Diseases of the Small Intestine

Question 1

What nutrients may be deficient in Small Intestine disease due to poor absorption of nutrients?

Answer 1

calcium, vitamin D3, Vitamin B12, folate

Question 2

What are clinical features of small bowel diarrhea in small Intestinal disease?

Answer 2

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

Question 3

What are the hallmark clinical signs of a patient with large bowel diarrhea

Answer 3

tenesmus, mucus in stool, and hematochezia

Question 4

When working up a SI disease case, if a patient presents with melena, what should I look for in blood work?

Answer 4

microcytosis (d/t iron deficiency) with thrombocytosis (high platelet count) is suggestive of chronic blood loss.

Question 5

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?

Answer 5

has the patient consumed any iron supplements or an medication that includes bismuth such as peptobismol?

Question 6

If I see panhypoproteinemia (low albumin and low globulins), ascities , pleural effusion, thromboembolis. what disease process should i consider?

Answer 6

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

Question 7

Why is protein losing enteropathy an umbrella term?

Answer 7

Question 8

On bloodwork, my patient has ionized hypocalcemia and hypovitaminosis D. How should I treat, and what other abnormalities should i look for on bloodwork?

Answer 8

there will be an elevated PTH
TX: test for serum vit D3
and treat with calcitriol - monistor calcium and phosphorus levels

Question 9

A owner reports being able to hear a “rumble” coming from their pets intestines. What is this?

Answer 9

borborygmi/ flatulence
the noises are caused by the propulsion of gas in the GI tract, swallowed air or bacterial fermentation of fibers

Question 10

A patient presents with weight loss. What should you always assess?

Answer 10

caloric intake

Question 11

What is the classic signalment of Acute Hemorrhagic Diarrhea Syndrome?

Answer 11

a patient presenting severely dehydrated with a history of vomiting and then an onset of acute to peracute onset of watery hemorrhagic diarrhea

Question 12

What are some clinical signs associated with Acute Hemorrhagic Diarrhea syndrome?

Answer 12

Small to mixed bowel diarrhea (acute necrotizing and neutrophilic enterocolitis,
vomiting, tachycardic, bounding pulses

Question 13

What bloodwork values may be found in AHDS?

Answer 13

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

Question 14

How do i diagnose AHDS?

Answer 14

-exclusion of other acute GI disease
PCR for Clostridium perfringens encoding for the pore forming toxin NetF
-run PCV + TP

Question 15

What warrants antibiotic use in AHDS?

Answer 15

signs of sepsis!!!
A positive fecal culture is NOT enough on its own to use abx. must have signs of sepsis

Question 16

What PCV level helps you rule out AHDS?

Answer 16

PCV lower than 30 at presentation

Question 17

Why will some AHDS patients present with hypoalbuminemia?

Answer 17

they are dehydrated at presentation which can falsely lower albumin

Question 18

What is my workup for a suspected AHDS patient?

Answer 18

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

Question 19

What are some DDX for AHDS?

Answer 19

Question 20

If I workup a patient for AHDS and they don’t improve within 48 hours, what are my next steps?

Answer 20

reevaluate for other causes of hemorrhagic diarrhea
look for complications: hypoalbuminemia, sepsis, DIC
recheck BW and do abdominal rads

Question 21

What helmith egg is this? What can I treat with?

Answer 21

Toxocara canis (dog) - roundworm
tx: fenbendazole

Question 22

What helmith egg is this? What can I tx with?

Answer 22

Toxocara cati (cats) Fenbendazole

Question 23

What hemith is this? What can I treat with?

Answer 23

Ancylostoma spp. hookworms
tx: fenbendazole or pyrantel

Question 24

What helmith is this? What can I treat with?

Answer 24

Dipylidium caninum
Praziquantel

Question 25

What clinical signs are associated with the hookworm shown? What do I tx with?

Answer 25

Ancylostoma caninum
-hemorrhagic enteritis with hematochezia and/or melena
-pups: degenerative anemia + pneumonia
-hypoalbuminemia

tx: fenbendazole

Question 26

What clinical sign is unique to greyhounds with Ancylostoma caninum infections?

Answer 26

Hematocrit will be in the normal range (usually they are polycthemic)

Question 27

If I am performing a direct smear and see a falling leaf motility, what protozoa am i looking at?

Answer 27

Giardia!

Question 28

How is giardia transmitted between dogs?

Answer 28

ingestion of cysts in contaminated feces

Question 29

What causes diarrhea as a clinical sign of giardia?

Answer 29

giardia trophozoites attach to the surface of the small intestine enterocytes and cause blunting of the intestinal villi leading to diarrhea.

Question 30

What diagnostics can i use to treat a symptomatic giardia dog? TX?

Answer 30

direct smear, fecal float and centrifuge, FECAL ELISA- most sensitive
TX: fenbendazole or metronidazole

Question 31

How do I diagnose + treat symptomatic patients with the gram positive anaerobic Clostridium difficile?

Answer 31

DX: isolation of bacteri avia (culture, antigen ELISA, PCR) and toxins A + B!
if they test positive for both:
tx: fecal transplant
metronidazole