Diarrhoea - Cat and Dog Flashcards
diarrhoea - define
incr freq, volume or fluidity
melaena - define
dark, tarry
flatulence - define
excess gas
dyscezia - define
difficult/painful defacation
haematochezia - define
fresh blood in stool
tenesmus - define
ineffectual straining
Differentiation small/ large bowel diarrhoea - small
volume +++ mucus - freq + tenesmus - dyschezia - weight loss ++ vomiting + general condition +
Differentiation small/ large bowel diarrhoea - large
volume + mucus +++ freq +++ tenesmus +++ dyschezia + weight loss + vomiting + general condition -
Differential Diagnoses acute small intestinal diarrhoea - No systemic signs
Diet
helminths
Protozoa (Giardia)
Iatrogenic (drugs)
Differential Diagnoses acute small intestinal diarrhoea - systemic signs - bacterial
Salmonella
Campylobacter
faecal culture needed
Differential Diagnoses acute small intestinal diarrhoea - systemic signs - viral
Distemper (dogs)
Parvovirosis (dogs)
Panleukopenia (cats)
faecal antigen test
Differential Diagnoses acute small intestinal diarrhoea - systemic signs - other
Toxins
Hemorrhagic Gastroenteritis (dogs)
Acute pancreatitis
Differential Diagnoses acute large intestinal diarrhoea
Whipworms Clostridia Giardia Campylobacter faecal examination, culture
DDx chronic small intestinal diarrhoea - metabolic
Hepatic disease (Portosystemic Shunt!)
Hyperthyroidism (cats)
Addison’s disease (dogs)
Renal insufficiency
DDx chronic small intestinal diarrhoea - pancreatic
exocrine pancreatic insufficiency
chronic pancreatitis
DDx chronic small intestinal diarrhoea - intestinal
Giardia infection Chronic partial obstruction Lymphangiectasia Neoplasia: Lymphosarcoma food-responsive disease Inflammatory Bowel Disease - Lympho-plasmacellular
DDx chronic large intestinal diarrhoea - Colon
Inflammatory Bowel Disease - Lympho-plasmacellular, Ulcerative Colitis (Boxer) Polyps Food-responsive disease Neoplasia Chronic partial obstruction Cats: Tritrichomonas foetus!
Investigations for chronic diarrhoea
Faecal exam Haematology, Biochemistry, UA If small intestinal diarrhoea: consider serum tests Abdominal ultrasound Empiric treatment with elimination diet If no response: Biopsies
faecal exam
flotation, culture
exclude Parasites, bacterial infection
Haematology, Biochemistry, UA
exclude renal failure, hepatic disease
serum tests
Trypsin-like Immunoreactivity (TLI), Pancreatic
lipase (PLI), cobalamin
Empiric treatment with elimination diet
Food-responsive disease
biopsy
endoscopy
exploratory laparotomy
Food-responsive disease
biopsy via endoscopy
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
biopsy via ex lap
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
main causes for chronic SI diarrhoea in dogs
Food-responsive disease
Antibiotic-responsive diarrhoea
Inflammatory Bowel Disease - lympho-plasmacellular Enteritis/Colitis
Neoplasia
food-responsive disease
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
antibiotic responsive diarrhoea (ARD)
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!
IBD - inflammatory bowel disease
Diagnosis by clinical exclusion!
Most common chronic enteropathy in dogs
Histopathology - Lympho-plasmacellular (most common!), Eosinophilic (rare), Ulcerative colitis
Therapy of chronic enteropathies/IBD in dogs: Sequential treatment protocol
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
therapy of IBD in cats
Elimination diet
Prednisolone for 10-14 days, then slow taper
if no response: Chlorambucil
Cobalamin supplementation
Protein losing enteropathy - define
Syndrome of intestinal diseases
Non-selective protein loss:
Albumin low, +/- Globulins low
Protein losing enteropathy - causes
IBD
Lymphangiectasia
Neoplasia (Lymphoma)
clinical picture
Diarrhoea
vomiting, anorexia
Weight loss
Ascites, pleural effusion, peripheral oedema
Usually albumin and globulin serum concentrations low
Important to biopsy early on in workup
