Diarrhoea - Cat and Dog

Question 1

diarrhoea - define

Answer 1

incr freq, volume or fluidity

Question 2

melaena - define

Answer 2

dark, tarry

Question 3

flatulence - define

Answer 3

excess gas

Question 4

dyscezia - define

Answer 4

difficult/painful defacation

Question 5

haematochezia - define

Answer 5

fresh blood in stool

Question 6

tenesmus - define

Answer 6

ineffectual straining

Question 7

Differentiation small/ large bowel diarrhoea - small

Answer 7

volume +++
mucus - 
freq +
tenesmus - 
dyschezia -
weight loss ++
vomiting +
general condition +

Question 8

Differentiation small/ large bowel diarrhoea - large

Answer 8

volume +
mucus +++
freq +++
tenesmus +++ 
dyschezia +
weight loss +
vomiting +
general condition -

Question 9

Differential Diagnoses acute small intestinal diarrhoea - No systemic signs

Answer 9

Diet
helminths
Protozoa (Giardia)
Iatrogenic (drugs)

Question 10

Differential Diagnoses acute small intestinal diarrhoea - systemic signs - bacterial

Answer 10

Salmonella
Campylobacter
faecal culture needed

Question 11

Differential Diagnoses acute small intestinal diarrhoea - systemic signs - viral

Answer 11

Distemper (dogs)
Parvovirosis (dogs)
Panleukopenia (cats)
faecal antigen test

Question 12

Differential Diagnoses acute small intestinal diarrhoea - systemic signs - other

Answer 12

Toxins
Hemorrhagic Gastroenteritis (dogs)
Acute pancreatitis

Question 13

Differential Diagnoses acute large intestinal diarrhoea

Answer 13

Whipworms 
Clostridia 
Giardia 
Campylobacter 
faecal examination, culture

Question 14

DDx chronic small intestinal diarrhoea - metabolic

Answer 14

Hepatic disease (Portosystemic Shunt!)
Hyperthyroidism (cats)
Addison’s disease (dogs)
Renal insufficiency

Question 15

DDx chronic small intestinal diarrhoea - pancreatic

Answer 15

exocrine pancreatic insufficiency

chronic pancreatitis

Question 16

DDx chronic small intestinal diarrhoea - intestinal

Answer 16

Giardia infection 
Chronic partial obstruction 
Lymphangiectasia 
Neoplasia: Lymphosarcoma 
food-responsive disease 
Inflammatory Bowel Disease - Lympho-plasmacellular

Question 17

DDx chronic large intestinal diarrhoea - Colon

Answer 17

Inflammatory Bowel Disease - Lympho-plasmacellular, Ulcerative Colitis (Boxer) 
Polyps 
Food-responsive disease 
Neoplasia 
Chronic partial obstruction 
Cats: Tritrichomonas foetus!

Question 18

Investigations for chronic diarrhoea

Answer 18

Faecal exam 
Haematology, Biochemistry, UA 
If small intestinal diarrhoea: consider serum tests
Abdominal ultrasound
Empiric treatment with elimination diet 
If no response: Biopsies

Question 19

faecal exam

Answer 19

flotation, culture

exclude Parasites, bacterial infection

Question 20

Haematology, Biochemistry, UA

Answer 20

exclude renal failure, hepatic disease

Question 21

serum tests

Answer 21

Trypsin-like Immunoreactivity (TLI), Pancreatic

lipase (PLI), cobalamin

Question 22

Empiric treatment with elimination diet

Answer 22

Food-responsive disease

Question 23

biopsy

Answer 23

endoscopy
exploratory laparotomy
Food-responsive disease

Question 24

biopsy via endoscopy

Answer 24

Multiple biopsies from stomach, proximal small intestine, ileum and colon possible
Non-invasive (except for anaesthesia)
Direct visualization of mucosa possible
Gives diagnosis in majority of cases
Difficulty: Intestinal lymphoma, lymphangiectasia
dont sample from peyers patch - looks like lymphoma

Question 25

biopsy via ex lap

Answer 25

Invasive - Caution in sick animals, cats, animals with decreased albumin levels Only yields 2-3 biopsies from stomach and small intestine, not for colonic biopsies! More expensive and painful for the animal 20% mortality vs 2% mortality for endoscopy

Question 26

main causes for chronic SI diarrhoea in dogs

Answer 26

Food-responsive disease Antibiotic-responsive diarrhoea Inflammatory Bowel Disease - lympho-plasmacellular Enteritis/Colitis Neoplasia

Question 27

food-responsive disease

Answer 27

Diarrhoea gets better when given elimination diet = protein that the animal has never eaten before: Better within first 2 weeks Keep on diet for at least 6-8 weeks

Question 28

antibiotic responsive diarrhoea (ARD)

Answer 28

Former Small intestinal bacterial overgrowth = SIBO Most commonly seen in young German Shepherd Dogs Chronic small intestinal or mixed diarrhoea Treatment - Metronidazole For 4 weeks But: usually relapse!

Question 29

IBD - inflammatory bowel disease

Answer 29

Diagnosis by clinical exclusion! Most common chronic enteropathy in dogs Histopathology - Lympho-plasmacellular (most common!), Eosinophilic (rare), Ulcerative colitis

Question 30

Therapy of chronic enteropathies/IBD in dogs: Sequential treatment protocol

Answer 30

Elimination diet Metronidazole for 3-4 weeks If inadequate response - prednisolone for at least 10 days, then taper dose to e.o.d. azathioprine or cyclosporine if steroids poorly tolerated or unsuccessful

Question 31

therapy of IBD in cats

Answer 31

Elimination diet Prednisolone for 10-14 days, then slow taper if no response: Chlorambucil Cobalamin supplementation

Question 32

Protein losing enteropathy - define

Answer 32

Syndrome of intestinal diseases Non-selective protein loss: Albumin low, +/- Globulins low

Question 33

Protein losing enteropathy - causes

Answer 33

IBD Lymphangiectasia Neoplasia (Lymphoma)

Question 34

clinical picture

Answer 34

Diarrhoea vomiting, anorexia Weight loss Ascites, pleural effusion, peripheral oedema Usually albumin and globulin serum concentrations low Important to biopsy early on in workup