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SAMS 1 > Lecture 13: Diarrhea I > Flashcards

Lecture 13: Diarrhea I Flashcards

1
Q

define diarrhea

A

increase in the frequency, volume and/or fluidity of feces

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2
Q

diarrhea occurs when:

A
  1. An increase in water content in SI overwhelms LI absorption capacity
  2. Water content increases in the LI
  3. Or both
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3
Q

describe the volume, frequency, urgency, mucus, tenesmus, melena or hematochezia, weight loss and vomiting associated with small bowel diarrhea

A
  1. Large volumes
  2. No change in frequency
  3. No urgency
  4. No mucus
  5. No tenesmus
  6. Melena
  7. Weight loss
  8. Vomiting
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4
Q

describe the volume, frequency, urgency, mucus, tenesmus, melena or hematochezia, weight loss and vomiting associated with large bowel diarrhea

A
  1. Small volumes
  2. Increase frequency
  3. Urgency
  4. Mucus
  5. Tenesmus
  6. Hematochezia
  7. No weight loss
  8. No vomiting
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5
Q

what are some bacterial causes of acute diarrhea

A

Salmonella, E. Coli, C. Perfringes, C. Difficle, campylobacter

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6
Q

how are bacterial enteritides transmitted

A

fecal-oral or food poisoning

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7
Q

t or f: salmonella, clostridial spp, E. Coli and campylobacter can be found in the feces of healthy patients

A

true

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8
Q

what is the mechanism of diarrhea caused by Salmonella, E. Coli, C. Perfringes, and campylobacter

A

enterocyte tight junction disruption—> increased permeability

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9
Q

what is the mechanism of diarrhea caused by Salmonella, E. Coli, C. Difficle and campylobacter

A

damage and invasion of enterocytes—> malabsoprtive

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10
Q

what bacteria has toxins that upregulate enterocyte electrolytes and H20 secretion—> secretory diarrhea

A

E. Coli

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11
Q

what are the clinical signs of bacterial enteritides and localize diarrhea

A

none, sudden onset large or mixed bowel diarrhea, hematochezia common, dehydration

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12
Q

t or f: bacterial enteritides often self limits without antibiotics in 1-2 weeks

A

true

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13
Q

what risk factors are associated with bacterial enteritides

A
  1. Raw diets
  2. Dietary indiscretion
  3. Young
  4. Immunosuppression
  5. Recent abx use
  6. Diet changes
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14
Q

how do you dx bacterial enteritides and what are their limitations

A
  1. Fecal culture- risk of contamination or commensals
  2. Fecal PCR: does not mean bacteria is producing toxin or alive
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15
Q

t or f: fecal cytology is a recommended diagnostic tool for bacterial enteritides

A

false

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16
Q

what is the main goal in treating animals with bacterial enteritides

A

support the patient but avoid unnecessary abx use

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17
Q

what scenarios should you consider testing for bacterial causes of diarrhea

A
  1. Severe, acute, systemic disease after known exposure
  2. No improvement on supportive tx for 3-4 weeks
  3. Diarrhea outbreak in shelter or litter of neonates
  4. Zoonosis
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18
Q

when should you consider antibiotic for bacterial enteritides

A
  1. Sepsis
  2. Bacterial translocation and systemic colonization
  3. Severe disease
  4. No improvement after 3-4 weeks supportive care
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19
Q

what is abx tx for salmonella

A

ampicillin and fluoroquinolone IV

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20
Q

what is abx tx for campylobacter

A

macrolide and fluorquinole

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21
Q

what is abx tx for clostridium

A

metronidazole, erythromycin, tylosin, amoxicillin or ampicillin

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22
Q

what signs are consistent with acute hemorrhagic diarrhea

A

acute severe large or mixed bowel diarrhea with hematochezia, vomiting, anorexia, depression, diarrhea is “raspberry jam” consistency

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23
Q

what lab work finding is consistent with acute hemorrhagic diarrhea syndrome

A

extreme hebmoconcentraiton PCV >60% with normal TP

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24
Q

With acute hemorrhagic diarrhea syndrome there is acute __ and __ inflammation

A

mucosal necrosis and neutrophilic inflammation

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25
what bacteria is associated with acute hemorrhagic diarrhea syndrome
C. Perfringes enterotoxin
26
what is tx for acute hemorrhagic diarrhea syndrome, do they require abx
1. Supportive care Do not require abx
27
what is prognosis for acute hemorrhagic diarrhea syndrome
good if aggressive management
28
episode of acute hemorrhagic diarrhea syndrome patients have higher risk of ___. Why?
chronic enteropathies due to severe mucosal injury—> expose GALT to luminal antigen and immune sensitization
29
what viral enteritides cause severe disease and what is localization
1. Parvo 2. Panleukopenia 3. FeLV 4. Distemper Small to mixed bowel diarrhea
30
how is parvo transmitted
Fecal-oral and fomites
31
maternal antibodies provide protection from parvo until __ weeks
12-14 weeks
32
what is pathogenesis of parvo
1. Tropism for rapidly diving cells—> thymus, BM, WBC precursor cells—> panleukopenia 2. Targets GI epithelial crypt cells—> malabsorptive diarrhea and mucosal permeability
33
t or f: canine parvovirus has high risk of bacterial translocation and sepsis
true
34
what are the signs of parvo
fever, vomiting, small bowel diarrhea—> mixed with hematochezia, sepsis, MOD, hypovolemic shock, death
35
what lab work abnormalities are seen with canine parvo and what are the risks
1. Hypoglycemia—>seizures 2. Leukopenia +/- anemia—> immunosuppression 3. Hypokalemia 4. Hypoalbunemia—> effusion
36
parvovirus often has co-infection with __
acarids
37
what is a major adverse effect/risk of parvovirus after infection
intussusception
38
how do you dx parvo
ELISA parvo antigen test (SNAP) Fecal PCR
39
what is appropriate inpatient tx of parvo
1. Fluids- balanced crystalloids or colloids if hypoalbuminemia 2. IV dextrose and KCl 3. IV antibiotics due to septic risk- beta lactams ( unasyn, cefoxitin), aminoglycosides 4. Analgesia 5. Antiemetic therapy- odansetron, cerebra, metoclopramide 6. Enteral feeding, NG tube 7. Appetite stimulants: miratazapine, capromorelin
40
What are the parameters checked to see if patient qualifies for outpatient tx of parvo
must have < 5 of the following 1. Cold extremities 2. Poor pulse quality 3. >8% dehydration 4. HR >180 5. CRT >2 6. Obtunded 7. Temp >103 or < 98
41
what BG would indicate tx with Karo syrup in parvo patient
<80
42
what is tx for outpatient therapy for parvo
1. Cefovecin 2. Cerenia 3. Pyrantel pamoate once no longer vomiting 4. Karo syrup 5. Metoclopramide 6. Odansetron
43
why are parvo pets receiving outpatient treatment not allow to go outside
shed in feces for 4 weeks and survives in environment for 5-7 months
44
during parvo outpatient recheck appointment if patient is painful what can you give
buprenorphine
45
what is mortality rate of parvo not tx, survival rate for inpatient tx, and outpatient tx
Mortality not tx: 90% Inpatient survival: 90% Outpatient survival: 86%
46
what is the new monoclonal antibody tx for parvo and who is it approved for
one time injection of canine anti-parvo antibodies Approved for dogs >8 weeks
47
how do you dx feline panleukopenia
1. Fecal ELISA antigen for parvo
48
t or f: most feline panleukopenia infections are Subclinical
true
49
what is the per acute of panleukopenia
depression and death from septic shock within 12hrs
50
what are the acute signs of feline panleukopenia
vomiting, small bowel diarrhea—> mixed, hematochezia, fever, leukopenia
51
what happens if cats are infected in utero with feline panleukopenia
cerebellar hypoplasia
52
what is survival rate for panleukopenia
21-50%
53
what are some negative prognostic indicators for panleukopenia
low body weight, total leukopenia, hypothermia, Hypoalbunemia, hypokalemia
54
What is vaccination schedule for parvo and panleukopenia
1. 1st vaccine at 4-6 weeks 2. Booster q4 weeks until 14-16 weeks 3. Booster at 1yr and then q3 years
55
what is environmental decontamination for parvo and panleukopenia
bleach
56
what is pathogenesis for distemper
1. Oronasal exposure 2. Spread to immune cells 3. Trophism for epithelial cells and CNS (GIT, RT, skin, eyes, neurons and atrocytes)
57
what are the signs of distemper
fever, malaise, URI, pneumonia, conjunctivitis, uveitis, vomiting, mucoid or hemorrhagic diarrhea, leukopenia, anemia, hyperkeratosis of nose and footpads, neurologic signs
58
what neurologic signs are associated with distemper
myoclonus, seizures, paresis, ataxia, hypermetria
59
what are CBC/chem findings for distemper
anemia, lymphopenia, panleukopenia, neutrophilia, left shift
60
how do you dx distemper
PCR
61
t or f: PCR for distemper can’t distinguish between vaccine and infection
true
62
dog presents with upper respiratory signs and foot pad keratosis, the following cytology was performed. What wrong
distemper- viral inclusions in RBC
63
what is tx for distemper
similar to parvo + anticonvulsants, oxygen supplementation
64
what is vaccine schedule for distemper
1. 1st vaccine at 6-8 weeks 2. Booster q1 month until 16 weeks 3. Booster at 1yr and then q3 years
65
worms cause small or large bowel diarrhea
small/mixed
66
Protozoa cause small or large bowel diarrhea
small/mixed
67
parasites cause small or large bowel diarrhea
large bowel
68
patient presents with vomiting, diarrhea, lethargy. Blood work shows hyponatremia, hyperkalemia, eosinophilia. ACTH stim test negative for Addison. What parasite can cause this presentation
whipworms
69
what is tx options for giardia
1. Drontal plus: fenbantel, pyrantel pamoate, praziquantel 2. Fenbendazole 3. Metronidazole 4. Nitazoxanide 5. Tinidazole
70
owner noted these in dogs feces. Dog has no GI signs. What is it and what other thing should you test for
Tapeworms Test for fleas: Flea tapeworm: dipylidium caninum
71
what are the pros and cons of IDEXX diarrhea RealPCR panel
Pros: one test for multiple agents, easy to obtain sample, results in 1-3 days Cons: promotes unnecessary use of abx
72
what are some indications for IDEXX diarrhea RealPCR panel
1. Acute severe diarrhea progressing to systemic signs or sepsis 2. False negative for parvo, panleukopenia, parvo 3. Suspect distemper 4. History of exposure and diarrhea > 1week 5. Multiple affected in household 6. Screening or outbreak in shelter 7. Client or pet immunosuppression 8. Chronic large bowel diarrhea in cats (tritichomonas)
73
what are some extra-GI causes of non-infectious acute diarrhea
1. Pancreatitis 2. Bacterial cholangitis 3. Biliary obstruction, microelectronics 4. Peritonitis 5. Addisonian crisis 6. MCT degranulation 7. Shock 8. Hypersensitivity reactions
74
What are some GI causes for non-infectious acute diarrhea
1. FB- partial obstruction 2. Nonspecific enterocolitis
75
what are some causes for nonspecific enterocolitis
1. Dietary indiscretion 2. Rapid change in diet 3. Drugs: NSAIDS, chemo, abx, methimazole 4. GI irritant toxin 5. Stress
76
what diagnostics would you consider in acute diarrhea without systemic illness
1. Fecal float vs deworming 2. Parvo/panleukopenia ELISA
77
what tx would you consider for acute diarrhea without systemic illness
1. Probiotics/prebiotics 2. Highly digestible diet 3. SQ fluids
78
when should you not consider anti-diarrheal therapy
1. Concern for bacterial or viral enteropathies 2. Concern for caustic or irritating substance in lumen 3. Concern for masking progressive disease
79
what causes of acute diarrhea would show a neutropenia
parvo, panleukopenia, salmonella, sepsis
80
what causes of acute diarrhea would show an eosinophilia
addisons, parasites, MCT
81
what causes of acute diarrhea would cause an anemia
GI hemorrhage, parasites
82
what causes of acute diarrhea would cause a hemoconcentration
dehydration, acute hemorrhagic diarrhea syndrome
83
what acute cause of diarrhea would show macrocytosis
FeLV
84
what acute cause of diarrhea would cause a lack of a stress leukogram, and what would stress leukogram look like
addisons SMILED: segmented neutrophils, monocytes increased, lymphocytes and and eosinophils: decreased
85
what causes of acute diarrhea would cause a panhypoproteinemia
GI hemorrhage or PLE
86
what acute causes of diarrhea would cause hypokalemia, and hypochloremia
FB obstruction upper GI
87
what acute cause of diarrhea would cause a hyponatremia and hyperkalemia
addisons
88
what acute cause of diarrhea would cause a hypocalcemia
PLE, pancreatitis

SAMS 1 (16 decks)

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