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3. Cat & Dog > Gastroenterology, Pt. 5 > Flashcards

Gastroenterology, Pt. 5 Flashcards

1
Q

Diarrhea; what is it? general properties

A
  • Abnormal fluidity and/or frequency of fecal discharges
  • Increased fecal water content
    > Amount of fluid delivered by ileum > colonic absorptive capacity
    > Increases fecal fluidity and/or volume (also from non-digestive content)
  • Increased frequency of defecation
    > Due to increased fluidity and/or volume
    > And/or primary alterations of motility
  • Enterosystemic cycle of fluid absorption and secretion
    >- >98% of all fluid absorbed, most in jejunum, best in colon
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2
Q

MECHANISMS OF DIARRHEA (4)

A

1) Osmotic (villi)
2) Secretory (crypts)
3) Increased permeability (exudative)
4) Altered motility

  • Disruption of enterosystemic cycle
  • More than one mechanism often involved
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3
Q

osmotic diarrhea - how does it occur?

A

(villi)
* Unabsorbed nutrients (dietary overload, maldigestion, malabsorption), bacterial products

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4
Q

Secretory diarrhea - how does it occur?

A

(crypts)
* Bacterial enterotoxins, prostaglandins (inflammation), fatty acids

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5
Q

Increased permeability - how does it occur?

A

(exudative)
* Ulceration, inflammation, or neoplastic infiltration lead to leakage of fluid and ions ± proteins and red cells

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6
Q

Altered motility diarrhea - how does it occur?

A
  • Increased peristalsis (primary rare), may occur as a consequence of increased fecal volume
  • Decreased segmental contractions (common)
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7
Q

SMALL VS LARGE BOWEL DIARRHEA - why differentiaite?

A
  • Severity of illness
    > Takes less disease to cause large bowel diarrhea
  • Differential diagnoses
  • Where to biopsy
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8
Q

small vs large bowel diarrhea:
frequency

A

small: N to slight ­up
large: up to super up

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9
Q

small vs large bowel diarrhea:
volume

A

small: N to slight up
large: down

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10
Q

small vs large bowel diarrhea:
mucous

A

small: no
large: likely

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11
Q

small vs large bowel diarrhea:
fecal blood

A

small: melena
large: hematochezia

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12
Q

small vs large bowel diarrhea:
steatorrhea

A

small: possible
large: no

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13
Q

small vs large bowel diarrhea:
borborygmus

A

small: possible
large: unlikely

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14
Q

small vs large bowel diarrhea:
tenesmus/dyschezia

A

small: no
large: common

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15
Q

small vs large bowel diarrhea:
attitude

A

small: more depressed
large: less depressed

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16
Q

small vs large bowel diarrhea:
hydration

A

small: more dehydrated
large: less dehydrated

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17
Q

small vs large bowel diarrhea:
weight loss (if chronic)

A

small: probable
large: uncommon

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18
Q

small vs large bowel diarrhea:
appetite (if chronic)

A

small: increased or decreased
large: often normal

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19
Q

bristol stool chart: what does it tell us

A

way of scoring poop based on texture
- 1 super hard balls, 7 liquid
- 4 is best

20
Q

purina fecal score - what does it tell us

A

1 is hard lumps, 7 is liquid
- 2 is best

21
Q

ACUTE COLITIS
¡ Differential diagnoses:

A

¡ Dietary change
> May also cause acute enteritis (small bowel)
¡ Clostridium perfringens, C. difficile?
¡ Giardia, Whipworms (Trichuris)
¡ Idiopathic (often recurrent)
> Irritable bowel syndrome (IBS)
> “stress-induced colitis”
¡ Acute pancreatitic colitis

22
Q

ACUTE COLITIS: TREATMENT

A
  • Same decision criteria as with acute vomiting, but hematochezia is not as much of a concern as melena or hematemesis
  • Treatment of acute diarrhea: 3 “S”
    > Supportive, symptomatic, specific
  • Fluid therapy
    > Fluid losses occur via osmosis, secretion, exudation
    > if dog is still drinking and normally hydrated no treatment given
  • Dietary restriction/change
  • Do not routinely use “typical antibiotics [e.g. amoxicillin]” with simple acute diarrhea
  • Motility modifiers
  • Adsorbents
  • Anti-inflammatory agents
  • consider deworming if history of colitis without dietary change
23
Q

what type of dietary change would we recommend for colitis treatment

A
  • “Bland diet” – no spices
  • Highly digestible – max number of nutrients absorbed in small intestine
  • Absorptive surface disturbed, so want to reduce osmotic effect
  • Want to decrease secretion from bacterial action on nutrients
  • Proteins with high biological value
  • Fats often reduced although highly digestible
  • Complex carbohydrates – cooked white rice highly digestible
  • Low fibre
  • Commercial GI foods
  • Home-made: rice, cottage-cheese, boiled chicken
24
Q

do we usually use antibiotics to treat acute colitis? which ones? why? drawbacks?

A

¡ Do not routinely use “typical antibiotics [e.g. amoxicillin]” with simple acute diarrhea > Metronidazole or tylosin

  • Metronidazole and tylosin have been frequently used in the management of chronic & recurrent idiopathic colitis
    > Effect on GI microbial flora (treatment for dysbiosis)
    > Effect on specific pathogens (Clostridium spp.)
    > Local anti-inflammatory and immunosuppressive effects
    > However, can promote dysbiosis and reductions of essential bacteria*
  • Some animals receive long-term therapy
25
Q

are antibiotics for acute colitis encouraged? why?

A
  • Short-term use may actually cause long-term dysbiosis
  • Routine use being discouraged
  • Most acute diarrhea resolves without use of antibiotics
  • If compelled to give a treatment, consider a probiotic
26
Q

what is normal gut motility? in most cases of diarrhea how is this altered? what drug is not reccomended and what is sometimes used?

A

¡ Normal motility is rhythmic segmentation and peristalsis
¡ In most cases of diarrhea the bowel is hypomotile
¡ Anticholinergics not usually recommended
¡ Loperamide (Imodium) increases segmentation and decreases peristalsis
* Used most to relieve discomfort of acute colitis

27
Q

Adsorbents used for acute colitis? what do they do?

A

¡ Kaolin (Kao-Pectate), bismuth (Pepto-Bismol), barium
¡ Bulk up feces
¡ Some protectant and bacterial toxin adsorbing effects

28
Q

Anti-inflammatory agents used to treat acute colitis? what can we use and what else does it do? what should we avoid?

A

¡ Bismuth subsalicylate (Pepto-Bismol): anti-inflammatory, anti-secretory, and antibacterial effects
¡ Other NSAIDS not recommended

29
Q

Stools liquid, red, strong odour, frequent
> what kind of disease?

A

acute bloody enteritis

30
Q

viral causes of acute bloody enteritis

A
  • Parvovirus
  • Coronavirus
31
Q

bacterial causes of acute bloody enteritis

A
  • Campylobacter (zoonotic concern)
  • Salmonella (zoonotic concern)
  • Salmon poisoning [Neorickettsia helminthoeca] (West coast)
32
Q

what is bacterial acute bloody enteritis also called?

A
  • Acute Hemorrhagic Diarrhea Syndrome (AHDS) (previously
    Hemorrhagic Gastro-Enteritis [HGE])
  • Peracute bloody diarrhea
33
Q

what breeds are overrepresented when it comes to bacterial acute bloody enteritis?

A

Small breeds over-represented
vEspecially Yorkie, Min Pinscher, Min Schauzer, Maltese

34
Q

PCV in bacterial acute bloody enteritis

A
  • PCV > 57%, low total protein
    > In other disorders of volume loss and dehydration PCV and TP move in same direction
35
Q

bacterium implicated in bacterial acute bloody enteritis, and why

A

Caused by Clostridium perfringens?
* Type A toxins NET E & NET F cause ulceration (bleeding) and vascular permeability

36
Q

helminths that can cause acute bloody enteritis

A
  • Ancylostoma (hookworms)
  • Strongyloides stercoralis
36
Q

poisonings that can cause acute bloody enteritis

A

¡ NSAIDS
¡ Lead

37
Q

Extra-GI disease that can cause acute bloody enteritis

A

¡ Extra-GI disease (acute GI ulceration, coagulopathy)
¡ Acute kidney injury, acute liver failure, acute pancreatitis, hypoadrenocorticism
¡ DIC

38
Q

can foreign body cause acute bloody enteritis?

A

yes

39
Q

should we always do a work up for acute bloody enteritis?

A

yes
¡ Work-up always indicated*

40
Q

what should our workup for acute bloody enteritis be?

A

¡ Blood-work (CBC, biochemistry, testing for hypoadrenocorticism)
¡ Fecal testing:
> Fecal flotation
> Parvovirus testing (if applicable)
> Giardia ELISA
¡ Abdominal imaging

41
Q

if we run a parvo test for acute bloody enteritis and its negative, what should we condier?

A

¡ Consider fecal culture for pathogens if Parvo negative

42
Q

what type of test can we use for parvovirus?

A

SNAP Parvo Antigen Test (IDEXX)
- Detects all genotypes CPV-2
> CPV-2a, CPV-2b, CPV-2c
> Negative up to day 3 post-exposure
- Detects feline parvovirus
> Negative up to day 5 post-exposure

43
Q

DIAGNOSTIC IMAGING for acute bloody enteritis? is it often done, when and why? main value?

A
  • Abdominal imaging often unrewarding if main problem is acute diarrhea
  • Not routinely performed if straightforward diagnosis of parvoviral enteritis
  • The more severe the diarrhea, sicker the animal, and the more open the diagnosis, the more likely imaging is performed
  • Main value is to:
    > Investigate/characterize extra-GI problems > Rule out heavy metal
    > Rule out foreign body or intussusception
44
Q

radiographic Findings consistent with enteritis

A
  • Functional ileus – gas and fluid
    distention
  • Contrast – delayed GI transit
  • Ultrasound – functional ileus, ± intestinal thickening, ± speckling of mucosa (necrosis)
45
Q

TREATMENT for acute bloody enteritis?

A
  • Fluid therapy
  • Antiemetics
  • Diet
    > As with pancreatitis, fasting replaced with aggressive antiemetic therapy and early feeding to promote more rapid intestinal recovery
  • IV dextrose if hypoglycemic
  • antibiotics, usually indicated
46
Q

use of antibiotics for acute bloody enteritis?

A
  • Usually indicated with hemorrhagic enteritis
  • Severe small intestinal mucosal damage
    > Hemorrhagic exudate indicates an ~10,000X ­increase in permeability
  • Provide prophylaxis against bacteremia and bacterial translocation
    > Ex β-lactam and/or fluoroquinolone, cefoxitin
  • Colorado State University trial for parvo where major cost restrictions
    > Convenia (cefovecin), Cerenia (maropitant), SC fluids
  • If primary bacterial, base on culture and sensitivity

3. Cat & Dog (33 decks)

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