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VET433: Gastroenterology > Diarrhea > Flashcards

Diarrhea Flashcards

1
Q

fecal scoring

A

1: dry – constipation
2-3: normal
4-7: wet – diarrhea

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2
Q

activity index

A

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
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3
Q

what history questions should be asked for a diarrhetic patient

A
  1. fecal scoring
  2. activity index (mentation, vomiting, stool frequency, consistency, weight loss)
  3. blood, mucus, tenesmus, urgency
  4. first event or recurrence
  5. deworming history
  6. drug history
  7. vaccination history
  8. vomiting or regurgitation
  9. lifestyle
  10. travel history
  11. appetite
  12. weight loss
  13. diet history
  14. pruritic behaviors
  15. environmental stress
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4
Q

characteristics of small bowel diarrhea

A
  • normal/increased frequency
  • normal/increased volume
  • melena
  • no mucus or tenesmus
  • normal urgency
  • vomiting + weight loss possible
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5
Q

characteristics of large bowel diarrhea

A
  • markedly increased frequency
  • decreased volume
  • hematochezia
  • mucus + tenesmus present
  • increased urgency
  • no vomiting or weight loss
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6
Q

what are diagnostics for GI parasites

A
  • centrifugation floatation
  • antech KeyScreen GI PCR
  • direct wet prep
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7
Q

antech key screen GI PCR

A
  • determines if giardia is zoonotic (strain A or B)
  • determines if ancylostoma (hookworms) are benzimidazole resistant
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8
Q

what can be identified on a direct wet prep

A

giardia
tritrichomonas

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9
Q

stages of giardia

A

cyst
trophozoite

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10
Q

what are the zoonotic strains of giardia

A

A & B

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11
Q

what type of diarrhea is usually caused by giardia

A

small bowel
OR
asymptomatic

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12
Q

ideal diagnostics for giardia

A
  • fecal float + ELISA
    OR
  • PCR
  • DFA
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13
Q

what does the giardia ELISA detect

A

cyst wall protein 1

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14
Q

giardia treatment

A

fenbendazole

can also do drontal plus - the febantel gets metabolized to fenbendazole

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15
Q

stages of tritrichomonas

A

trophozoite only

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16
Q

what species does tritrichomonas foetus affect

A

cats

usually young, purebred

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17
Q

what type of diarrhea does tritrichomonas cause

A

large bowel diarrhea, chronic

malodorous, dribbling feces with a red, swollen, painful anus from colitis

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18
Q

tritrichomonas diagnostics

A
  • direct wet prep
  • inpouch fecal culture
  • PCR
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19
Q

tritrichomonas treatment

A

ronidazole

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20
Q

what are the common enteropathogenic bacteria

A
  • C. perfringens
  • C. difficile
  • Campylobacter jejuni
  • Salmonella
  • E. coli
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21
Q

what C. perf toxins cause disease and what type of disease

A

netE and netF

acute hemorrhagic diarrhea syndrome

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22
Q

how to diagnose enteropathogenic bacteria

A

fecal culture or PCR

NOT ALWAYS INDICATED

23
Q

when is fecal culture/PCR indicated

A
  1. hematemesis or bloody diarrhea w/ sepsis
  2. zoonotic risk to immunocompromised owner
  3. hemorrhagic diarrhea in immunocompromised patients
  4. multipet diarrhea
  5. increased neutrophils on fecal smear
24
Q

treatment for each enteropathogenic bacteria

A

C. perfringens: metronidazole, amoxicillin, tylosin

C. difficile: metronidazole

Campylobacter: macrolides (azithromycin)

Salmonella: fluoroquinolones (enrofloxacin)

25
Q

when is antibiotic treatment indicated for enteropathogenic bacteria

A
  • signs of sepsis
  • immunosuppressed animals
26
Q

what are the differentials for chronic diarrhea

A
  1. food responsive enteropathy
  2. antibiotic responsive enteropathy
  3. immunosuppressant responsive enteropathy
  4. non-responsive enteropathy
27
Q

food responsive enteropathy signalment

A

young adults (~3 years)

28
Q

clinical signs of FRE

A

large or mixed bowel diarrhea

29
Q

FRE treatment

A

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

30
Q

negative prognostic indicators for chronic colitis

A
  • high clinical activity index
  • hypocobalaminemia
  • hypoalbuminemia
  • hypovitaminosis D
31
Q

antibiotic responsive enteropathy signalment

A

young to middle aged
large and giant breed

esp. GSDs

32
Q

clinical signs of ARE

A

small, large or mixed bowel diarrhea

33
Q

treatment for ARE

A

AVOID ANTIBIOTICS

  1. diet trial - fiber enhanced
  2. probiotics
  3. fecal microbiota transplant
34
Q

immunosuppressant responsive enteropathy

A

clinical IBD

involves microbiome, host, and environmental factors

35
Q

what 4 criteria must be met to make a clinical diagnosis of IBD

A

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

36
Q

diagnostics for IBD

A
  1. elimination or fiber enrich diet trial (failed)
  2. minimum database
  3. serum total T4
  4. fecal float, ELISA, DFA, or PCR
  5. serum TLI
  6. serum PLI
  7. serum B12/folate
  8. abdominal radiographs and ultrasound
  9. GI biopsy
37
Q

where is B12 absorbed

A

ileum

38
Q

where is folate absorbed

A

jejunum

39
Q

is B12/folate a good diagnostic for dysbiosis

A

NO because can get a high folate with low B12 in patients with dysbiosis (bacteria consume B12 and produce folate)

40
Q

what would you expect to see on ultrasound for IBD

A

thickened muscularis and submucosa

41
Q

what two diagnostics should be performed in all chronic enteropathy patients

A

B12/folate
abdominal imaging

42
Q

what are the two main types of IBD

A
  • lymphoplasmacytic
  • granulomatous
43
Q

lymphocytic, plasmacytic IBD treatment

A

most common and easiest to treat

  1. diet trial - elimination or fiber enriched
  2. immunomodulators
  3. vitamin B12

can use probiotics or FMT

44
Q

probiotic considerations

A
  • there is not a regulatory agency
  • want to use products that have published research - visbiome, nutramax, purina
  • may contain single or multiple strains
45
Q

what causes granulomatous IBD

A

“boxer colitis”

caused by a highly adherent and invasive strain of E. coli

46
Q

what can be seen on histo of a dog with granulomatous IBD

A

PAS positive macrophages

47
Q

granulomatous IBD treatment

A

fluoroquinolones (Baytril) for 6-8 weeks

MUST use antibiotics due to highly pathogenic strain

48
Q

signalment for protein losing enteropathies

A

dogs with small bowel diarrhea

RARE to se it in cats

49
Q

intestinal lymphangiectasia

A

leakage of the lymphatics attahed to the GIT

50
Q

lymphangiectasia signalment

A

small breed dogs
(yorkies, maltese)

51
Q

lymphangiectasia clinical signs

A

small bowel diarrhea
panhypoproteinemia
hypocholesterolemia
hypocalcemia + hypimagenesemia

52
Q

diagnostis of lymphangiectasia

A

abdominal US

ID tiger striping

53
Q

lymphangiectasia treatment

A
  1. diet trial - low fat (<20% ME bases)
  2. vitamin B12
  3. thrombolytics
  4. prednisone (if refractory)
    5.Mg supplementation
54
Q

what are 4 indications for using antibiotics in patients with Gi disease

A
  1. hemorrhagic diarrea + sepsis
  2. zoonotic in immunocompromised patients
  3. managing ARE
  4. managing specific (if not responsive to fiber fiet)
  5. management of granulomatous colitis

VET433: Gastroenterology (16 decks)

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