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SA DX & TX II > Exam 1 - Approach to Diarrhea > Flashcards

Exam 1 - Approach to Diarrhea Flashcards

1
Q

what is the definition of acute diarrhea?

A

duration of < 2-3 weeks - often self-limiting, usually requires little diagnostic evaluation, & focus is placed on symptomatic treatment

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2
Q

what are some common causes of acute diarrhea?

A

diet change, dietary indiscretion, poor quality diet, toxins, parasites, bacteria, & acute hemorrhagic diarrhea

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3
Q

what are some parasites commonly involved in causing diarrhea especially in younger animals?

A

giardia & toxocara - do at least 1 fecal exam

if you don’t see anything, treat with fenbendazole anyway

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4
Q

what is the main viral cause of diarrhea in young dogs?

A

parvo

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5
Q

T/F: bacterial causes of diarrhea are poorly understood because many bacteria are found in the feces of healthy dogs as well as those with diarrhea

A

true

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6
Q

what is acute hemorrhagic diarrhea syndrome likely caused by?

A

clostridium perfringens netF toxin

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7
Q

when are antimicrobials not indicated in a patient with acute hemorrhagic diarrhea syndrome?

A

not indicated for cases without signs of fever or sepsis

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8
Q

what animals are typically affected by acute hemorrhagic diarrhea syndrome? what is commonly seen on labwork?

A

typically small to medium breeds

dramatically increased PCV - hemoconcentration

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9
Q

what are some less common systemic causes of diarrhea?

A

acute liver disease, pancreatitis, acute kidney injury such as lepto, & addisons

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10
Q

what are some less common toxic causes of diarrhea?

A

chemicals & plants (sago palm)

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11
Q

what are some less common drug related causes of diarrhea?

A

antibiotics, NSAIDS, steroids, chemo, copper chelators, & dogoxin

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12
Q

what are some less common intestinal obstruction causes of diarrhea?

A

foreign body & intussussception

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13
Q

what is the difference in quantity in when comparing small bowel diarrhea to large bowel diarrhea?

A

small bowel - large volumes of watery diarrhea

large bowel - normal to mildly increased

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14
Q

what is the difference in frequency in when comparing small bowel diarrhea to large bowel diarrhea?

A

small bowel - normal to mildly increased

large bowel - markedly increased

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15
Q

what is the difference in tenesmus/urgency in when comparing small bowel diarrhea to large bowel diarrhea?

A

small bowel - absent

large bowel - usually present

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16
Q

what is the difference in the presence of mucus when comparing small bowel diarrhea to large bowel diarrhea?

A

small bowel - usually absent

large bowel - frequently present

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17
Q

what is the difference in presence of blood when comparing small bowel diarrhea to large bowel diarrhea?

A

small bowel - melena

large bowel - fresh blood

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18
Q

what is the difference in presence of weight loss when comparing small bowel diarrhea to large bowel diarrhea?

A

small bowel - may be present

large bowel - uncommon

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19
Q

what are some warning signs of potentially life-threatening diseases in patients with diarrhea?

A

shock, moderate/severe dehydration, abdominal pain, depression, frequent vomiting, abdominal masses, dilated bowel loop, ascites, & signs of systemic illness (lymphadenopathy, coughing, pyrexia, ocular/nasal discharge, icterus, hepatomegaly, & oliguria)

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20
Q

what is typically included in a diagnostic workup of a patient with diarrhea?

A

fecal, infectious disease testing (case by case - ex: parvo), CBC/chem/urinalysis (if systemically unwell)

+/- : baseline cortisol, abd rads/US

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21
Q

T/F: fecal cytology is helpful for detecting enteropathogens

A

false - not helpful, rectal scraping may be useful for fungal/algal organisms

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22
Q

what are some possible indications for pursuing a enteropathogen PCR panel?

A

diarrhea that isn’t self limiting, animal with signs of sepsis, when multiple animals are affected, immunocompromised animal, & pets eating raw diets

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23
Q

why are antibiotics not needed in most cases of diarrhea?

A

most cases are usually self-limiting - can be potentially detrimental

can consider in febrile patients or those with signs of sepsis

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24
Q

why is metronidazole often used for diarrhea?

A

activity against anaerobes

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25
Q

what is typically included in symptomatic treatment for a patient with diarrhea?

A

isolate the patient & practice good hygiene

fluid therapy - treat electrolyte abnormalities & hypoglycemia

diet - feed small meals as soon as possible & easily digestible diet

broad spectrum anthelmintics

probiotics - may speed resolution of acute diarrhea, choose a good product with good quality control

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26
Q

what is a contraindication for using loperamide for a patient with diarrhea?

A

dog with the ABCB1 mutation - toxic

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27
Q

why is fiber useful for patients with diarrhea?

A

binds water & improves stool quality

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28
Q

in young dogs/cats <2 years old, what are the most common causes of chronic diarrhea?

A

infectious disease & dietary problems

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29
Q

in older dogs/cats, what are the most common causes of chronic diarrhea?

A

neoplasia, IBD, & hyperthyroidism in cats

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30
Q

what disease predisposition do norweigian lundehunds have?

A

PLE & lymphangiectasia

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31
Q

what disease predisposition do german shepherds have?

A

EPI, IBD, & dysbiosis

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32
Q

what disease predisposition do soft coated wheaton terriers have?

A

PLE/PLN

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33
Q

what disease predisposition do boxers have?

A

granulomatis colitis

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34
Q

what disease predisposition do yorkies have?

A

lymphangiectasia

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35
Q

what history questions are important when working up a case for chronic diarrhea?

A

description of diarrhea, dietary history, lethargy, weight loss, & hyporexia

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36
Q

what should you pay attention to on physical exam when working up a case for chronic diarrhea?

A

BCS, abdominal palpation, peripheral lymph node palpation, & rectal exam

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37
Q

what are some extra-gastrointestinal causes of chronic small bowel diarrhea in cats?

A

hyperthyroidism, hepatobiliary disease, pancreatitis, EPI, hypercalcemia, & renal disease

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38
Q

what are some extra-gastrointestinal causes of chronic small bowel diarrhea in dogs?

A

hepatobiliary disease, pancreatitis, EPI, hypercalcemia, renal disease, & addisons

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39
Q

what are some infectious causes of chronic small bowel diarrhea in cats?

A

helminths, protozoa, viral, bacterial, & fungal

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40
Q

what are some infectious causes of chronic small bowel diarrhea in dogs?

A

helminths, protozoa, bacterial, & fungal

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41
Q

what are some dietary responsive causes of chronic small bowel diarrhea in cats?

A

allergy/intolerance & dysbiosis

42
Q

what are some dietary responsive causes of chronic small bowel diarrhea in dogs?

A

allergy/intolerance

43
Q

what are some inflammatory causes of chronic small bowel diarrhea in cats?

A

IBD

44
Q

what are some inflammatory causes of chronic small bowel diarrhea in dogss?

A

IBD

45
Q

what are some neoplastic causes of chronic small bowel diarrhea in cats?

A

lymphoma, mast cell tumor, & carcinoma

46
Q

what are some neoplastic causes of chronic small bowel diarrhea in dogs?

A

carcinoma & lymphoma

47
Q

why perform a chemistry panel on a patient with chronic diarrhea?

A

evaluate for consequences of gi disease - hypoalbuminemia

evaluate for systemic disease that can cause GI signs - liver disease or hypercalcemia

48
Q

why perform a urinalysis on a patient with chronic diarrhea?

A

polyuria may suggest a metabolic cause of GI signs - hypercalcemia/hyperthyroidism

look for urate crystals or bilirubinuria - suggest hepatic disease

49
Q

why should you run a CBC for a patient with chronic diarrhea?

A

signs of inflammation/neoplasia

sick patient should have a stress leukogram - absence of one is consistent with addison’s disease

50
Q

what are examples of endocrine diseases that can cause chronic diarrhea?

A

addison’s in dogs & hyperthyroidism in cats

51
Q

why do both a direct smear & zinc sulfate floatation with centrifuge for patients with chronic diarrhea?

A

direct - detect protozoal trophozoites

zinc - detect helminths/other parasites, can pool 3 days of feces to increase sensitivity

52
Q

how does giardia affect dogs & cats differently?

A

dogs - large bowel diarrhea

cats - small bowel diarrhea

53
Q

what diagnostic test has better sensitivity for giardia than microscopic examination?

A

antigen testing

54
Q

what diagnostic test is used by most labs to diagnose cryptosporidium?

A

immunofluorescence assays

55
Q

T/F: most crypto infections in dogs & cats are sub-clinical

A

true - may cause chronic diarrhea in immunocompromised patients

56
Q

why is it difficult to establish clostridium perfringens as a cause of chronic diarrhea?

A

enterotoxin producing strains have been found in healthy dogs - the enterotoxins are what cause diarrhea

57
Q

________ _______ is an important cause of large bowel diarrhea in cats

A

tritrichomonas foetus

58
Q

what is the most sensitive test for trich?

A

fecal PCR

59
Q

how is histoplasmosis diagnosed?

A

cytology & EIA for antigen in serum or blood

60
Q

how is heterobilharzia diagnosed?

A

fecal PCR is best - can also do fecal sedimentation

61
Q

what is this?

A

tritrichomonas foetus

62
Q

what are the arrows pointing to?

A

giardia cysts

63
Q

what is this?

A

heterobilharzia americana egg

64
Q

when are survey rads a better test for a patient with chronic diarrhea?

A

patients with vomiting as well as diarrhea

65
Q

if this animal presented with diarrhea and you saw this on rads, what are you suspicious of?

A

canine schistosomiasis

66
Q

what is the most useful imaging modality for dogs with diarrhea?

A

abdominal ultrasound - best in dogs with weight loss or a palpable abdominal mass

67
Q

what is a TLI test?

A

tests for pancreatic disease - serum cTLI concentration is decreased in dogs/cats with EPI

very sensitive/specific test for this condition

68
Q

what is the most accurate lab test for pancreatitis?

A

cPL/fPL

69
Q

what is your interpretation of a high serum folate & low/normal serum cobalamin?

A

possible dysbiosis

70
Q

what is your interpretation of a low serum folate & normal serum cobalamin?

A

proximal small intestinal disease

71
Q

what is your interpretation of a normal serum folate & low serum cobalamin?

A

distal small intestinal disease, EPI, or dysbiosis

72
Q

what is your interpretation of a low serum folate & low serum cobalamin?

A

small intestinal disease or EPI

73
Q

what is your interpretation of a normal serum folate & serum cobalamin?

A

small intestinal disease is not ruled out

74
Q

what diagnostic test evaluates intestinal absorption?

A

serum folate - should be absorbed proximal small intestinal (plentiful in all dog foods)

serum cobalamin - should be absorbed in distal small intestinal (plentiful in diet - should find r protein, protects from acid, binds to instrinsic factor)

75
Q

what animals should be supplemented with cobalamin?

A

serum concentrations are <400ng/L

76
Q

how could issues with cobalamin absorption cause issues?

A

could be lacking intrinsic factor produced from the exocrine pancreas or you could be missing the receptors in the distal small intestine

77
Q

how should you supplement cobalamin?

A

cyanocobalamin - SQ once weekly for 6 weeks & then once monthly

can be used as an appetite stimulant

78
Q

how do you give therapeutic trials diagnostic value?

A

performed in a logical manner with ideally only one intervention at a time

79
Q

what are the 3 ways you can go with chronic enteropathies?

A
  1. several diet trials - food responsive enteropathy
  2. biopsy then immunosuppressant trial - immunosuppressant responsive enteropathy (IBD)
  3. tylosin trial - antibiotic responsive enteropathy
80
Q

what are the 3 general causes of adverse food reactions?

A
  1. food allergy - hypersensitivity
  2. food intolerance - metabolic, pharmacological, & idiosyncratic
  3. intoxication - bacterial, fungal, or other
81
Q

what are the 4 general options for diet trials?

A
  1. intestinal diet
  2. hydrolyzed antigen - smaller proteins, so easier to digest
  3. novel protein - need a good dietary history
  4. fiber supplemented
82
Q

T/F: about 50% of dogs & cats respond to diet changes

A

true - tend to be younger, have large bowel diarrhea, & less severely affected

83
Q

how long should a diet trial last?

A

expect to see a response within 3 weeks

if there is an improvement - continue for 12 weeks

at this time, may be possible to switch back to original diet

TEST QUESTION*

84
Q

what is the drug commonly started with in animals with immunosuppressant responsive enteropathy?

A

prednisone/prednisolone - 2mg/kg PO every day

in dogs - add on cyclosporine

in cats - add on chlorambucil

85
Q

T/F: we don’t know why some dogs with chronic enteropathy respond to antibiotics

A

true - tend to be younger, large breed dogs (especially GSD)

tend to have a short lived response

86
Q

what antibiotic is commonly used for antibiotic responsive enteropathy? how long should you treat for?

A

tylosin - 20mg/kg PO every 12 hours - sometimes metronidazole at 10mg/kg PO every 12 hours

expect to see a response within 3 weeks - treat for 6-8 weeks

87
Q

what are the advantages & disadvantages of pursuing an intestinal biopsy in cases of chronic enteropathy?

A

allows a histomorphicological diagnosis but doesn’t always tell us the etiology & aggrement between different pathologists is not great

88
Q

what are the advantages & disadvantages of doing a surgical intestinal biopsy?

A

advantages - whole gi tract can be assessed, fuller thickness biopsies can be collected

disadvantages - invasive & less biopsies collected

89
Q

what are the advantages & disadvantages of doing a endoscopic intestinal biopsy?

A

advantages - less invasive, multiple biopsies collected

disadvantages - smaller/more superficial biopsies & can’t sample the jejunum

90
Q

what is stage I of the diagnostic approach to a patient with diarrhea?

A

rule out parasites - fecal float, direct smear, giardia antigen testing, & give fenbendazole

diet trial with highly digestible diet

91
Q

what is stage IIa of the diagnostic approach to a patient with diarrhea?

A

rule out metabolic disease - CBC/chem, urinalysis, baseline cortisol, ACTH stim, thyroid testing in cats

92
Q

what is stage IIb of the diagnostic approach to a patient with diarrhea?

A

non-invasive tests for gi disease - serum cPLI/fTLI, serum folate/cobalamin, +/- abdominal rads/ultrasound

93
Q

what is stage III of the diagnostic approach to a patient with diarrhea?

A

therapeutic trials - parenteral cyanocobalamin if needed, diet trials, antibiotic trials in dogs (tylosin or metro), +/- probiotics, prebiotics, or synbiotics

94
Q

what is stage IV of the diagnostic approach to a patient with diarrhea?

A

abdominal ultrasound +/- rads & intestinal biopsy (endoscopy for upper/lower gi tract or surgical - may be better in cats because you can also sample the liver)

95
Q

what is stage V of the diagnostic approach to a patient with diarrhea?

A

further treatment based on histomorphological diagnosis

inflammation - steroids/other immunosuppressive drugs, further diet trials, therapy for infectious agents, & chemo or surgery for neoplasia

96
Q

what are some factors that require earlier intestinal biopsies?

A

PLE, severe weight loss/hyporexia, other systemic illness (lymphadenopathy or pyrexia), melena/hematemesis, & masses seen on imaging

97
Q

if your client won’t allow a biopsy, what do you need to rule out?

A

metabolic disease, infectious disease, dietary responsive disease, or presence of a mass

only 2 remaining possibilities are lymphoma & IBD - perform a treatment trial with prednisolone

98
Q

what 2 tests are used to differentiate gi small cell lymphoma & lymphoplasmacytic enteritis in cats?

A

immunophenotyping - determines if lymphoid cells are of b-cell or t-cell origin

PARR - used to determine if the cells are clonal, polyclonal, or pseudoclonal

99
Q

if you have an older cat that presents with weight loss with or without diarrhea & with or without increased appetite, what 3 differentials are you considering?

A
  1. IBD
  2. alimentary lymphoma
  3. hyperthyroidism
100
Q

what are the 3 most common causes of chronic small intestinal disease?

A

parasites, diet, & bacteria

101
Q

T/F: the most common causes of chronic small intestinal disease cannot be diagnosed with biopsy

A

true

102
Q

does histoplasmosis cause small or large bowel diarrhea in dogs?

A

large bowel!!!

SA DX & TX II (62 decks)

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