Gastroenterology - Diarrhea Flashcards
Describe the two types of diarrhea
osmotic - absorption of water dependent on solutes
- solutes not absorbed = water remains in lumen
secretory - secretion of water into lumen exceeds reabsorption
What are the effects on infection on the GIT?
- disruption and destruction of epithelium
- water and nutrients not effectively absorbed
- exudation of serum and blood with destruction
What are the effects of inflammation on the GIT?
- inflammatory cytokines induce secretions
- high rate loss of epithelium resulting in malabsorption
- fibrosis and loss of functional cells
What is the effect of decreased motility on the GIT?
decreases absorption of nutrients
What are the possible causes of melena?
- ingestion of blood
- GI erosion/ulceration
- immune-mediated thrmbocytopenia
- foreign body
- coagulopathies
- neoplasia
- drug-induced
- vascular anomaly
- paraneoplastic
- organ disease
- inflammation
What can be seen on physical exam in a dog with diarrhea?
- abdominal pain +/- distension
- peripheral edema
- coat color change
- muscle wasting
- enlarged lymph nodes
- thickened intestines
- dehydration
- signs of systemic illness
What diagnostics should be run for a systemically well dog with acute diarrhea?
Big 4/QATS
Fecal
How is a systemically well dog with acute diarrhea treated?
- usually self-limiting
- symptomatic therapy
Which physical exam finds would be of concern in a systemically unwell dog with diarrhea?
- abdominal palpation abnormal
- significant hematochezia or melena
- dehydration
- weight loss
What diagnostics should be done for a systemically unwell dog with diarrhea?
- QATS/Big 4 + blood smear
- BP, CBC, chem, UA, fecal
- abdominal imaging
What are possible abnormalities seen on CBC with diarrhea?
- anemia
- thrombocytosis (blood loss)
- leukopenia, leukocytosis, or circulating neoplasia
- eosinophilia
What are the possible abnormalities seen on serum chemistry with diarrhea?
- hypoproteinemia +/- hypocholesterolemia
- hyperglobulinemia
- hypo/hypercalcemia
- hypoglycemia
- hyponatremia with hyperkalemia
What can be done for fecal analysis?
- direct smear with saline
- stained smear slide +/- rectal scrape
- zinc centrifugation
- parvovirus SNAP test
What is measured on a GI panel?
- B-12
- Folate
- Trypsin-like Immunoreactivity
- Pancreatic Lipase Immunoreactivity
When might antithrombin be decreased?
malabsorptive GI disease
What might low B-12 indicate?
malabsorption or bacterial competition
What might high folate indicate?
Low folate?
- high: bacterial dysbiosis
- low: malabsorption
What might low TLI indicate?
exocrine pancreatic insufficiency
What might high TLI indicate?
- pancreatitis
- emaciation
- renal disease
- small intestinal disease
What does hight PLI indicate?
pancreatitis
What does PLI measure?
lipase of specific pancreatic origin
What are the therapy options for diarrhea?
- fluids
- fiber
- diet modification
- antibiotics
- vitamins
- steroids
- immune modulation
- probiotics
- prebiotics
When are antibiotics indicated for treatment of diarrhea?
chronic diarrhea
hematochezia
Which antibiotics are used for diarrhea?
Metronidazole or Tylosin
More serious: Unasyn, Clavamox, Enrofloxacin
Which vitamins are supplemented to treat diarrhea?
- Folic acid/Folate/Bp
- Injectable B-12
Which steroids are used in the treatment of diarrhea?
- Prednisone/Prednsiolone
- Dexamethasone
- Budesonide
What are the features of Budesonide?
- topical activity
- less systemic side effects
- more potent than pred
- needs to be compounded
What drugs are used for immune modulation and what are their actions?
Atopica/cyclosporine - reduces cell mediated immune response
Azathioprine - inhibits lymphocyte activation/proliferation (do not used in cats)
Chlorambucil - cross links cellular DNA (anti-neoplastic)
What are the effects of Bismuth Subsalicylate?
anti-microbial, weak antacid, anti-secretory, and anti-inflammatory
What are probiotics and their effects?
living organisms
- improve epithelial barrier function
- modulate mucosal immune system
- alter intestinal flora
What are prebiotics and their effect?
non-digestible carbohydrates
- stimulate growth and metabolism of protective bacteria
