Lecture 7 2/6/25 Flashcards by Danika Boltz

What is the general overview of chronic small bowel diarrhea?

-3 weeks or longer in duration
-can be accompanied by other clinical signs; vomiting, weight loss, changes in appetite, melena/hematemesis/hematochezia
-requires a diagnostic workup

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What are the extra-GI causes of chronic small bowel diarrhea?

-hepatic dz
-pancreatic dz
-renal dz
-endocrine dz
-hypercalcemia
-underlying dz such as neoplasia or systemic infection

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What is the primary GI cause of chronic small bowel diarrhea?

chronic enteropathy

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What conditions fall under chronic enteropathy?

-endoparasites
-food-responsive enteropathy
-microbiota modulation responsive enteropathy/idiopathic dysbiosis
-lymphangiectasia
-immunosuppressant responsive enteropathy/IBD
-non-responsive enteropathy
-GI lymphoma
-fungal infections

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What are the characteristics of hypoadrenocorticism/Addison’s disease as a cause of diarrhea in dogs?

-seen in 4% of dogs with chronic GI signs
-classical hypoadrenocorticism involves deficiencies in glucocorticoids and mineralocorticoids
-atypical hypoadrenocorticism involves deficiency in just glucocorticoids

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What findings should increase suspicion of Addison’s disease in dogs?

-signalment; typically female, predisposed breeds
-intermittent GI signs
-lack of stress leukogram
-lymphocytosis
-increased K and decreased Na

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How is Addison’s disease diagnosed?

-resting cortisol measurement
-measurements >2 ug/dl rules out Addison’s
-measurements < 2 ug/dl indicates need for an ACTH stimulation test

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What findings should increase suspicion of hyperthyroidism in cats?

-older cats
-concurrent weight loss
-CBC and chem abnormalities; especially elevated liver enzymes

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How is hyperthyroidism diagnosed?

-total T4 measurement
-thyroid scintigraphy

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What are the differentials for weight loss despite a good appetite?

-inadequate caloric intake
-maldigestion
-malabsorption
-diabetes mellitus
-energy consumptive dz

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What is the main goal when doing a diagnostic approach to chronic small bowel diarrhea?

-narrow down the differential list
-rule out diseases
-screen for clin path data that supports differentials

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What does an inflammatory leukogram with left shift indicate for a patient with chronic small bowel diarrhea?

need for aggressive diagnostics and therapeutics

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What does marked anemia indicate for a patient with chronic small bowel diarrhea?

possibility of GI bleeding; should be imaged sooner and possibly started on blood transfusions

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What does erythrocytosis indicate for a patient with chronic small bowel diarrhea?

hemoconcentration and a need for fluid therapy

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Which changes on a CBC aid in ordering the differentials list?

-lack of stress leukogram (Addison’s)
-eosinophilia

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What does eosinophilia correlate with in chronic small bowel diarrhea patients?

-parasites
-food allergies
-mast cell cancer
-hypoadrenocorticism

What are the possible anemia types seen in chronic SI diarrhea animals?

-regenerative, macrocytic, hypochromic: indicates regenerative anemia from hemorrhage
-non-regenerative, microcytic, hypochromic: indicates iron deficiency anemia and chronicity
-reticulocytosis without anemia: indicates increased RBC turnover

Which findings on the chem panel indicate extra-GI disease?

-azotemia: kidney dz
-elevated liver enzymes: hepatic dz
-hyperglycemia: diabetic ketoacidosis/diabetes
-hypercalcemia

What are the characteristics of reactive hepatopathy?

-dogs only
-ALT and ALP increase; 2-4x normal
-no increase in TBili
-no evidence of liver dysfunction; glucose, urea, albumin, and cholesterol are normal

How does hypokalemia influence treatment?

patient should be supplemented with IV fluids and nutritional support

How does a finding of severe hypoalbuminemia influence treatment?

-IV fluids has an increased risk of third-spacing
-can see edema and/or cavitary effusion
-negative prognostic indicator in dogs with chronic enteropathy

What are the characteristics of increased BUN?

-can be indicative of GI bleeding
-can concurrently see anemia/inappropriate reticulocytosis, thrombocytosis, melena, and/or hematemesis

What are the characteristics of panhypoproteinemia?

-indicates malabsorptive disease
-decreased albumin and globulin due to protein-losing enteropathy
-can see hypocholesterolemia in patients with concurrent lymphangiectasia

What are the causes of decreased albumin?

-decreased production
-loss
-sequestration

What are the characteristics of globulins?

-includes non-albumin proteins, immunoglobulins, and acute phase proteins -larger than albumin -glomerulus is selective; less likely to be filtered compared to albumin

What are the findings associated with protein losing enteropathy?

-low albumin -low globulins; can be normal or high w/ inflammation -low cholesterol -decreased cobalamin -changes in folate -diagnosed through deworming, diet/probiotic trials, and biopsy

What are the findings associated with protein losing nephropathy?

-low albumin -normal globulins; can be high w/ inflammation -normal cholesterol; can be high w/ inflammation -azotemia and glucosuria -diagnosed through UA and urine protein-creatinine ratio

What are the findings associated with liver dysfunction?

-low albumin -normal globulins; can be high with inflammation -low cholesterol -low urea and glucose -high Tbili and PT/PTT (low clotting factors) -diagnosed through bile acids and NH3 measurements

What are the characteristics of urinalysis in patients with chronic SI diarrhea?

-often normal -used to screen for concurrent dz -must be performed in patients with hypoalbuminemia to determine if loss is via the kidneys

What are the characteristics of fecal testing?

-should be done in all patients with chronic GI signs -ideally want a large, non-diarrheal sample -can do a sugar/routine float or a zinc/giardia float -ideally repeat exam 3 times -treat all identified parasites appropriately

Which tests are used to rule out pancreatitis?

-SNAP cPL test -pancreatic lipase immunoreactivity/PLI

Which disease causes maldigestion?

exocrine pancreatic insufficiency

Which diseases cause malabsorption?

-food-responsive enteropathy -antibiotic-responsive enteropathy -lymphangiectasia -immunosuppressant-responsive enteropathy -GI lymphoma

Which B vitamins are evaluated to identify malabsorptive disease?

-cobalamin, vit. B12 -folate, vit. B9

What are the characteristics of folate?

-absorbed in proximal SI -decreased in malabsorptive dz of duodenum -increased in bacterial overgrowth of upper SI (produced by bact.)

What are the characteristics of cobalamin?

-absorbed in distal SI/ileum -decreased in malabsorptive dz of ileum and bacterial overgrowth of SI (used by bact.)

What are the characteristics of cobalamin supplementation?

-should be done when serum conc. is in the low normal range; less than 400 ng/L -can be done parenterally or orally

What is important regarding folate supplementation?

benefit of supplementation has not been demonstrated

What are the characteristics of the trypsin-like immunoreactivity test?

-sensitive and specific test for maldigestion -species specific -requires 8-12 hour fast and non-hemolyzed serum -low values diagnostic for exocrine pancreatic insufficiency