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Small Animal Medicine: Exam 2 (Spring 2016) > L21: Diagnostic Approach To Chronic Diarrhea (Gallagher) > Flashcards

L21: Diagnostic Approach To Chronic Diarrhea (Gallagher) Flashcards

1
Q

Organizing the differential list

A
  • systemic vs. GI dz
  • based on signalment, hx, and PE
  • if small bowel, can be maldigestion (EPI) or malabsorption (non-PLE or PLE)
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2
Q

Major causes of MALABSORPTIVE small bowel dz in DOGS

A
  • dietary responsive (allergy or intolerance)
  • parasites (Giardia, nematode)
  • Abx responsive diarrhea
  • IBD
  • neoplasia (LSA, Carcinoma, Leiomyosarcoma)
  • Fungal (Pythium, Histoplasma)
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3
Q

Major causes of MALABSORPTIVE small bowel dz in CATS

A
  • dietary responsive (allergy or intolerance)
  • parasites (Giardia)
  • IBD
  • neoplasia (LSA, small cell or lymphoblastic)
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4
Q

Specific things to assess on PE:

A
  • General attitude
  • body condition/muscle score
  • abdominal effusion
  • PLN
  • thickened GIT/lymphadenopathy
  • rectal exam (look for perianal fistula, thickening of colon, etc.)

*dogs with PLE may have weight loss more in muscle than fat

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5
Q

Major causes of PLE in DOGS

A
  • intestinal lymphangiectasia
  • lymphoma
  • severe IBD
  • fungal (pythium, histoplasma)
  • GI hemorrhage (ulceration/erosion, neoplasia, parasites)
  • massive hookworm/whipworm infection
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6
Q

Major causes of PLE in CATS

A
  • GI lymphoma
  • severe IBD
  • GI hemorrhage (neoplasia, ulceration)
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7
Q

Major causes of Large Bowel Dz in DOGS

A
  • dietary responsive (allergy or intolerance)
  • fiber-responsive colitis
  • irritable bowel syndrome (functional)
  • parasites (whips, Giardia)
  • bacterial dz (Clostridium, histiocytic ulcerative colitis)
  • Fungal (Pythium, histoplasma)
  • IBD
  • Neoplasia (carcinoma, lymphoma)
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8
Q

Major causes of Large bowel dz in CATS

A
  • dietary responsive (allergy or intolerance)
  • fiber-responsive colitis
  • IBD
  • tritrichomonas
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9
Q

Giardia vs. Tritrichomonas appearance on saline smear

A

Giardia: “falling leaf” pattern, only see 2-3 per slide
Tritrichomonas: independently motile, see many per slide, most common in cats

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10
Q

Types of fecal exams

A

Flotation
Direct saline smear (for Tritrich. And Giardia)
Fecal cytology - look for spirochetes (campylobacter), Clostridium
Rectal cytology
Giardia ELISA
InPouch TF culture (for Tritrichomonas; largely replaced by PCR)

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11
Q

Major causes of PLE in DOGS

A
  • intestinal lymphangiectasia
  • lymphoma
  • severe IBD
  • fungal (pythium, histoplasma)
  • GI hemorrhage (ulceration/erosion, neoplasia, parasites)
  • massive hookworm/whipworm infection
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12
Q

Major causes of PLE in CATS

A
  • GI lymphoma
  • severe IBD
  • GI hemorrhage (neoplasia, ulceration)
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13
Q

Major causes of Large Bowel Dz in DOGS

A
  • dietary responsive (allergy or intolerance)
  • fiber-responsive colitis
  • irritable bowel syndrome (functional)
  • parasites (whips, Giardia)
  • bacterial dz (Clostridium, histiocytic ulcerative colitis)
  • Fungal (Pythium, histoplasma)
  • IBD
  • Neoplasia (carcinoma, lymphoma)
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14
Q

Major causes of Large bowel dz in CATS

A
  • dietary responsive (allergy or intolerance)
  • fiber-responsive colitis
  • IBD
  • tritrichomonas
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15
Q

Giardia vs. Tritrichomonas appearance on saline smear

A

Giardia: “falling leaf” pattern, only see 2-3 per slide
Tritrichomonas: independently motile, see many per slide, most common in cats

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16
Q

Types of fecal exams

A

Flotation
Direct saline smear (for Tritrich. And Giardia)
Fecal cytology - look for spirochetes (campylobacter), Clostridium
Rectal cytology
Giardia ELISA
InPouch TF culture (for Tritrichomonas; largely replaced by PCR)

17
Q

IDEXX RealPCR diarrhea panel tests for:

A
  • Clostridium perfringens
  • Salmonella spp.
  • Cryptosporidium spp.
  • Giardia spp.
  • Toxoplasma gondii
  • Canine Enteric Coronavirus
  • Felive Coronavirus (FeCoV)
  • Canine parvovirus
  • Feline panleuk
  • Canine Distemper

*caution: very sensitive and can have false positives

18
Q

Soft-coated wheaton terriers can get PLE and PLN at the same time

A

:)

19
Q

Lymphangiectasia –> lymphopenia

Chronic GI dz/inflammation–> thrombocytosis

A

:)

20
Q

If you determine patient has PLE with albumin

A

Do intestinal biopsy

21
Q

If patient has NON-PLE, what should you do next?

A

Serum Trypsin-like immunoreactivity (TLI) test to differentiate between small bowel dz and EPI

(Esp. Do TLI test if dog has rapid appetite, losing weight, has large voluminous diarrhea)

22
Q

Normal pancreatic exocrine enzyme lvl (on TLI test)

A

5-45

23
Q

Cobalamin/Folate Dx test

A
  • previously used for dx of SIBO
  • low concs. Of Cobalamin assoc. with chronic enteropathy, GI dz in cats
  • often won’t get resolution of CS w/o supplementing Cobalamin
24
Q

Diagnostic imaging

A

Rads:

  • plain films rarely used but can ID chronic FB/focal obstruction
  • contrast films can ID masses not palpable, chronic partial obstructions

US: rarely provides definitive dx

25
Q

Biopsy for diarrhea patients

A
  • usually last dx test
  • exclude other causes first, unless p has low albumin or severe CS

-use endoscopy to get biopsies; can only go down to proximal duodenum or up to ileum

26
Q

Other dx tests for diarrhea patients

A
  • Ex lap: can get to jejunum

- laparoscopy: minimally invasive, can get full thickness GI biopsy and biopsy other organs

27
Q

ARD

A

Anabolic responsive diarrhea

Small Animal Medicine: Exam 2 (Spring 2016) (13 decks)

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