Internal Medicine: Gastroenterology: Approach to Chronic Diarrhoea and Constipation Flashcards
What are the DDXs dor alimentart and systemic diseases that causes diarrhoea?
Alimentary
* Adverse reactions to food
* Inflammatory bowel disease
* Antibiotic-responsive
* Lymphangiectasia
* Lymphoma/tumours
* Infectious
* Partial obstructions
Systemic diseases
* Liver disease
* Renal disease
* Pancreatic disease
* Endocrine- addisons, diabetes, hyperthyroidism
What should be done on history and physical examination of diarrhoea?
- Detailed history- GI signs, systemic signs, diet history, vaccine
- Classify GI signs- verify vomiting, classify diarrhoea, grade
- Examine- oral cavity, abdominal palpatoin, rectal examination
Look under tongue for linear foreign body
What is melaena?
What is haematochezia?
Melaena- black coloured stool, GI bleeding
Haematochezia- fresh blood in faeces
What are the characteristics of small intestinal diarrhoea?
- Increased volume
- Colour change
- Normal to slight increase in frequency
- ±weight loss
- ±flatulence, borborygmi, halitosis
What are the characteristics of large intestinal diarrghoea?
- Decreased volume
- Increased frequency
- Urgency and tenesmus
- Mucus and haematochezia
- Dyschezia
- Constipation ± variable consistency
- No weight loss
Can be diffuse
What is melaena a sign of?
Upper GI disease
What is required for colonoscopy?
- Starve for 48 hours
- 3 doses, 4 hours apart of poly-ethylene glycol- stomach tube
- 2 warm water enemas
What therapies can only be used for large intestine disease?
- Supplement fibre
- Sulfasalazine
What lab tests can be done?
Faecal analysis-
* Parasites- giardia, crypto, tritrichomonas foetus (cats)
* Bacteria- salmonella, campylobacter
Haematology, Biochem, Urinalysis
* liver disease
* Kidney disease
Endocrine tests
* ACTH stim test- hypoadreno
* Total thyroxine- hyperthyroidism
Trypsin-like immunoreactivity- TLI
* Exocrine pancreatic insuffiency
Total lipase or pancreatic lipase
* Possible pancreatitis
Folate and cobalamin
* Malabsorption
What is radiograhy good for?
- Foreign body
- Masses
- Obstructions
What are ultrasounds good for?
- Identify intestinal masses
- Lymph nodes
- Assess wall layering
What are the different biopsy procedures?
Endoscopy
* Minimally invasive and direct examination
* Requires equipment and expertise
* Small superficial samples from limited region
Coeliotomy
* Multiple full-thickness biopsies
* Surgical risk
* Best for cats
What can be diagnosed from biopsy?
Non-specific- normal/mild inflamm
* Adverse reaction to food
* Antibiotic-responsive
* IBD
Moderate-severe inflammtion
* IBD
Lymphoma
Lacteal dilation
* Lymphangiestasia
* Secodnary to another disease
How can therapy aid diagnosis?
- Diet- food responsive
- Antibacterial- antiobiotic responsive
- Steroids- IBD
- Cytotoxics- Severe IBD or lymphoma
What is constipation?
Difficult, incomplete or infrequent evacuation of dry hardened faeces from the bowel
What are the different aetiologies and causes of constipation?
