Lecture 6 2/4/25 Flashcards
What is the stepwise approach to a patient with diarrhea?
-define the type; small bowel vs large bowel
-determine the chronicity
-describe the frequency
-describe the severity
-generate differentials
What are the extra-GI diseases that can cause diarrhea?
-hepatic dz
-renal dz
-pancreatitis
-endocrine dz
What are the primary GI disease manifestations of diarrhea?
-acute small intestinal diarrhea
-chronic small intestinal diarrhea
-large bowel diarrhea
How does the approach to diarrhea differ when it is acute versus chronic?
-approach acute diarrhea based on severity
-approach chronic diarrhea bas on extra-GI vs primary GI
What is the pathophysiology of small intestinal diarrhea?
-large volume of diarrhea
-malabsorption
-weight loss if chronic
-loss of protein, lymph, and blood when severe
What causes small intestinal diarrhea to occur at large volumes?
-decreased absorption of fluid and electrolytes
-incomplete absorption of nutrients
-increased secretion of fluid and electrolytes
-downstream capacity of colon to reabsorb water is overwhelmed
What are the differentials for acute mild SI diarrhea?
-dietary indiscretion
-stress
-recently prescribed drugs
-endoparasites
-viral infections
What is the most common cause of acute mild SI diarrhea?
dietary indiscretion
Which patients most commonly present with acute mild SI diarrhea due to endoparasites?
young patients and rescued pets
What information should be gathered during a history when an animal has acute SI diarrhea?
-possibility of dietary indiscretion
-environmental history
-duration, frequency, severity, and progression
-drug history
-any other clinical signs/concerns
What should be assessed on physical exam when an animal has acute SI diarrhea?
-hydration status
-abdominal palpation
-rectal exam
-rectal temp
Which diagnostics should be done in cases of acute mild SI diarrhea?
-fecal float
-PCV/TP to assess hydration
What are the treatment options for acute mild SI diarrhea?
-often self-limiting
-switch pet to an easily digestible/low residue diet
-deworming
-probiotics
Which therapies are NOT indicated in acute mild SI diarrhea cases?
-novel protein diets
-antibiotics
What are the characteristics of acute mild SI diarrhea monitoring?
-signs should resolve in 1 to 5 days
-persistence or worsening warrants further diagnostic investigation and elevates the case to severe SI diarrhea
What are the extra-GI differentials for acute severe SI diarrhea?
-acute hepatic dz
-acute renal injury
-acute pancreatitis
-hypoadrenocorticism
What signs/results should raise suspicion that acute severe SI diarrhea is extra-GI in causation?
-physical exam finding of icterus, abdominal pain, etc.
-bloodwork findings of elevated liver enzymes, azotemia, inappropriate Na/K ratio
What are the primary GI differentials for acute severe SI diarrhea?
-intestinal obstruction
-viral enteropathogens
-endoparasites
-bacterial enteropathogens
-acute hemorrhagic diarrhea syndrome
What are the characteristics of canine parvovirus?
-caused by canine parvovirus-2
-targets rapidly dividing cells
-causes neutropenia!!***
-seen in unvaccinated dogs under 6 months of age
What are the clinical signs of parvovirus?
-depression
-anorexia
-vomiting
-profuse, hemorrhagic diarrhea
-fever
What are the clin path findings in dogs with parvo?
-leukopenia
-neutropenia!!!***
-anemia
-electrolyte depletion
-hypoglycemia
-panhypoproteinemia if severe
What are the characteristics of parvo diagnosis?
-can be done with cage-side rapid tests
-possible to get false negatives early in disease or 14 days after infection
-vaccination can cause a weak positive shortly after administration
-should look for co-infection with a fecal float
What are the steps of hospitalization treatment for parvo patients?
-IV fluids
-antibiotics for febrile and/or neutropenic dogs
-antiemetics
-anthelmintics/dewormers
-nutritional support
-probiotics
What are the steps of outpatient treatment for parvo patients?
-initial hospitalization and IV fluids
-SQ fluids at home
-monitoring of rectal temp
-antimicrobial treatment
-maropitant
-karo syrup
-oral potassium supplementation
-buprenorphine for pain management
-repeat visits every day for physical exam
Which other viral enteropathogens can cause acute severe SI diarrhea?
-feline panleukopenia
-canine distemper
Which bacterial enteropathogens can cause acute severe SI diarrhea?
-Campylobacter
-Clostridium difficile
-Clostridium perfringens
-Salmonella
What are the characteristics of acute severe SI diarrhea caused by bacterial enteropathogens?
-uncommon
-diagnosis based on suspicion of environmental exposure; PCR and culture often not needed
What are the characteristics of acute hemorrhagic diarrhea syndrome?
-lesions occur from duodenum to colon
-unclear etiology, but associated with Clostridium perfringens
-seen in adult toy and small breed dogs
-stress related
What is the clinical presentation of acute hemorrhagic diarrhea syndrome?
-large volume of hemorrhagic diarrhea
-vomiting
-hemoconcentration
-panhypoproteinemia
**hemoconcentration and panhypoproteinemia is discordant
How is acute hemorrhagic diarrhea syndrome diagnosed?
diagnosis of exclusion; rule out other causes
How is acute hemorrhagic diarrhea syndrome treated?
-IV fluids
-supportive care
-metronidazole if concern for bacterial translocation
Which findings should prompt a more aggressive workup and treatment of SI diarrhea?
-severe vomiting
-abdominal pain
-melena or liquid blood stools
-moderate to severe dehydration
-neonate with diarrhea
-signs of systemic illness
-unresponsive or recurrent diarrhea following conservative treatment
What are the typical diagnostics for acute severe SI diarrhea workup?
-CBC
-chem
-UA
-abdominal radiographs
-cage-side parvo test
What is the treatment for acute severe SI diarrhea?
-hospitalization
-IV fluids
-easily digestible diet
-antibiotics to cover for translocation if pet has neutropenia, fever, and/or evidence of mucosal sloughing
Which bacteria types must we account for when choosing an antibiotic in a diarrhea patient?
-anaerobes
-gram neg. species
-Enterococcus
