatments are recommended?

A

chronic, intermittent large bowel diarrhea

  • fiber
  • Metronidazole or Tylosin +/- long-term Tylosin
39
Q

What is the most common sign of Tritrichomonas diarrhea? What animals most commonly are affected?

A

colonizes ileum and colon –> waxing/waning, malodorous large bowel diarrhea (subclinical to intractable)

young cats in batteries or shelters (purebreds)

40
Q

How is Tritrichomonas diarrhea diagnosed? What treatment is recommended?

A
  • fecal smear (low yield)
  • fecal PCR
  • in-pouch fecal culture

Ronidazole

41
Q

What is the most common sign of fiber-responsive diarrhea? What treatment is recommended?

A

large bowel diarrhea

high fiber commercial diets or addition of psyllium to current diet –> soluble fibers absorbed water and are highly fermentable into SCFAs by bacteria = healthy colonic mucosa and immune function!

42
Q

What 3 treatments are recommended for large bowel IBD?

A
  1. Sulfasalazine - specifically treats inflammation at the lower GIT –> transported to colon and broken down by the flora
  2. prednisone
  3. diet - hydrolyzed or novel protein
43
Q

What is thought to cause histiocytic ulcerative colitis? What does it result in? What dogs are over-represented?

A

inflammatory responst to E. coli –> ulcerative, granulomatous colitis –> large bowel diarrhea +/- weight loss and anorexia

young (<2 y/o) Boxers and French Bulldogs

44
Q

How is histiocytic ulcerative colitis diagnosed? Treated?

A

colonoscopy, biopsies, FISH to highlight E. coli

Enrofloxacin

45
Q

What are the most common signs of irritable bowel syndrome in dogs? What is the cause?

A
  • episodic large bowel diarrhea
  • nausea, vomiting
  • distress with abdominal cramping or bloating

stress

46
Q

What treatments are recommended for irritable bowel syndrome in dogs?

A
  • highly digestible diet supplemented with fiber
  • antidiarrheals - Loperamide
  • anxiolytics - Librax
  • antispasmodics - Hyoscine
47
Q

A patient presents with continous large volumes of pulpy orange diarrhea. The patient has had a ravenous appetite, but has lost considerable amount of weight. What is the origin of this diarrhea? What is the top differential?

A

small bowel

EPI –> should have a low TLI and cobalamine

Small Animal Medicine II (57 decks)

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