Diarrhoea and Vomiting

Question 1

pathophysiology of diarrhoea

Answer 1

osmotic
secretory
increased gut mucosa permeability
abnormal gut motility

acute < 3 weeks, chronic >3 weeks persistent or intermittent

Question 2

small intestinal diarrhoea

Answer 2

normal to large volume
watery
melaena
borbyrgmi
weight loss +/- vomiting
inappetance

Question 3

large intestine

Answer 3

urgency/increased frequency
straining
fresh blood
small volume more often
mucous
incontinence

Question 4

parasites

Answer 4

always essential to rule out
shedding not continuous

protozoa - giardia - SNAP (3-5 stool sample)

helminths - fecal floation

therapeutic trial - give fenbendazole for 5 days and see if it goes away

Question 5

diet

Answer 5

GI diet - highly digestible, low fat, little and often

supports mucosal barrier function
promotes normal motility
decreases inflammation
incorporate nutrients with positive effect on small intestinal flora

Question 6

adsorbants

Answer 6

pectin, chalk, activate charcoal

may help, not sure

aim to bind intestinal flora, protect mucosa, absorb toxins and bind water

Question 7

fecal analysis

Answer 7

giardia - SNAP
parvo - SNAP
culture for salmonella, campylobacter, clostridia
fecal flotation - nematodes and cestodes

Question 8

antibiotics

Answer 8

only if significant immunosuppression, breached mucosal barrier, or if a bacteria identified that we know responds well (narrow spectrum)

Question 9

diet trial

Answer 9

elimination
hypoallergenic, hydrolysed protein

Question 10

chronic diarrhoea and unwell

Answer 10

hematology - non regnerative anemia
biochem - panhyproteinemia - protein losing enteropathy
urinalysis - proteinuria
basal cortisol
B12
TLI/PLI - pancreatitis, exocrine pancreatic insufficiency
biopsy - indicated if previous tests and treatment failed, if hypoporteinemia and significant weight loss, or if suspected neoplasia

Question 11

vomiting

Answer 11

active expulsion, protective function not necessarily GI disease

Question 12

regurgitation

Answer 12

passive, unexpected, usually undigested

Question 13

dysphagia

Answer 13

dysfunction in swallowing, gagging, retching, exagerrated swallowing, feat of eating

Question 14

stages of vomiting

Answer 14

prodromal -
nausea - hypersalvation, loss of appetite, lip licking
excessive swallowing

retching -
duodenal contractions
rythmic inspiratory movements against closed glottis
dilation of cardia and low oesophageal sphincter

expulsion -
reduced oesophageal and phryngeal tone
contraction of abdominal muscles

Question 15

vomiting reflex

Answer 15

2 separate centres -
CRTZ - humoral pathway - stimulated by chemical stimuli
vomiting centre in brainstem - nerve impulses from central and peripheral pathways, also input from vestibular apparatus

Question 16

causes of vomiting

Answer 16

diet - change, spoiled food, intolerence, allergy, immune mediated

stomach - inflammation, foreign body, outflow obstruction, motility disorder, neoplasia

intestinal - IBD, foreign body, intussuception, volvulus, ileus dysfunction, neoplasia

endocrine - pancreatitis, peritonitis, liver disease, renal disease, pyo, prostatic disease, hyperthyroidism, uremia, addisions, diabetic ketoacidosis

bacterial -
salmonella, clostridium, e coli, campylobacter

viral - parvo, feline panleukopenia, FELV/FIV/FIP, distemper, adenovirus

worms - toxocara, taenia, trichuris

protozoa - isisopra, crypto, giardia, tritrichomonas

toxins - ethylene glycol, grapes, ivy, daffodils, lilies, conkers, acorns

drugs - antibiotics, NSAIDs, cyclosporine

CNS - motion sickness, vestibular disease, encephalitis, neoplasia

Question 17

vomiting - signallment

Answer 17

puppies/kittens - infectious disease of intussusception
young dogs - foreign body, dietary indiscretion
older dogs - neoplastic, pyo
older cats - hyperthyroidism, CKD

Question 18

concern in vomiting

Answer 18

weak, collapsed
dry/tacky, pale or congested mm
tachycardia, bradycardia or arryhtmia
weak and threay pulses
hypothermia or pyrexia
abdominal pain or distension
melaena, haemorrhagic diarrhoea

Question 19

primary vs secondary GI disease

Answer 19

primary = problem with GI itself
secondary = metabolic problem causing GI effects

Question 20

primary GI disease

Answer 20

palpable abnormality in gut
concurrent diarrhoea
normal history otherwise
vomiting before other signs of malaise
vomiting consistently related to time of eating

diagnostics -
radiographs
abdominal ultrasound
endoscopy
ex lap

Question 21

secondary GI disease

Answer 21

vomiting intermittent and unrelated to eating
evidence of abnormalities in other systems
not bright, alert and happy generally
ill before vomiting started

diagnostics -
biochem
hematology
urinalysis
imaging

Question 22

anti-emetics

Answer 22

maropitant - blocks peripheral and central pathways - visceral analgesia in cats

metoclopramide - more central pathways, prokinetic effect

Question 23

megaoesophagus

Answer 23

myasthenia gravis or induced by anaesthesia/sedation/other drugs

persistent abnormal dilation of oesophagus
contrast radiography
tensilon test