Gastro - Diarrhea Flashcards
What is diarrhea?
increased frequency, volume, or fluidity of feces
What is melena?
dark, tarry feces
What is flatulence?
excess gas
What is dyschezia?
difficult or painful defecation
What is hematochezia?
fresh blood in stool
What is tenesmus?
ineffectual straining
When does something go from acute to chronic?
if it has been over 3 weeks
Differentiate between small and large bowel diarrhea.
Small bowel diarrhea will have a large volume, weight loss, vomiting, and poor general condition associated with it
Large bowel diarrhea has less volume than small, it has mucus present, increased frequency, tenesmus, some dyschezia, weight loss, and vomiting
What type of diarrhea is this?
large bowel
What type of diarrhea is this?
small bowel
What type of diarrhea is this?
small bowel - note the melena
What type of diarrhea is this?
small bowel - large volume
What are the differential diagnoses for small intestinal diarrhea if there are no systemic signs?
Diet, helminths, Giardia, and iatrogenic
What are the differential diagnoses for small intestinal diarrhea if there are systemic signs?
Bacterial infection, viral infection, toxins/medications, hemorrhagic gastroenteritis, acute pancreatitis, foreign body obstruction, intussusception
What bacterial agents can cause acute small intestinal diarrhea with systemic signs?
Salmonella and campylobacter
What viral agents can cause acute small intestinal diarrhea with systemic signs?
Distemper, parvovirus, and panleukopenia
What diagnostic test do you want to do to confirm bacterial infection as the cause of acute small intestinal diarrhea with systemic signs?
fecal culture
What diagnostic test do you want to do to confirm viral infection as the cause of acute small intestinal diarrhea with systemic signs?
fecal antigen test
What are the differential diagnoses for acute large intestinal diarrhea?
Whipworms, Clostridia, Giardia, and Campylobacter
What diagnostic tests should you do to confirm the cause of acute large intestinal diarrhea?
fecal examination for parasites, culture
What are the differential diagnoses for extra-GI chronic small intestinal diarrhea?
Metabolic - hepatic disease, hyperthyroidism, Addison’s disease, renal insufficiency
Pancreatic - exocrine pancreatic insufficiency and chronic pancreatitis
What are the differential diagnosis for GI caused chronic small intestinal diarrhea?
Giardia infection, chronic partial obstruction, lymphangiectasia, lymphoma, food-responsive disease, inflammatory bowel disease
What are the differential diagnosis for chronic large intestinal diarrhea?
Inflammatory bowel disease, polyps, food-responsive disease, neoplasia, chronic partial obstruction, and tritrichomonas foetus in cats
What diagnostics should be done when investigating the cause of chronic diarrhea?
Fecal examination, blood work, UA, ultrasound, if no response to elimination diets then endoscopy
What tests should you consider if the diarrhea is of small intestinal origin?
Trypsin-like immunoreactivity (TLI), pancreatic lipase (PLI), cobalamin, and folate tests
What are the benefits to doing endoscopic guided biopsies?
They are non-invasive except of anesthesia, direct visualization of mucosa is possible, and it gives diagnosis in a majority of cases
What makes endoscopies difficult?
Intestinal lymphoma and lymphangiectasia
When do you want to caution doing exploratory laparotomy?
In sick animals, cats, and animals with decreased albumin levels
Why are exploratory laparotomies not recommended?
It only yields 2-3 biopsies from the stomach and small intestine, not for colonic biopsies They are more expensive and painful for the animal 20% mortality vs. 2% mortality for endoscopy
What are the main causes for chronic small intestinal diarrhea in the dog?
Food-responsive disease and Inflammatory bowel disease being the most common followed by antibiotic-responsive diarrhea and neoplasia
How will you know when a patient has food responsive diarrhea?
Their diarrhea gets better when given elimination diet or a hydrolyzed diet
When should a patient respond to an elimination diet or hydrolysed diet if they have food responsive diarrhea?
Within the first 2 weeks of the diet change
What breed of dogs is antibiotic responsive diarrhea most commonly seen in?
young german shepherd dogs
What kind of diarrhea is associated with antibiotic responsive diarrhea?
Chronic small intestinal or mixed diarrhea
What is the treatment of choice for antibiotic responsive diarrhea?
Metronidazole or Tylosin
True or False: Patients with antibiotic responsive diarrhea usually relapse.
True
What is the most common chronic enteropathy in dogs?
inflammatory bowel disease
What is the most common finding on histopathology of inflammatory bowel disease?
Lympho-plasmacellular
What can also be found on histopathology (they are rare)in IBD cases?
Eosinophilia and ulcerative colitis (only large intestine, in boxers)
What is the sequential treatment protocol for chronic enteropathies/IBD in dogs?
Elimination diet
Then Metronidazole or Tylosin for 3-4 weeks
Then Biopsies
If there is an inadequate response to the sequential treatment protocol in dogs, what should be done next?
Prednisolone at 2.2 mg/kg/day for at least 10 days and then taper the dose
If steroids are poorly tolerated or unsuccessful in dogs, what is the next step?
Give azathioprine or cyclosporine
How is IBD treated in cats?
Elimination diet, then prednisolone 2 mg/kg/day for 10-14 days, then slow taper. If there is no response to Chlorambucil Do not forget Cobalamin supplementation
In a general sense, what is protein losing enteropathy?
A syndrome of intestinal diseases that leads to non-selective protein loss - albumin and globulins are low
What are the causes of protein losing enteropathyies?
IBD, lymphangiectasia, and Neoplasia (lymphoma)
How do patients with protein losing enteropathies present?
Diarrhea, vomiting, anorexia, weight loss, ascites, pleural effusion, peripheral edema, and usually albumin and globulin serum concentrations are low
What is an important diagnostic tool that should be done in patients that you suspect to have protein losing enteropathies?
biopsies
