Diseases of the Small Intestine Flashcards
What nutrients may be deficient in Small Intestine disease due to poor absorption of nutrients?
calcium, vitamin D3, Vitamin B12, folate
What are clinical features of small bowel diarrhea in small Intestinal disease?
melana may be present, normal to increased stool volume, normal to increased frequency of defecation, weight loss if chronic, vomiting, may have fatty feces, may have feces with undigested feeds
What are the hallmark clinical signs of a patient with large bowel diarrhea
tenesmus, mucus in stool, and hematochezia
When working up a SI disease case, if a patient presents with melena, what should I look for in blood work?
microcytosis (d/t iron deficiency) with thrombocytosis (high platelet count) is suggestive of chronic blood loss.
If a patient presents with a history of dark, tarry, oxidized blood in feces, what should I ask the owner about in regards to history?
has the patient consumed any iron supplements or an medication that includes bismuth such as peptobismol?
If I see panhypoproteinemia (low albumin and low globulins), ascities , pleural effusion, thromboembolis. what disease process should i consider?
protein losing enteropathy
(protein leakage in the gut exceeds plasma protein synthesis resulting in hypoproteinemia)
most likely in dogs, if this hx in cats it is prob GI lymphoma
Why is protein losing enteropathy an umbrella term?
On bloodwork, my patient has ionized hypocalcemia and hypovitaminosis D. How should I treat, and what other abnormalities should i look for on bloodwork?
there will be an elevated PTH
TX: test for serum vit D3
and treat with calcitriol - monistor calcium and phosphorus levels
A owner reports being able to hear a “rumble” coming from their pets intestines. What is this?
borborygmi/ flatulence
the noises are caused by the propulsion of gas in the GI tract, swallowed air or bacterial fermentation of fibers
A patient presents with weight loss. What should you always assess?
caloric intake
What is the classic signalment of Acute Hemorrhagic Diarrhea Syndrome?
a patient presenting severely dehydrated with a history of vomiting and then an onset of acute to peracute onset of watery hemorrhagic diarrhea
What are some clinical signs associated with Acute Hemorrhagic Diarrhea syndrome?
Small to mixed bowel diarrhea (acute necrotizing and neutrophilic enterocolitis,
vomiting, tachycardic, bounding pulses
What bloodwork values may be found in AHDS?
hypovolemia: elevated albumin,
sepsis: neutropenia (decreased WBC (neutrophil)) , segmented neutrophil count higher than 20,000 and band neutrophils over 2500
may have enterotoxemia d/t clostridium perfringens
How do i diagnose AHDS?
-exclusion of other acute GI disease
PCR for Clostridium perfringens encoding for the pore forming toxin NetF
-run PCV + TP
What warrants antibiotic use in AHDS?
signs of sepsis!!!
A positive fecal culture is NOT enough on its own to use abx. must have signs of sepsis
What PCV level helps you rule out AHDS?
PCV lower than 30 at presentation
Why will some AHDS patients present with hypoalbuminemia?
they are dehydrated at presentation which can falsely lower albumin
What is my workup for a suspected AHDS patient?
1.) perform PCV and TS.
2.) Perform CBC, serum chemistry and UA
3.). BARE MINIMUM: fecal float, Giardia ELISA, basal cortisol
4.) exclude other causes of acute GI disease based on the clinical picture and suspisions
What are some DDX for AHDS?
If I workup a patient for AHDS and they don’t improve within 48 hours, what are my next steps?
reevaluate for other causes of hemorrhagic diarrhea
look for complications: hypoalbuminemia, sepsis, DIC
recheck BW and do abdominal rads
What helmith egg is this? What can I treat with?
Toxocara canis (dog) - roundworm
tx: fenbendazole
What helmith egg is this? What can I tx with?
Toxocara cati (cats) Fenbendazole
What hemith is this? What can I treat with?
Ancylostoma spp. hookworms
tx: fenbendazole or pyrantel
What helmith is this? What can I treat with?
Dipylidium caninum
Praziquantel
What clinical signs are associated with the hookworm shown? What do I tx with?
Ancylostoma caninum
-hemorrhagic enteritis with hematochezia and/or melena
-pups: degenerative anemia + pneumonia
-hypoalbuminemia
tx: fenbendazole
What clinical sign is unique to greyhounds with Ancylostoma caninum infections?
Hematocrit will be in the normal range (usually they are polycthemic)
If I am performing a direct smear and see a falling leaf motility, what protozoa am i looking at?
Giardia!
How is giardia transmitted between dogs?
ingestion of cysts in contaminated feces
What causes diarrhea as a clinical sign of giardia?
giardia trophozoites attach to the surface of the small intestine enterocytes and cause blunting of the intestinal villi leading to diarrhea.
What diagnostics can i use to treat a symptomatic giardia dog? TX?
direct smear, fecal float and centrifuge, FECAL ELISA- most sensitive
TX: fenbendazole or metronidazole
How do I diagnose + treat symptomatic patients with the gram positive anaerobic Clostridium difficile?
DX: isolation of bacteri avia (culture, antigen ELISA, PCR) and toxins A + B!
if they test positive for both:
tx: fecal transplant
metronidazole
