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BVM3 Alimentary > Logical Approach to Diarrhea in Dogs and Cats > Flashcards

Logical Approach to Diarrhea in Dogs and Cats Flashcards

1
Q

What can diarrhea commonly be confused with (by owner usually)?

A

Can be confused with constipation (straining)

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2
Q

How do you classify diarrhea?

A

Acute vs Chronic
Small bowel vs. large bowel vs. mixed

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3
Q

How do you usually treat acute diarrhea?

A

Symptomatically

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4
Q

How do you usually treat chronic diarrhea? What proportion of cases are in specialty vs general practice?

A

Requires investigation - complicated causes
Small proportion in GP, high proportion in specialty

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5
Q

Why is a thorough history essential for patients with diarrhea?

A

Physical exam often unremarkable

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6
Q

Describe small bowel vs. large bowel diarrhea consistency/appearance/color

A

Small bowel - soft, typical diarrhea, MUCOUS (irritation), NO FRANK BLOOD, digested blood (melena)
Large bowel - frank blood indicates large bowel issue,

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7
Q

Is frank blood or melena a sign of a bigger issue?

A

MELENA - BIG PROBLEM

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8
Q

Weight loss in small bowel vs. large bowel diarrhea?

A

Small bowel - can occur, but doesn’t have to
Large bowel - no weight loss, as digestion of nutrients occurs in SI (in small animals)
*Opposite in horses

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9
Q

Vomiting in in small bowel vs. large bowel diarrhea?

A

Small bowel - vomiting receptors in SI, common
Large bowel - usually no, but can be associated with inflammatory bowel disease

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10
Q

What are some physical signs seen in the patient in small bowel vs. large bowel diarrhea?

A

Small bowel - borborygmus, flatulence
Large bowel - tenesmus (straining, very uncomfortable) *can also occur in SI diarrhea

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11
Q

Frequency in small bowel vs. large bowel diarrhea?

A

Small bowel - can be small amounts frequently or large amounts infrequently
Large bowel - easier to recognize - small amounts frequently

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12
Q

How is need to defecate triggered in large bowel diarrhea?

A

When colon is inflamed receptors in tissue send signal to poo over and over again (similar to cystitis) - animal feels need to defecate frequently, but there is little formed stool in colon = diarrhea
- Defecation reflex not triggered by amount of feces in colon, but by irritation of receptors in the colon

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13
Q

Appetite in small bowel vs large bowel diarrhea?

A

Small bowel - can be increased or decreased
Large bowel - normal

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14
Q

Water balance in small bowel vs large bowel diarrhea?

A

Small bowel - Water lost in diarrhea/vomit
Large bowel - usually not (absorption in small bowel)

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15
Q

Physical exam in small bowel vs large bowel diarrhea?

A

Small bowel - history key! Often unremarkable
Large bowel - also unremarkable, uncomfortable on rectal exam

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16
Q

What is the difference between primary vs secondary GI disease?

A

Primary - Structural
Secondary - Functional

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17
Q

How does secondary GI disease usually present?

A

Diarrhea usually not the primary presenting complaint (except exocrine pancreatic insufficiency)
Usually has same characteristics as small bowel disease

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18
Q

If Large bowel diarrhea is the main presenting sign, what should you think of as the cause?

A

Primary GI lesion

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19
Q

If mixed bowel diarrhea is the major clinical sign what should you think of as the cause?

A

Primary GI disease

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20
Q

Is BW usually helpful in diagnosing chronic GI disease? What can you use to help you diagnose the cause of diarrhea?

A

BW usually not helpful - No “easy” blood tests
Must rule out secondary GI disease
Fecal exam, therapeutic trials, and biopsy can all help

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21
Q

What are the causes of acute small bowel diarrhea?

A

Diet-related
Parasites
Infection (viral, bacterial)
AHDS (Acute Hemorrhagic Diarrhea Syndrome)

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22
Q

What are the causes of chronic small bowel diarrhea?

A

Toxins
Parasites
Diet-related
Bacteria/Protozoa
Deep Mycoses (fungal disease)
Dietary hypersensitivity
Neoplastic
Lymphangiectasia
Brush border enzyme biochemical defects
IBD

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23
Q

Give examples of the following causes of acute small bowel diarrhea:
- Diet-related
- Parasites
- Protozoa
- Viral
- Bacterial

24
Q

Give examples of the following causes of chronic small bowel diarrhea:
- Parasites
- Diet-related
- Bacteria
- Protozoa
- Fungal disease

25
Q

What is AHDS? What is another name for this syndrome?

A

Acute hemorrhagic diarrhea syndrome
Hemorrhagic Gastroenteritis (HGE)

26
Q

How fast is the onset of clinical signs in HGE? What are the clinical signs?

A

Acute onset of vomiting and bloody diarrhea

27
Q

How does PCV and plasma protein change in AHDS/HGE?

A

Significant hemo-concentration (increased PCV) with normal or low plasma protein

28
Q

What are the breed predispositions for AHDS/HGE?

A
  • Typically described in small breed dogs but any size/breed can be affected
29
Q

What is the cause of AHDS/HGE?

A

Cause may be necrotizing toxin produced by Clostridia perfringens Type A

30
Q

Do antimicrobials help in the treatment of AHDS/HGE?

A

antimicrobial therapy does not improve outcome unless the patient is septic

31
Q

What macronutrient causes dietary hypersensitivity that leads to chronic small bowel diarrhea

A

PROTEIN

  • Dog - beef, lamb, chicken, wheat (gluten)
  • Cat - fish, milk, dairy
32
Q

What clinical signs does dietary sensitivity cause? Where are the skin signs typically seen in dogs vs cats?

A

Chronic intermittent diarrhea, vomiting, pruritis

  • Cat (ears, face)
  • Dog (axillary region, feet)
33
Q

Which neoplasias cause chronic small bowel diarrhea?

A

Diffuse lymphosarcoma
Adenocarcinoma
Mstocytoma
(and others)

34
Q

What is lymphangiectasia?

A

Pathological dilation of lymph vessels
Rare disorder that causes loss of special proteins from intestines

35
Q

What is the NEW name for IBD?

A

Chronic Enteropathy (CE)

36
Q

What are the 4 types of chronic enteropathy? Which is probably the “real” IBD?

A

Diet Responsive CE
Abx Responsive CE
Immunosuppressive responsive CE (probably real IBD)
Non-responsive CE

37
Q

What is the etiology of antibiotic responsive CE?

A
  • Abnormal/unbalanced bacterial population
  • Abnormal gut reaction to normal bacterial population
  • Combination of both
38
Q

Does detection of gut inflammation indicate IBD that NEEDS immunosuppressive therapy? What should you try first?

A

No

  • A good proportion of patients will
    respond to dietary change
  • A small number to antibiotics
  • A small number need immunosuppressive therapy
39
Q

What are the factors which contribute to chronic enteropathy?

40
Q

What are the requirements of CE Diet treatment trials?

A

Dietary trial must be novel protein or hydrolyzed
- If one doesn’t work, try another!

41
Q

What are the secondary GI causes of chronic small bowel diarrhea?

A

Hypoadrenocorticism
Hyperthyroidism
Exocrine pancreatic insufficiency (EPI)
Chronic pancreatitis
Liver disease

42
Q

Which secondary condition typically has no other clinical signs besides diarrhea?

A

Exocrine pancreatic insufficiency

43
Q

What is protein losing enteropathy?

A

Syndrome rather than a specific disease
Occurs when diffuse SI disease results in excessive loss of serum proteins into the gut causing hypoproteinemia

44
Q

What are the main causes of protein losing enteropathy?

A

Immunosuppressive-responsive or non-responsive chronic enteropathy (IBD)
Lymphangiectasia
Lymphoma

45
Q

What are the most common clinical signs associated with PLE?

A

GI signs (vomiting, diarrhea)
Weight loss
Effects of hypoproteinemia (ascites, effusion, peripheral edema)

46
Q

Which parasites are responsible for causing large bowel diarrhea?

A

Truchuris vulpis (dogs)
Ancylostoma caninum

47
Q

Which protozoa are responsible for causing large bowel diarrhea?

A

Giardia
Entamoeba
Tritrichomonas fetus (cats)

48
Q

Which bacteria are typically responsible for causing large bowel diarrhea? Which of these are zoonotic?

A

Campylobacter (zoonotic)
Clostridium
Salmonella (zoonotic)
Granulomatous colitis (E. coli)

49
Q

What are some diet-related reasons an animal would develop large bowel diarrhea?

A

Toxicity (garbage, etc)
Fiber responsive
Dietary hypersensitivity and intolerance

50
Q

What are some inflammatory causes of large bowel diarrhea?

A

Idiopathic
Eosinophilic
Granulomatous

51
Q

How does STRESS cause large bowel diarrhea?

A

Can cause changes in gut microbiome

52
Q

What is mixed bowel diarrhea?

A

Mixture of small intestinal and large intestinal diarrhea signs

53
Q

What are the most common causes of mixed bowel diarrhea?

A
  • Giardia, Campylobacter, Tritrichomonas fetus (cats)
  • Dietary indiscretion/intolerance/hypersensitivity
  • Acute hemorrhagic diarrhea syndrome (AHDS/HGE)
  • Inflammatory
54
Q

What are the best diagnostic tools for diagnosing EPI as a cause for small bowel diarrhea?

A

Serum Trypsin-like Immunoreactivity TLI

55
Q

If B12 and Folate are low at diagnosis, what does this indicate for a patient with IBD?

A

May be a poor prognostic marker

56
Q

What should you do before considering biopsy in cases with small bowel diarrhea?

A

Rule out secondary GI disease

57
Q

What are the aims of diagnostic approach for chronic diarrhea?

A

Aim to go from least invasive/expensive to most invasive/expensive
Consider dietary trial, only changing one element at a time so you know what worked
Treat for parasites
Only try abx as last resort

BVM3 Alimentary (24 decks)

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