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BVetMed3 Alimentary > Diarrhoea In SA > Flashcards

Diarrhoea In SA Flashcards

1
Q

What it the normal approach to a clinical problem?

A

Define the problem
Define the system
Define the location
Define the lesion

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2
Q

What is the approach to clinical problem solving in patients with diarrhoea?

A

Define the problem
Define the location
Define the system
Define the lesion

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3
Q

Why is the problem based approach to diarrhoea different?

A

With diarrhoea, we here the problem is coming from (small, large bowel or mixed) can indicate what system is involved

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4
Q

What is the problem associated with diarrhoea?

A 
Alteration in normal pattern of defaecation 
- soft, unformed stools, 
- increased faecal water content 
And/or
- increased frequency of defaecation
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5
Q

What can reports of diarrhoea be confused with?

A

Vaginal discharge
Anal sac discharge

CONSTIPATION

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6
Q

How can constipation be confused with diarrhoea?

A

Straining and not passing a lot is associated with large bowel diarrhoea

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7
Q

Which is the most important tool in classifying the type of diarrhoea present?

A

HISTORY

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8
Q

How would you approach acute diarrhoea?

A

Treat symptomatically

Most acute diarrhoea is self resolving

(Parvo and HGE require investigation)

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9
Q

How do you approach chronic diarrhoea?

A

Requires investigation

Only a small proportion of cases in general practice

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10
Q

What possible locations are associated with diarrhoea

A

Small bowel
Large bowel
Mixed

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11
Q

Why is it important to differentiate between small and large bowel diarrhoea?

A

Can help determine if primary or secondary GI disease

Different causes

Different diagnostic approach

Different treatment

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12
Q

How could you test for exocrine pancreatic insufficiency?

A

Trypsin like immunoreactivity that tests for exocrine pancreatic insufficiency

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13
Q

Describe the appearance of small bowel diarrhoea.

A 
Variable consistency 
Large quantity
Blood - digested (melina) or half digested 
Weight loss (chronic)
Vomiting 
Borborygmi and flatulence 
Variable appetite 
Can easily dehydrate
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14
Q

Describe the appearance of large bowel diarrhoea

A 
Small amounts and frequently 
Mucous
Fresh blood
Tenesmus 
Occasional vomiting 
Decreased appetite 
Can lose weight if the pathology uses up calories (e.g. neoplasia or inflammation)
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15
Q

Why might blood be seen in large bowel diarrhoea?

A

Blood not severe but sign that large bowel is irritated

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16
Q

What type of GI disease can cause small bowel diarrhoea?

A

Primary most common

Secondary - forms part of clinical signs but not usually primary complaint - exception EPI

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17
Q

What system is associated with small bowel diarrhoea?

A 
Primary GIT 
Secondary GIT:
hepatic disease
Pancreatic insufficiency 
Pancreatitis 
Hyperthyroidism 
Addisons (hypoadrenocorticism)
Renal disease
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18
Q

In which secondary GI disorder would diarrhoea present as the main clinical sign?

A

Exocrine pancreatic insufficiency

Small bowel diarrhoea with secondary large due to fats irritating colon

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19
Q

If overt large bowel diarrhoea is the major presenting sign, what is the likely location of the lesion?

A

Primary GI disease

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20
Q

What is the likely location of the lesion if mixed bowel diarrhoea is seen?

A

Primary GI

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21
Q

How might blood work be useful when investigating diarrhoea?

A

To eliminate secondary causes

Can do TLIR for EPI

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22
Q

What typical investigations are required for dealing with diarrhoea?

A

Faecal exam
Therapeutic trial
More invasive tests (potentially)

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23
Q

What can cause acute small bowel diarrhoea?

A 
Diet
Parasites
Protozoa 
Infection 
Toxins
24
Q

What diet related factors can result in small bowel diarrhoea?

A

Overeating
Dietary change
Spoiled food
Garbage

25
Q

What parasites can result in small bowel diarrhoea?

A

Ascarids
Hookworms

Particularly puppies

NB ALWAYS check animals have been dewormed before progressing to invasive procedures

26
Q

What Protozoa can result in small bowel diarrhoea?

A

Giardia sp

Coccidia

27
Q

What infections can result in small bowel diarrhoea?

A

Viral enteritis

  • parvo
  • corona
  • rota

Bacterial (less common)

  • Campylobacter
  • Salmonella
  • Clostridium difficile
28
Q

What is a good approach to acute small bowel diarrhoea on a budget?

A

Worm them
Treat giardia
Sort out food

29
Q

What lesions are associated with chronic small bowel diarrhoea?

A 
Parasites 
Diet related
Bacteria and Protozoa 
Deep mycoses (NOT IN UK)
Chronic enteropathy (CE)
Neoplasia 
Lymphangiectasia 
Brush border enzyme biochemical defects
30
Q

What bacteria and Protozoa are associated with chronic small bowel diarrhoea?

A

Campylobacter
Clostridium

Giardia
Crypto
Isospora

31
Q

What parasites are associated with chronic small bowel diarrhoea?

A

Toxocara (round worms)

Ancylostoma (hookworms)

32
Q

What diet related factors can cause chromic small bowel diarrhoea?

A 
Lactose intolerance 
Gluten intolerance (rare)
Dietary hypersensitivity
33
Q

What signs of dietary hypersensitivity present in dogs?

What are common allergens?

A

Chronic intermittent diarrhoea, vomiting,

Pruritis - auxiliary region (elbow) and feet (between toes)

Beef, Lamb, Chicken, Wheat (gluten)

34
Q

What signs of dietary hypersensitivity present in cats?

What are common allergens?

A

Chronic intermittent diarrhoea, vomiting

Pruritis:ears, face

Fish, milk, dairy

35
Q

What is antibiotic responsive diarrhoea (ARD)?

A

No underlying cause, rather DYSBIOSIS

-abnormal/unbalanced gut flora
And/or
- abnormal gut reaction to normal population

ONLY RESPONDS TEMPORARILY

36
Q

What is the new name for inflammatory bowel disease?

A

CHRONIC ENTEROPATHY (CE)

37
Q

What are the types of CE?

A

Diet responsive CE
Antibiotics responsive CE
Immunosuppressive responsive CE (probs real IBD)
Non-responsive CE

38
Q

What treatment can be used for CE?

A 
Dietary trial 
Then
Metronidazole or tylosin (for dysbiosis)
No response to either?
Immunosuppressive treatment (pred, cyclosporin)
39
Q

What are the potential neoplastic causes of chronic small bowel diarrhoea?

A

Diffuse lymphosarcoma
Adenocarcinoma
Mastocytoma

Other

40
Q

Can you diagnose brush border enzyme biochemical defects?

A

No, only suspect

41
Q

What lesions can be responsible for large bowel diarrhoea?

A 
Parasites 
Protozoa 
Bacteria 
Diet
Inflammatory
Neoplasia 
Stress
Strictures
42
Q

What parasites can cause large bowel diarrhoea?

A 
Trichuris vulpis (dogs)
Anculostoma caninum
43
Q

What protozoa can cause large bowel diarrhoea?

A

Giardia (mainly small bowel)
Entamoeba
Tritrichomonas foetus (cats) - can be mixed bowel

44
Q

What bacteria can cause large bowel diarrhoea?

A 
Campylobacter (young, mixed bowel)
Clostridium 
Salmonella 
ARD 
Colitis - ETEC (enteropathogenic invasive E.Coli) - esp. Boxers and frenchies
45
Q

What dietary factors can cause large bowel diarrhoea?

A

Toxicity
Fibre-responsive
Dietary hypersensitivity

46
Q

What inflammatory conditions can cause large bowel diarrhoea?

A

Idiopathic ulcerative
Eosinophilic
Granulomatous

47
Q

What diagnostic tools can be used to investigate chronic small and large bowel diarrhoea?

A

Faecal floatation for helminths (+/- Rx Anthelmintics)

Fresh faecal examination for giardia or antigenic test

Full blood count

48
Q

What diagnostic approaches would you consider for small bowel ONLY?

A

Serum trypsin like immunoreactivity
(For EPI)

Cobalamin and folate

49
Q

Why might you test for cobalamin and folate?

A

Too non-specific for diagnosis

Useful to assess if supplementation required

Cobalamin is useful for healing gut damage

50
Q

What size small intestinal walls would you expect on ultrasound?

Why is this important to appreciate?

A

Duodenum < 3mm

Jejunum/ileum < 2mm

If mucosa or muscularis thickened, it will influence biopsy method

51
Q

When should you biopsy?

A 
If:
Hypoproteinaemic
Significantly thickened intestinal wall 
Significant weight loss
Hypercalcaemic 
If neoplasia strongly suspected 
Owner unable/unwilling to follow diagnostic plan
52
Q

What should you do before you biopsy in patients that are otherwise healthy?

A

If they have no clues that there may be an infiltrative disease make sure they are:

  • wormed
  • treated with metronidazole or tylosin
  • (if SB) rule out secondary GI
  • consider antibacterial trial (tetracycline or tylosin)
  • Proper dietary trial ( single novel protein or hydrolysed diet, increased fibre diet)
53
Q

What are the key questions to be answered by a biopsy?

A

Is this a case of inflammatory CE?
Is there neoplasia?
Does the patient have deep mycoses (NOT UK)?
Does the patient have primary or secondary lymphangiectasia?

54
Q

What are the general guidelines for a diagnostic approach to chronic diarrhoea?

A

Non-invasive to invasive

Inexpensive to expensive

Therapeutic or dietary trials that only change ONE element at a time

55
Q

How long would you expect a response to a dietary trial to take?

A

Full response at 6-10 weeks

Reasonable response within 2 weeks

56
Q

How should cats on elimination diets be managed?

A

KEPT INDOORS !!!

BVetMed3 Alimentary (16 decks)

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