SA Acute Gastroenteric Disease Flashcards
Most acute vomiting and diarrhoea is ..?
Self limiting
Most chronic diarrhoea requires…?
A specific diagnosis before treatment
What are the categories of acute vomiting and diarrhoea?
- Non-fatal / self-limiting e.g. parasitism
- 2° to extra-intestinal / systemic disease
- Severe potentially life-threatening
- Secondary to other organs
What are some examples of severe potentially life threatening causes of V&D?
- Enteric infection
- AHDS/HE – acute haemorrhagic diarrhoea syndrome/haemorrhagic gastroenteritis
- Intestinal obstruction
Name some examples of surgical disease that can cause V&D
- Intussusception
- Volvulus
- Incarceration
- Stricture/partial obstruction
- Foreign body
N.B. Vomiting is the major sign
What is the most important part of care/treatment in a patient with V&D?
Prevention of dehydration
How much of the daily fluid volume that enters the gut is absorbed by the gut?
98%
So 2% is lost in faecal water
What decisions need to be made when presented with a V&D patient
- Is intensive emergency treatment needed (fluid/ electrolyte, acid/base) ?
- Is there an underlying non-enteric cause ?
- Is surgical management needed ?
- Is hospitalisation needed ?
- Is an infectious cause likely ?
- Is non-specific treatment sufficient ?
What are the clinical signs of V&D
- Vomiting ± abdominal pain
- Profuse diarrhoea
- Mucoid diarrhoea + tenesmus
Describe the features of diarrhoea that would localise it to the SI
- Large volumes
- Normal to mild increase in frequency of defaecation
- No tenesmus
- No blood or mucus
- Weight loss occurs with time
Describe the features of diarrhoea that would localise it to the LI
- Normal to increased volume
- Frequent defaecation
- Tenesmus present
- Blood/mucus seen
- Weight loss not usually seen
Describe the features of acute gastritis
- Acute onset of frequent vomiting
- Often associated with acute diarrhoea
- Very common
- But often self-limiting
What are some causes of acute gastritis?
Many causes; not all ‘inflammatory’:
- Dietary indiscretions, garbage intoxication
- Foreign material
- Hairballs (bezoars) in cats
- Certain drugs
- Acute systemic disease
An acute onset of profuse diarrhoea is a sign of?
Acute enteritis
What are the causes of acute enteritis?
Aetiology often obscure
Usually self-limiting
Dietary indiscretions, garbage intoxication
Enteric infection
Define Tenesmus
Excessive straining even if the bowel is empty
Acute colitis is rare and common in which spp?
Fairly common in dog; rare in cat
What are the causes of acute colitis?
- Idiopathic
- Garbage ingestion
- Whipworms
- Protozoa (Giardia, Cryptosporidium etc)
Describe the steps in making a diagnosis
- History
- Physical exam
- Biochemistry testing
- Imaging
- Response to symptomatic treatment
- Reassess if signs persist for more than 48 hours
What information should be gathered in the history of a dogs with V&D?
- Age and vaccination status
- Recent dietary intake
- Exposure to toxins, f.b. or infectious disease
- Nature of signs
How can hydration of a patient be assessed?
PCV / TP
MM
Skin tenting
Which tests can be carried out to help diagnose issues with V&D?
- haematology
- serum biochemistry
- urinalysis
- faecal examinations for parasites
Which faecal microbiology tests can be used?
- ELISA test for viral antigen
- Electron microscopy
- Direct smears and floatation for Giardia parasites
- Wet-prep for Tritrichomonas (cats)
- Giardia SNAP test
- Parvovirus SNAP test
What is imagine used for in V&D diagnostics?
- Rule out obstruction / other surgical dz.
- Ultrasound for intussusception
What are the emergency diagnostics when presented with a patient in peracute crisis?
- PCV/total protein (refractometer)
- Examine blood smear
- Blood glucose (glucometer)
- Blood urea (dipstick)
- Urinalysis
What are some principles of treating V&D?
- Signs usually self-limiting
- Treat the specific cause if identified
- Important to maintain hydration
- Good prognosis for complete recovery
- Reassess if persists for > 48 hours
Which drugs are contraindicated in V&D cases?
Corticosteroids / NSAIDs
How can hydration be maintained?
Oral rehydration solutions if not vomiting or severely dehydrated
Glucose- electrolyte solutions
If vomiting water give parenteral fluids
What are some symptomatic treatment methods
Restricted GI intake
- Fasting for a minimum of 12 hours
- Followed by frequent feedings
- Small amounts of bland, low-fat food eg. boiled rice & chicken
What are the advantages of ‘Feeding through diarrhoea’?
Reduces potential of sepsis
Speeds recovery
Why is ‘Feeding through diarrhoea’ not practical?
- Concurrent vomiting
- Cosmetic problem
When can anti-emetics be used?
When an obstruction has been ruled out
Name some anti-emetic drugs
- Maropitant
- Metoclopramide
- Chlopromazine
- Atropine
What is the ROA for Maropitant?
Subcutaneous injection (1 mg/kg) Oral preparation (2 mg/kg)
What are the uses of gastric mucosal protectants
If vomiting persists
If ulceration present
Why are NSAIDs contraindicated?
- Anti-inflammatory and analgesic
BUT - Damage GI mucosa and damage kidneys if hypovolemic
How do anti-diarrhoeals work?
Absorbents / protectants
- protect’ mucosa
- bind toxins
- bind excess water
Name some anti-diarrhoeal drugs that bind excess water
Kaolin-pectin
Activated charcoal
Bismuth subsalicylate
Name the motility modifying anti-diarrhoeal drug
Opioids
- slow the rate of transit
- anti-secretory
What are the pros and cons of using antibiotics in V&D treatment?
Cons: - ‘upset’ the natural flora - cause diarrhoea - risk of sepsis if mucosal barrier compromised Pros: - Promote resistance
What are the indications for antibiotic use in cases of V&D?
- Haemorrhagic diarrhoea
- Diarrhoea + pyrexia
- Known infection: Salmonella, Campylobacter, pathogenic E. coli
Describe the features of probiotics
- Live micro-organisms
- Administered orally
- Alter the intestinal microflora proposed to have a beneficial effect on health
What are the 2 main methods of removing a gastric foreign body?
- Induction of vomiting
- Natural passage
Describe induction of vomiting to remove a f.body and which drugs can be used?
- Only if smooth object recently ingested
- Also useful if non-corrosive poison ingested
- Apomorphine
- Xylazine
When is natural passage of a f.body indicated?
- Small objects if no signs of gastric disease
- Failure to pass in 48 hours necessitates surgery
What are 2 viral causes of acute gastroenteritis?
Parvovirus
Coronavirus
Name 3 bacterial causes of acute gastroenteritis
Salmonella
Campylobacter
E. coli
What are the main features of Canine acute haemorrhagic diarrhoea syndrome
- Affects all ages
- Especially toy and miniature breeds
- Syndrome of unknown aetiology
- Not an inflammatory disease altered mucosal permeability or secretion
What are the clinical signs of Canine acute haemorrhagic diarrhoea syndrome
- sudden onset of vomiting ± blood
- may precede diarrhoea by a few hours
- severe bloody diarrhoea
- marked haemoconcentration
- depression
- shock
What will be seen on the clinical exam/diagnostics in a patient with Canine acute haemorrhagic diarrhoea syndrome
- Marked elevation of PCV - often 60 to 80
- Normal skin turgor
- Normal WBC, radiographs, blood chemistries
How is Canine acute haemorrhagic diarrhoea syndrome treated?
- Prompt vigorous fluid therapy is essential
- IV balanced electrolyte solution
- 80 ml/kg/hr infused rapidly until: CRT normal, PCV <50
- Also withhold all food and water
- Parenteral broad-spectrum antibiotics
- Protectants
What is the prognosis of Canine acute haemorrhagic diarrhoea syndrome?
- If untreated death occurs rapidly due to shock and circulatory failure
- If treated mortality is low. Some dogs have repeat episodes
