Diarrhea

Question 1

Passing of loose or liquid stool, disorders of small OR large intestine, and MANY non- primary GI causes all describe what?

Answer 1

Diarrhea

Question 2

What part of the GIT absorbs almost all of the nutrients?

Answer 2

SI

Question 3

Enzymes from where facilitate breakdown of food into smaller molecules which facilitates transport across epithelium of the SI.

Answer 3

bile and pancreatic enzymes

Question 4

The absorption of water is dependent on the solutes. Solutes not absorbed for any reason =

Answer 4

= water remains in the lumen and that explains the osmotic pathologic aspect of diarrhea

Question 5

secretion of water into lumen&raquo_space; reabsorption describes what?

Answer 5

the secretory aspect of diarrhea. Bacterial toxins and other agents open channels to allow water loss.

Question 6

With regards to infection, we know that the disruption and destruction of the epithelium takes place. Water and nutrients not effectively absorbed describes what aspect of an infection resulting in diarrhea?

Answer 6

Osmotic

Question 7

Exudation of serum and blood with destruction describes what aspect of an infection resulting in diarrhea?

Answer 7

Secretory

Question 8

Inflammatory cytokines from inflammatory cells induces what aspect of inflammation that results in diarrhea?

Answer 8

Secretory

Question 9

High rate loss of epithelium –> replaced w immature cells which are less fxn’al enzymes and transporters –> malabsorption –> this describes what aspect of an inflammatory condition resulting in diarrhea?

Answer 9

Osmotic

Question 10

T/F Diarrhea can be caused from deranged motility.

Answer 10

True. Deranged motility = increased motility

Question 11

How long does diarrhea last to be considered acute?

Answer 11

Acute

Question 12

How long does diarrhea last to be considered chronic ?

Answer 12

Chronic > 3 weeks

Question 13

The physical exam for melena is highly variable but what is something that we should always, always do on every animal whether melena is present or not?

Answer 13

Rectal!

Question 14

At what point should our tx of diarrhea be more aggressive?

Answer 14

If weight loss, inappetence or dehydration is present

Question 15

If an animal has acute diarrhea but is systemically well, what therapy, if any, should we utilize?

Answer 15

Diet, Psyllium or Metronidazole

Question 16

We can expect to see the following CBC when dealing with what kind of dz?

Anemia
Thrombocytosis
Leukopenia or Leukocytosis
Normal

Answer 16

Primary GI dz

As an aside: on the chemistry, basically gonna see HYPO anything … HYPOAlb, HYPOCholesterolemia, HYPOCa, HYPO or HYPERK, HYPOCl, HYPONa . . . or it can be normal sooo that’s not helpful

Question 17

Our fecal analysis is super helpful. When performing a simple saline float, what would we be able to see?

Answer 17

Ova, parasites like coccidia

Question 18

What organisms would we be able to see on a stained smear slide?

Answer 18

Campylobacter; Clostridium

Question 19

What organisms would we be able to see on zinc centrifugation?

Answer 19

Ova, parasites, Giardia

Question 20

GI panel!! Important shit

T/F If the B12 and folate are within normal range, then we do not have GI dz.

Answer 20

False! Do not rule out GI dz just bc these numbers are normal

B12 and Folate do NOT tell you type of GI dz nor do they rule out GI dz but they are important to guide therapy and next steps of testing.

Question 21

B-12 vitamin absorbed in the ileum. Needs intrinsic factor from pancreas. If B-12 is low then what does that tell us?

Answer 21

Low= malabsorption from primary GI (specifically the ileum) or EPI

Question 22

Folate: B-vitamin that’s absorbed in the jejunum. If it’s low = malabsorption. What does it mean if it’s high?

Answer 22

High= dysbiosis: bacterial

Question 23

TLI= Trypsin Like Immunoreactivity. If it’s low, what does that mean?

Answer 23

Low consistent w EXOCRINE Pancreas Insufficiency

Question 24

PLI= Pancreatic Lipase. It’s elevations are consistent w what?

Answer 24

Elevations consistent with concurrent pancreatitis

Question 25

Speckling on US tells us what?

Answer 25

inflammatory dz

Question 26

Striations on US tells us what?

Answer 26

lymphangestasia . . . looks at slides 33-35 for pics

Question 27

T/F On US, neoplasia can show up as a mass lesion OR as diffuse thickening.

Answer 27

True

Question 28

What can we aspirate in relationship to GI dz?

Answer 28

Very thick small bowel wall
Mass lesions
Suspect infiltrative organs- LNs, liver, spleen

Question 29

Really unsure if we need to know the extra tests on slide 39.

Answer 29

Send help.

Question 30

The following are examples of what?

Metronidazole, Unasyn, Clavamox, Tylosin, Oxytetracycline, Enrofloxacin

Answer 30

Antibiotics !

Question 31

Why do we use antibiotics as part of our diarrhea therapy?

Answer 31

Bc of potential break in mucosal barrier

Question 32

What should we be careful of when using antibiotics?

Answer 32

DO NOT STOP BEFORE DOSE IS UP. Be careful with your suspect granulomatous colitis patients and tx duration. Tx for 8-12 wks. Do NOT stop it early even if they’re feeling better bc can develop resistance and animal could die.

Question 33

Metamucil, Konsil, generi psyllium powder, canned pumpkin, w/d diets are all adding what ?

Answer 33

Fiber! Bind that baby up.

Question 34

All of the following are true for diet management except what ?

Novel protein
Grain free
Hydrolyzed proteins
High fat
Home cooked diets

Answer 34

High fat.

Nah, we gotta restrict fat.

Question 35

We give folic acid/folate B9 supplementation to help a patient with diarrhea but what drug depletes this vitamin?

Answer 35

Sulfa drugs deplete this vitamin

Question 36

T/F Injectable Vitamin B-12 (cyanocobalamin) can be given to patient with diarrhea.

Answer 36

True

Question 37

T/F Prednisone/Prednisolone have longer DOA than Dexmethasone.

Answer 37

False. Dex has longer duration of effect.

Question 38

T/F We utilize steroids for diarrhea therapy.

Answer 38

True

Question 39

T/F Budesonide is a topical activity steroid and is 15x more potent than prednisolone but with less systemic

Answer 39

True

Question 40

Atopica/Cyclosporine, Azathioprine and Chlorambucil are all what ?

Answer 40

They handle the immune modulation aspect of our diarrhea therapy

Question 41

Atopica/Cyclosporine work by reducing what?

Answer 41

Reduce cell mediated immune responses (T cell suppression)

Question 42

Azathioprine inhibits what?

Answer 42

Inhibits lymphocyte activation and proliferation

Question 43

T/F Azathioprine is used dogs and cats.

Answer 43

FALSE –> NEVER IN CATS

Question 44

Chlorambucil cross links cellular DNA –> cell cycle is nonspecific anti neoplastic and immunosuppressive medication. Small cell lymphoma or high grade IBD. What species can we use this immune modulator in?

Answer 44

Cats and dogs!

Question 45

Sulfasalazine is an antibacterial and anti inflammatory that is used for ______ ______ diarrhea.

Answer 45

Large bowel diarrhea

Question 46

Bismuth subsalicylate is a diarrhea tx and sometimes part of Helicobacter therapy. It has antimicrobial properties, weak antacid and anti secretory. What are the 2 MAJOR things to know about it???

Answer 46

RADIOOPAQUE AND DARK STOOLS!!

Question 47

Clicker question: A 2 YO lab presents w a concern for acute onset lethargy and dark stools which you determine to be melena. If finances are limited, which blood work tests would you prioritize?

A. CBC, coagulation profile (PT, PTT)
B. Fecal analysis
C. Chem panel
D. Urinalysis

Answer 47

A. CBC, Coag profile

Question 48

Living microorganisms used to impart health benefits bc they improve epithelial barrier fxn, modulate mucosal immune system, alter intestinal flora- replace bad with good are called what?

Answer 48

Probiotics

Question 49

Non digestible dietary carbs that stimulate growth and metabolism of enteric protective bacteria (Bran, psyllium, lactosucrose, fructoligosaccharides) are called what?

Answer 49

Prebiotics