Diarrhea Flashcards
fecal scoring
1: dry – constipation
2-3: normal
4-7: wet – diarrhea
activity index
scoring of characteristics of diarrhea on a scale of 0-3 based on normal, mild, moderate, or severe change
- activity/attitude (mentation)
- vomiting
- stool consistency
- stool frequency
- weight loss
what history questions should be asked for a diarrhetic patient
- fecal scoring
- activity index (mentation, vomiting, stool frequency, consistency, weight loss)
- blood, mucus, tenesmus, urgency
- first event or recurrence
- deworming history
- drug history
- vaccination history
- vomiting or regurgitation
- lifestyle
- travel history
- appetite
- weight loss
- diet history
- pruritic behaviors
- environmental stress
characteristics of small bowel diarrhea
- normal/increased frequency
- normal/increased volume
- melena
- no mucus or tenesmus
- normal urgency
- vomiting + weight loss possible
characteristics of large bowel diarrhea
- markedly increased frequency
- decreased volume
- hematochezia
- mucus + tenesmus present
- increased urgency
- no vomiting or weight loss
what are diagnostics for GI parasites
- centrifugation floatation
- antech KeyScreen GI PCR
- direct wet prep
antech key screen GI PCR
- determines if giardia is zoonotic (strain A or B)
- determines if ancylostoma (hookworms) are benzimidazole resistant
what can be identified on a direct wet prep
giardia
tritrichomonas
stages of giardia
cyst
trophozoite
what are the zoonotic strains of giardia
A & B
what type of diarrhea is usually caused by giardia
small bowel
OR
asymptomatic
ideal diagnostics for giardia
- fecal float + ELISA
OR - PCR
- DFA
what does the giardia ELISA detect
cyst wall protein 1
giardia treatment
fenbendazole
can also do drontal plus - the febantel gets metabolized to fenbendazole
stages of tritrichomonas
trophozoite only
what species does tritrichomonas foetus affect
cats
usually young, purebred
what type of diarrhea does tritrichomonas cause
large bowel diarrhea, chronic
malodorous, dribbling feces with a red, swollen, painful anus from colitis
tritrichomonas diagnostics
- direct wet prep
- inpouch fecal culture
- PCR
tritrichomonas treatment
ronidazole
what are the common enteropathogenic bacteria
- C. perfringens
- C. difficile
- Campylobacter jejuni
- Salmonella
- E. coli
what C. perf toxins cause disease and what type of disease
netE and netF
acute hemorrhagic diarrhea syndrome
how to diagnose enteropathogenic bacteria
fecal culture or PCR
NOT ALWAYS INDICATED
when is fecal culture/PCR indicated
- hematemesis or bloody diarrhea w/ sepsis
- zoonotic risk to immunocompromised owner
- hemorrhagic diarrhea in immunocompromised patients
- multipet diarrhea
- increased neutrophils on fecal smear
treatment for each enteropathogenic bacteria
C. perfringens: metronidazole, amoxicillin, tylosin
C. difficile: metronidazole
Campylobacter: macrolides (azithromycin)
Salmonella: fluoroquinolones (enrofloxacin)
when is antibiotic treatment indicated for enteropathogenic bacteria
- signs of sepsis
- immunosuppressed animals
what are the differentials for chronic diarrhea
- food responsive enteropathy
- antibiotic responsive enteropathy
- immunosuppressant responsive enteropathy
- non-responsive enteropathy
food responsive enteropathy signalment
young adults (~3 years)
clinical signs of FRE
large or mixed bowel diarrhea
FRE treatment
diet trial
- elimination (limited ingredient vs hydrolyzed)
- fiber enriched
- fat restricted
- highly digestible
expect response within 10-14 days
must maintain trial for 3 months
negative prognostic indicators for chronic colitis
- high clinical activity index
- hypocobalaminemia
- hypoalbuminemia
- hypovitaminosis D
antibiotic responsive enteropathy signalment
young to middle aged
large and giant breed
esp. GSDs
clinical signs of ARE
small, large or mixed bowel diarrhea
treatment for ARE
AVOID ANTIBIOTICS
- diet trial - fiber enhanced
- probiotics
- fecal microbiota transplant
immunosuppressant responsive enteropathy
clinical IBD
involves microbiome, host, and environmental factors
what 4 criteria must be met to make a clinical diagnosis of IBD
1.persistent GI signs (>3 weeks)
2. failure to respond to symptomatic therapy
3. failure to document other causes of gastroenteritis
4. histologic dx of benign intestinal neoplasia
MUST get an intestinal biopsy in order to definitively diagnose IBD
diagnostics for IBD
- elimination or fiber enrich diet trial (failed)
- minimum database
- serum total T4
- fecal float, ELISA, DFA, or PCR
- serum TLI
- serum PLI
- serum B12/folate
- abdominal radiographs and ultrasound
- GI biopsy
where is B12 absorbed
ileum
where is folate absorbed
jejunum
is B12/folate a good diagnostic for dysbiosis
NO because can get a high folate with low B12 in patients with dysbiosis (bacteria consume B12 and produce folate)
what would you expect to see on ultrasound for IBD
thickened muscularis and submucosa
what two diagnostics should be performed in all chronic enteropathy patients
B12/folate
abdominal imaging
what are the two main types of IBD
- lymphoplasmacytic
- granulomatous
lymphocytic, plasmacytic IBD treatment
most common and easiest to treat
- diet trial - elimination or fiber enriched
- immunomodulators
- vitamin B12
can use probiotics or FMT
probiotic considerations
- there is not a regulatory agency
- want to use products that have published research - visbiome, nutramax, purina
- may contain single or multiple strains
what causes granulomatous IBD
“boxer colitis”
caused by a highly adherent and invasive strain of E. coli
what can be seen on histo of a dog with granulomatous IBD
PAS positive macrophages
granulomatous IBD treatment
fluoroquinolones (Baytril) for 6-8 weeks
MUST use antibiotics due to highly pathogenic strain
signalment for protein losing enteropathies
dogs with small bowel diarrhea
RARE to se it in cats
intestinal lymphangiectasia
leakage of the lymphatics attahed to the GIT
lymphangiectasia signalment
small breed dogs
(yorkies, maltese)
lymphangiectasia clinical signs
small bowel diarrhea
panhypoproteinemia
hypocholesterolemia
hypocalcemia + hypimagenesemia
diagnostis of lymphangiectasia
abdominal US
ID tiger striping
lymphangiectasia treatment
- diet trial - low fat (<20% ME bases)
- vitamin B12
- thrombolytics
- prednisone (if refractory)
5.Mg supplementation
what are 4 indications for using antibiotics in patients with Gi disease
- hemorrhagic diarrea + sepsis
- zoonotic in immunocompromised patients
- managing ARE
- managing specific (if not responsive to fiber fiet)
- management of granulomatous colitis
