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?
What is the treatment for constipation?
- Remove underlying cause
- Oral laxitives- lactulose
- Enemas
- Oral polyethylene glycol
- Gentle manual evacuation under anaesthetic
- Surgery
- Dietary managment- high fibre
