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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
what is typically included in symptomatic treatment for a patient with diarrhea?
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
26
what is a contraindication for using loperamide for a patient with diarrhea?
dog with the ABCB1 mutation - toxic
27
why is fiber useful for patients with diarrhea?
binds water & improves stool quality
28
in young dogs/cats <2 years old, what are the most common causes of chronic diarrhea?
infectious disease & dietary problems
29
in older dogs/cats, what are the most common causes of chronic diarrhea?
neoplasia, IBD, & hyperthyroidism in cats
30
what disease predisposition do norweigian lundehunds have?
PLE & lymphangiectasia
31
what disease predisposition do german shepherds have?
EPI, IBD, & dysbiosis
32
what disease predisposition do soft coated wheaton terriers have?
PLE/PLN
33
what disease predisposition do boxers have?
granulomatis colitis
34
what disease predisposition do yorkies have?
lymphangiectasia
35
what history questions are important when working up a case for chronic diarrhea?
description of diarrhea, dietary history, lethargy, weight loss, & hyporexia
36
what should you pay attention to on physical exam when working up a case for chronic diarrhea?
BCS, abdominal palpation, peripheral lymph node palpation, & rectal exam
37
what are some extra-gastrointestinal causes of chronic small bowel diarrhea in cats?
hyperthyroidism, hepatobiliary disease, pancreatitis, EPI, hypercalcemia, & renal disease
38
what are some extra-gastrointestinal causes of chronic small bowel diarrhea in dogs?
hepatobiliary disease, pancreatitis, EPI, hypercalcemia, renal disease, & addisons
39
what are some infectious causes of chronic small bowel diarrhea in cats?
helminths, protozoa, viral, bacterial, & fungal
40
what are some infectious causes of chronic small bowel diarrhea in dogs?
helminths, protozoa, bacterial, & fungal
41
what are some dietary responsive causes of chronic small bowel diarrhea in cats?
allergy/intolerance & dysbiosis
42
what are some dietary responsive causes of chronic small bowel diarrhea in dogs?
allergy/intolerance
43
what are some inflammatory causes of chronic small bowel diarrhea in cats?
IBD
44
what are some inflammatory causes of chronic small bowel diarrhea in dogss?
IBD
45
what are some neoplastic causes of chronic small bowel diarrhea in cats?
lymphoma, mast cell tumor, & carcinoma
46
what are some neoplastic causes of chronic small bowel diarrhea in dogs?
carcinoma & lymphoma
47
why perform a chemistry panel on a patient with chronic diarrhea?
evaluate for consequences of gi disease - hypoalbuminemia evaluate for systemic disease that can cause GI signs - liver disease or hypercalcemia
48
why perform a urinalysis on a patient with chronic diarrhea?
polyuria may suggest a metabolic cause of GI signs - hypercalcemia/hyperthyroidism look for urate crystals or bilirubinuria - suggest hepatic disease
49
why should you run a CBC for a patient with chronic diarrhea?
signs of inflammation/neoplasia sick patient should have a stress leukogram - absence of one is consistent with addison's disease
50
what are examples of endocrine diseases that can cause chronic diarrhea?
addison's in dogs & hyperthyroidism in cats
51
why do both a direct smear & zinc sulfate floatation with centrifuge for patients with chronic diarrhea?
direct - detect protozoal trophozoites zinc - detect helminths/other parasites, can pool 3 days of feces to increase sensitivity
52
how does giardia affect dogs & cats differently?
dogs - large bowel diarrhea cats - small bowel diarrhea
53
what diagnostic test has better sensitivity for giardia than microscopic examination?
antigen testing
54
what diagnostic test is used by most labs to diagnose cryptosporidium?
immunofluorescence assays
55
T/F: most crypto infections in dogs & cats are sub-clinical
true - may cause chronic diarrhea in immunocompromised patients
56
why is it difficult to establish clostridium perfringens as a cause of chronic diarrhea?
enterotoxin producing strains have been found in healthy dogs - the enterotoxins are what cause diarrhea
57
________ _______ is an important cause of large bowel diarrhea in cats
tritrichomonas foetus
58
what is the most sensitive test for trich?
fecal PCR
59
how is histoplasmosis diagnosed?
cytology & EIA for antigen in serum or blood
60
how is heterobilharzia diagnosed?
fecal PCR is best - can also do fecal sedimentation
61
what is this?
tritrichomonas foetus
62
what are the arrows pointing to?
giardia cysts
63
what is this?
heterobilharzia americana egg
64
when are survey rads a better test for a patient with chronic diarrhea?
patients with vomiting as well as diarrhea
65
if this animal presented with diarrhea and you saw this on rads, what are you suspicious of?
canine schistosomiasis
66
what is the most useful imaging modality for dogs with diarrhea?
abdominal ultrasound - best in dogs with weight loss or a palpable abdominal mass
67
what is a TLI test?
tests for pancreatic disease - serum cTLI concentration is decreased in dogs/cats with EPI very sensitive/specific test for this condition
68
what is the most accurate lab test for pancreatitis?
cPL/fPL
69
what is your interpretation of a high serum folate & low/normal serum cobalamin?
possible dysbiosis
70
what is your interpretation of a low serum folate & normal serum cobalamin?
proximal small intestinal disease
71
what is your interpretation of a normal serum folate & low serum cobalamin?
distal small intestinal disease, EPI, or dysbiosis
72
what is your interpretation of a low serum folate & low serum cobalamin?
small intestinal disease or EPI
73
what is your interpretation of a normal serum folate & serum cobalamin?
small intestinal disease is not ruled out
74
what diagnostic test evaluates intestinal absorption?
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
what animals should be supplemented with cobalamin?
serum concentrations are <400ng/L
76
how could issues with cobalamin absorption cause issues?
could be lacking intrinsic factor produced from the exocrine pancreas or you could be missing the receptors in the distal small intestine
77
how should you supplement cobalamin?
cyanocobalamin - SQ once weekly for 6 weeks & then once monthly can be used as an appetite stimulant
78
how do you give therapeutic trials diagnostic value?
performed in a logical manner with ideally only one intervention at a time
79
what are the 3 ways you can go with chronic enteropathies?
1. several diet trials - food responsive enteropathy 2. biopsy then immunosuppressant trial - immunosuppressant responsive enteropathy (IBD) 3. tylosin trial - antibiotic responsive enteropathy
80
what are the 3 general causes of adverse food reactions?
1. food allergy - hypersensitivity 2. food intolerance - metabolic, pharmacological, & idiosyncratic 3. intoxication - bacterial, fungal, or other
81
what are the 4 general options for diet trials?
1. intestinal diet 2. hydrolyzed antigen - smaller proteins, so easier to digest 3. novel protein - need a good dietary history 4. fiber supplemented
82
T/F: about 50% of dogs & cats respond to diet changes
true - tend to be younger, have large bowel diarrhea, & less severely affected
83
how long should a diet trial last?
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
what is the drug commonly started with in animals with immunosuppressant responsive enteropathy?
prednisone/prednisolone - 2mg/kg PO every day in dogs - add on cyclosporine in cats - add on chlorambucil
85
T/F: we don't know why some dogs with chronic enteropathy respond to antibiotics
true - tend to be younger, large breed dogs (especially GSD) tend to have a short lived response
86
what antibiotic is commonly used for antibiotic responsive enteropathy? how long should you treat for?
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
what are the advantages & disadvantages of pursuing an intestinal biopsy in cases of chronic enteropathy?
allows a histomorphicological diagnosis but doesn't always tell us the etiology & aggrement between different pathologists is not great
88
what are the advantages & disadvantages of doing a surgical intestinal biopsy?
advantages - whole gi tract can be assessed, fuller thickness biopsies can be collected disadvantages - invasive & less biopsies collected
89
what are the advantages & disadvantages of doing a endoscopic intestinal biopsy?
advantages - less invasive, multiple biopsies collected disadvantages - smaller/more superficial biopsies & can't sample the jejunum
90
what is stage I of the diagnostic approach to a patient with diarrhea?
rule out parasites - fecal float, direct smear, giardia antigen testing, & give fenbendazole diet trial with highly digestible diet
91
what is stage IIa of the diagnostic approach to a patient with diarrhea?
rule out metabolic disease - CBC/chem, urinalysis, baseline cortisol, ACTH stim, thyroid testing in cats
92
what is stage IIb of the diagnostic approach to a patient with diarrhea?
non-invasive tests for gi disease - serum cPLI/fTLI, serum folate/cobalamin, +/- abdominal rads/ultrasound
93
what is stage III of the diagnostic approach to a patient with diarrhea?
therapeutic trials - parenteral cyanocobalamin if needed, diet trials, antibiotic trials in dogs (tylosin or metro), +/- probiotics, prebiotics, or synbiotics
94
what is stage IV of the diagnostic approach to a patient with diarrhea?
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
what is stage V of the diagnostic approach to a patient with diarrhea?
further treatment based on histomorphological diagnosis inflammation - steroids/other immunosuppressive drugs, further diet trials, therapy for infectious agents, & chemo or surgery for neoplasia
96
what are some factors that require earlier intestinal biopsies?
PLE, severe weight loss/hyporexia, other systemic illness (lymphadenopathy or pyrexia), melena/hematemesis, & masses seen on imaging
97
if your client won't allow a biopsy, what do you need to rule out?
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
what 2 tests are used to differentiate gi small cell lymphoma & lymphoplasmacytic enteritis in cats?
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
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?
1. IBD 2. alimentary lymphoma 3. hyperthyroidism
100
what are the 3 most common causes of chronic small intestinal disease?
parasites, diet, & bacteria
101
T/F: the most common causes of chronic small intestinal disease cannot be diagnosed with biopsy
true
102
does histoplasmosis cause small or large bowel diarrhea in dogs?
large bowel!!!

SA DX & TX II (62 decks)

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