L9: Clinical Approach to Chronic Diarrhea Flashcards
major causes of chronic diarrhea in DOGS
IBD (plasmocytic, lymphocytic, eosinophilic) Antibiotic Responsive D Food Responsive Disease (FRD) Parasites Lymphangiectasia EPI Intestinal neoplasia Fungal disease
major causes of chronic diarrhea in CATS
IBD (plasmocytic, lymphocytic, eosinophilic) Diffuse intestinal tumor FRD ARD Viral infections intestinal parasites
components of chronic diarrhea Hx**
duration diet progression environment appetite fecal appearance frequency vomiting? (suggests disease of upper GIT) tenesmus? (suggests involvement of distal rectum, colon or anus) body weight and condition
Q: 1yo MC Shih Tzu with 2mo. hx of small bowel diarrhea. Eating well. Not on HWP. Goes to dog park. Top differential?
A: parasites
Q: 12yo MC Shih Tzu has 1 mo hx of small bowel diarrhea and weight loss (20%). Poor appetite. Top differential?
A: Neoplasia
clinical association to dehydration
diarrheal fluid loss (d,v)
clinical association to depression/weakness
electrolyte imbalance, debilitation
clinical association to emaciation/malnutrition
protein calorie malnutrition
clinical association to pallor (anemia)
GI blood loss, anemia of chronic disease
clinical association to edema/effusion
PLE
clinical association to thickened bowel
infiltrative disease
clinical association to mesenteric lymphadenopathy
reactive, neoplasia, infiltrative disease
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Fecal exam methods
- Microscopic: centrifuge, saline smear (looks for progressively motile org.), cytology (histoplasmosis, lymphoma)
- Culture
- check for C. perfringens
- Giardia, Tritrichomonas
- PCR Panel (neg. result doesn’t exclude parasites!)
- canine alpha1 proteinase inhibitor test (detects protein in blood leaked into the GIT; can get false positives)
Hematologic findings in chronic diarrhea
- MOST normal
- neutrophilia
- monocytosis
- eosinophilia (may also be seen with Addison’s)
- lymphopenia
- erythrocytes/MCV
clinical association to panhypoproteinemia
PLE, hemorrhage
clinical association to dec. Ca
hypoalbuminemia
clinical association to inc. liver enzymes
reactive hepatopathy, IBD, hyperthyroidism
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Dx/Tx for Food Responsive Disease
Diet Trials
- serum food allergy testing unreliable
- need 2-6wk tx period
Antibiotic Responsive Disease
- SIBO? Intestinal dysbiosis?
- results from inc. or altered bacteria, abnormal host response
- common in GSDs
Dx of Antibiotic Responsive Disease
Cobalamin/folate
-cobalamin def. seen commony in GI dz (esp in cats); low conc. assoc. with tx failure
what can lead to cobalamin def. in dogs?
ileal disease
what can lead to cobalamin def. in cats?
low intrinsic factor (IF) (made in pancreas of cats, released into stomach)
