Diarrhoea Flashcards
Acute (4)
- self limiting
- starve for 24 hours
- GI diet
- probiotics
Origin
- SI (6)
- LI (6)
SI:
- large volume
- malaena
- lack of urgency
- normal frequency
- weight loss
- flatulence
LI:
- normal volume
- fresh blood
- urgency
- increased frequency
- normal weight maintained
- mucous coated
Physical exam (6)
- hydration
- peripheral LN
- cardiac auscultation
- abdominal palpation
- rectal exam
- temperature
causes of chronic diarrhoea
- extra- intestinal (5)
- intestinal (6)
Extra intestinal:
- pancreatitis
- hypoadrenocoticism
- liver disease
- kidney disease
- hyperthyroidism
Intestinal:
- parasitic disease
- infectious disease
- food responsive diarrhoea
- AB responsive diarrhoea
- idiopathic inflammatory bowel disease
- intestinal neoplasia
Investigation (6)
- bloods
- faecal parasitology and bacteriolog
- DI
- diet trial
- AB trial
- GI biopsy
Faecal parasitology (5)
- faecal flotation test
- toxocara ova
- uncinaria and trichuris ova
- giardia (also a snap test available)
or try 5 days of fenbendazole
Bloods (8)
- normal
- mild, chronic anamia (microcytic, hypochromic)
- minimal changes in WBCs (unless infection)
- esosinophilia indicates paracites/ hypoadrenocoticoism
biochem:
- pancytoproteinaemia: decrease in albumin and globulin
- -> PLE/PLN/liver failure
- decreased cholesterol
- mild liver enzyme increase
- evidence of dehydration
Bacteriology (4)
- campylobacter: ABs until 3 consecutive clear sample if systemic signs/ lives with immunosuppressed people
- salmonella: fluroquinilones if systemic signs/lives with immunosupprressed people
- E.coli: normally always found, don’t treat
- clostidium: perfingens –> haemorrhagic gastroeneteritis
- -> DDX is parva (get decreased WBC compared to neutrophilia with clostridium)
DI
- radiograph: not much use: exclusion of FB
- US: see obstructive disorders, extra-intestinal causes, assess GI motility, assess intestinal wall (layers and thickening?)
Markers of absorption (3)
TLI: trypsin-like immunoreactivity: indicative of exocrine pancreatic disease
- cobalamin (B12): decrease in SI disease/ pancreatic disease–> decrease causes decrease in efficacy of therapies and inability to regenerate enterocytes
- folate: decrease in proximal SI disease
Diet
- highly digestible
- novel protein: might do well for first 3-4 months but will develop antibodies to new protein
- hydrolysed: proteins are broken into very small pieces
Viral testing
- FeLV: persistent diarrhoea deu to secondary pathogens
- FIV: peracute entercoloitis
mainly is suspect GI lymphoma: most will be negative but if positive, cat will have bad reaction to chemotherapy
AB trial
- antibiotic responsive diarrhoea syndrome
- young large dogs
- altered microflora
- response normally seen in 2 weeks, continue for 4 weeks
- metronidatzole
- oxytetracycline
- tylosin: not licensed but some will ONLY respond to this
Intestinal Biopsies
- endoscopy vs coeliotomy
- preperation (3)
Endoscopy:
- less invasive
- can see oesophagus and colon
- difficult to assess SI distal to proximal duodenum
- biopsies are small and superficial
Coeliotomy
- invasive
- can’t see oesophagus or intrapelvic colon
- easy to inspect whole of SI
- full thickness biopsy: gold standard
upper GI: starve for 12 hours
lower GI: starve for 24 hours & multiple enemas
multiple biopsies increase chance of diagnosis
Inflammatory bowel disease (IBD)
- Dx
- aetiology
- types (4)
- predisposition
- prognosis
- Tx
- diagnosis of exclusion
- breakdown in normal immune tolerance to normal protein/CHO
- lymphocytic plasmocytic enteritis:
- eosinophilic enteritis: ensure not parasitic
- neutrophilic enteritis: ensure not infectious
- granulomatous enteritis: lots of macrophages ( consider histocytic colitis)
cats get it often in triditus: IBD + pancreatitis + hepatitis
common bile duct and pancreatic duct open at same point
Prognosis: hypoalbuminaemia and hypocobalaminaemia decrease response to Tx
Tx: corticosteroids: immunosuppresive (budesonide is locally acting but more expensive)
