Diarrhea

Question 1

WHAT IS DIARRHEA ?

Answer 1

Passing of loose or liquid stool Disorders of small or large intestine Also MANY non-primary GI causes

Question 2

PHYSIOLOGY

Answer 2

The small intestine absorbs almost ALL nutrients

Once ingesta reaches SI, food has been broken down into very small aggregates & partially digested

Bile and pancreatic enzyme facilitate breakdown into smaller molecules which facilitates transport across epithelium of the small intestine

Question 3

What do we need to watch in diarrhea?

Answer 3

ACID BASE BALANCE

WATER BALANCE

NUTRITION

Question 4

What is the difference between acute and chronic diarrhea in terms of timeline?

Answer 4

ACUTE < 3 weeks

CHRONIC > 3 weeks

Question 5

CAUSES OF MELENA

Answer 5

Coagulopathies
Immune mediated thrombocytopenia Ingestion of blood (oral, nasal, pulmonary, pharyngeal bleeding)

GI erosion/ulceration
Foreign body
Neoplasia
Drug induced – NSAID, aspirin
Vascular anomaly
Paraneoplastic – gastrinoma, mastocytosis
Metabolic – uremia, liver disease/portal hypertension or coagulopathy Inflammatory – gastritis, enteritis

Question 6

DIAGNOSTICS

Answer 6

Prioritize

Severity

Breed

Environment

Exam findings

History

Question 7

ACUTE DIARRHEA – SYSTEMICALLY WELL

Answer 7

Self limiting, mild

History & PE unremarkable

Ex: Diet indiscretion, no PE concerns
 Minimum database: Big 4/QATS & Fecal

Symptomatic Therapy
Diet, Psyllium, or Metronidazole

Question 8

CHRONIC DIARRHEA & SYSTEMICALLY WELL

Answer 8

If no obvious non-primary gastrointestinal causes …  Unremarkable baseline bloodwork
 Negative fecal

Determine small vs. large vs. mixed bowel diarrhea

Aids you in your decisions for further evaluation and therapy

Question 9

What is the best way to diagnose melena?

Answer 9

Rectal Exam

Question 10

B12

Answer 10

B-12 vitamin absorbed in the ileum

Needs intrinsic factor from pancreas
Low = malabsorption from primary GI or EPI

Question 11

FOLATE

Answer 11

B-vitamin absorbed in the jejunum Low = malabsorption
High = dysbiosis

B12 & Folate

DO NOT tell you type of GI Dz nor rule out GI Dz

Question 12

TLI

Answer 12

Trypsin Like Immunoreactivity

Low consistent with Exocrine Pancreatic Insufficiency

Question 13

PLI

Answer 13

Pancreatic Lpase

Elevations consistent with concurrent pancreatitis

Question 14

What is the best yield for fecal analysis?

Answer 14

Zinc Centrifuguation

Question 15

What can we aspirate in relationship to GI disease ?

Answer 15

Very thick small bowel wall
Mass lesions
Suspect infiltrative organs – lymph nodes, liver, spleen

Question 16

DIARRHEA THERAPY

Answer 16

FLUIDS

ANTIBIOTICS

Metronidazole Unasyn Clavamox

Tylosin

Oxytetracycline

7. 5-15 mg/kg PO or IV BID 22-30 mg/kg IV TID
8. 75 mg/kg PO BID 10-15 mg/kg PO TID

20 mg/kg PO TID 8-20 mg/kg PO SID

Helicobacter triple therapy
 Amoxicillin, Clarithromycin, Metronidazole
 Amoxicillin, Bismuth Subsalicylate, Metronidazole

Enrofloxacin

FIBER

Question 17

What meds would you give?

Answer 17

Vitamins- B12 and folate

STEROID THERAPY

Prednisone
DOG: 1 mg/kg PO BID

Prednisolone
CAT: 1 mg/kg PO BID

Injectable Dexamethasone SP  1/8 th of Pred dose

 Longer duration of effect

Question 18

BUDESONIDE

Answer 18

Topical activity steroid
15 x more potent than prednisolone Less systemic side effects

DOG: 1 – 3 mg PO SID CAT: 1 mg PO SID

Question 19

2 yo lab presents with a concern for acute onset lethargy and dark stools. Which you determine to be melena. If finaces are limited, what bloodwork test would you run?

Answer 19

CBC, coag profile,

DDX: thrombocytopenia, warfarin