Diarrhea Flashcards
What is diarrhea?
Passing of loose or liquid stool secondary to disorders of the GI system
What is the normal physiology of the small intestine?
- Site of absorption of almost all nutrients
- Food has been broken down into very small partially digested particles
- Bile and pancreatic enzymes facilitate breakdown into smaller molecules which facilitates transport across the epithelium
What are three very important balances maintained by proper GI physiology?
Acid base balance
Water balance
Nutrition
What is the result of disruption of the osmosis functions of the GIT?
- Malabsorption of water dependent solutes
- Water remaining in the lumen
What is the result of disruption of secretory functions of the GIT?
- Increased secretion of water into the lumen
- Bacterial toxins and other agents open channels to allow water loss
What effect does infection have on the GIT?
- Disruption and destruction of epithelium
- Malabsorption of water and nutrients
- Exudation of serum and blood with destruction
What effect does inflammation have on the GIT?
- Secretory issues
- High rate of loss of epithelium leading to malabsorption and osmotic disruption
What effect does increased motility have on the GIT?
Increased transit time leads to decreased chance of absorption of nutrients and water
What are some clinical signs/presenting concerns for an animal with diarrhea?
Diarrhea, tenesmus, hematochezia, melena, dyschesia, inappetence, systemic signs of illness, abdominal distension, borborygmi, flatulence, vomiting, weight loss, ravenous appetite
What characterizes diarrhea as acute versus chronic?
Acute 3 weeks
What are some differentials for a patient with diarrhea?
Metabolic disorders, toxin/drug, primary intestinal disease, foreign body, environmental, organ failure, pancreatitis or EPI, neoplasia, infection
What are the questions to ask that can help narrow down your differential list?
Onset, duration, appearance and content, frequency, relationship to food, diet change, current diet/encironment/medication, medical history, weight loss, vomiting, appetite
What are some causes of melena?
Coagulopathies, immune mediated thrombocytopenia, ingestion of blood, GI erosion/ulceration, foreign body, neoplasia, drug/toxin causing bleeding, vascular anomaly, paraneoplastic, metabolic, inflammatory
What are common physical exam findings in a patient with melena?
Dehydration, abdominal pain and distension, edema, coat colour change, muscle wasting, enlarged LNs, signs of systemic illness, thickened intestines
May be totally normal- always perform a rectal exam
What should diagnostics be prioritized based on?
Severity, breed, age, environment, exam findings, history
T/F: Acute and stable diarrhea typically responds to empiric treatment.
True
Presence of what three things with diarrhea require more aggressive treatment?
Weight loss, inappetence, dehydration
What kind of diarrhea demands a more complete work up?
Chronic diarrhea
T/F: Acute non-ill diarrhea is typically self-limiting, has unremarkable findings, and requires little to no symptomatic therapy.
True
Dietary change, psyllium, or metronidazole can be tried if needed
What are the typical causes of acute diarrhea in an otherwise healthy animal?
Dietary indiscretion
What diagnostic tests can you run as minimum database for an animal that is systemically well with diarrhea?
Big 4 and fecal
How is a patient with chronic diarrhea with no systemic illness worked up?
Big four and fecal- typically unremarkable
Must differentiate between large and small bowel diarrhea to aid in diagnosis
What are some common presentations of an animal with diarrhea, acute or chronic, that is systemically unwell?
Pain or FB on abdominal palpation
Hematochezia or melena
Dehydration and weight loss
Must provide systemic support
What diagnostics should be done on an animal with diarrhea that is systemically unwell?
QATS, BP, bloodwork, UA, fecal, radiographs
What is treatment dependent upon?
Cause of the diarrhea
Surgical or medical management possible
What is the benefit of doing more extensive labwork on a systemically unwell patient with diarrhea?
Rule out non-GI disease or learn about extent of primary GI disease
Cortisol levels or ACTH stim, anti-thrombin, Ca panel with vit-D
What are some common CBC findings of a systemically unwell patient with diarrhea?
Anemia, thrombocytopenia, leukopenia or cytosis
May be normal
What are some common chem findings of asystemically unwell patient with diarrhea?
Hypoalbuminemia (PLE, neoplasia, pythiosis)
Hypocholesterolemia
Hypocalcemia
Hypo or hyperkalemia, hypochloremia, hyponatremia
May be normal
What is typically the only changes noted on a UA of a systemically unwell patient with diarrhea?
Minimally concentrated to dilute with PU/PD
What endocrine tests are done in a systemically unwell patient with diarrhea?
T4- may be sick euthyroid or hyperthroid
Cortisol can also be run
What will fecal analysis tell you in a patient with diarrhea?
Parasites and protozoa
Bacteria overgrowth
Inflammatory or neoplastic cells
What values do a GI panel give you?
B12, folate, TLI, and PLI
Where is B12 absorbed?
Ileum
What cofactor is needed for proper B12 absorption from ileum?
Intrisic factor produced from the pancreas
Low levels may result in malabsorption and deficiencies despite adequate levels
What does a high and low folate level tell you?
High- Intestinal dysbiosis
Low- Malabsorption
What TLI levels are consistent with exocrine pancreatic insufficiency?
Low levels
What condition is an elevated PLI level consistent with?
Pancreatitis
What does speckling in the mucosa of the intestine on US indicate?
Inflammatory disease
What does striations in the mucosa of the intestine on US indicate?
Lymphangectasia
What does loss of layers or thickening of layers indicate on US?
That there’s a problem- very nonspecific finding
What other things can you find on intestinal US?
Masses, intussuseptions, LN enlargement, effusions
What can be aspirated when investigating GI disease?
Thickened small bowel wall, mass lesions, infiltration lesions
T/F: Fecal occult blood testing in infrequently used since it is incredible insensitive.
True- must be on a non-meat or cooked vegetable food diet otherwise it will give you a false positive
What is fecal alpha proteinase inhibitor and what do we use it for?
Increases with GI protein loss due to intestinal barrier compromise and leaking
Useful for differentiating PLE from other causes of low albumin
What is pANCAs and what do we use it for?
Peripheral antineutrophilic cytoplasmic autoantibody
Maker of inflammation in people with colitis and Chrone’s
What is methylmalonic academia and what do we use it for?
Precursor to or concurrent result with to B12 deficiency
Has an inverse relationship
What is a hallmark of treatment for any patient with diarrhea?
FLUIDS
What antibiotics can be tried with animals with diarrhea?
Metronidazole, unasyn, clavamox, tylosin, oxytetracycline, enrofloxacin
What kind of things can you give to increase fiber in the diet?
Metamucil, konsil, generic psyllium powder, canned pumpkin
Rx- W/D from hills
What are some dietary changes that you can attempt with animals with diarrhea?
Novel protein, gran free, hydrolyzed proteins, fat restricted, home cooked diets
What two vitamins can be helpful to supplement in patients with diarrhea?
Folic acid/folate and B-12
Can you try prednisone/solone or dexamethasone for diarrhea?
Yes- if inflammatory
What is budesonide?
Topical steroid that is more potent than prednisolone with less systemic side effects
What other immune modulation drugs can you use to treat diarrhea?
Cyclosporine
Azathioprine- never in cats
Chlorambucil
What is sulfasalazine and what is it used for?
MOA isn’t clear but helps with large bowel diarrhea
Has some antibacterial and anti-inflammatory properties
What is bismuth subsalicylate and what is it used for?
Diarrhea treatment and adjuct therapy for helicobacter
Antimicrobial, weak antacid, anti secretory, and anti-inflammatory properties
Radioopaque and creates dark stool
What are probiotics?
Dosages of living organisms that promote GI health by improving epithelial barrier function and modulating mucosal immune system
Lactobacilli and bifidobacteria
What are prebiotics?
Non-digestible dietary carbohydrates to stimulate growth and metabolism of enteric protective bacteria
