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Alimentary > SA Diarrhoea > Flashcards

SA Diarrhoea Flashcards

1
Q

How is chronic diarrhoea defined?

A

lasting > 3weeks

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2
Q

If acute diarrhoea is present, what should next be defined? What is the usual treatment of acute diarrhoea? How does this differ from chronic?

A
  • with/without systemic signs?
  • SI/LI/Mixed?
  • Usually can be treated symptomatically +/- fasting for dogs if without systemic signs
    > chronic must be investigated/worked up
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3
Q

Define diarrhoea

A

^ freq/volume/fluidity

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4
Q

Define meleana. What is this indicative of?

A

Black tarry stools indicates digested blood -> upper GI bleeding (stomach or SI)

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5
Q

Define flatulence

A

Excessive gas

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6
Q

Define dyschezia

A

Difficult/painful defeacation

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7
Q

Define heamatochezia. What is this indicative of?

A

Fresh blood in the stool indicative of lower GI (colon) bleeding

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8
Q

Define tenesmus

A

Ineffectual but urgent straining

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9
Q

Does intermittent diarrhoea over a period > 3 weeks still count as chronic?

A

YES

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10
Q

How can SI/LI be differentiated?

A

> history [SI v. LI]

  • volume +++ … +
  • mucus - … +++
  • frequency + … +++
  • tenesmus - … +++
  • dychezia - … +
  • weight loss ++ … +
  • vomiting + … +
  • general condition + … -
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11
Q

How are SI and LI diarrhoea subsequently refined?

A
  • SI could be 1* or 2*

- LI is almost certainly 1* colon

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12
Q

What are the DDx for acute SI diarrhoea with NO systemic involvement? How may these be treated/ruled out?

A
  • dietary (fast dogs [not cats], try elimination or hyposensitive diet)
  • helminths (worm)
  • protozoa (giardia)
  • Iatrogenic (drug induced - many drugs can cuase this!)
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13
Q

What are the clinical signs that would suggest systemic involvement with acute SI diarrhoea?

A 
Depressed/flat
CV affected (^HR) 
Dehydration
^ temperature 
> indicates infection
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14
Q

What are the DDx for acute SI diarrhoea with systemic signs?

A
  • Bacterial infection (salmonella, campylobacter)
  • Viral ([dogs] distemper, parvo [cats] panleukopenia)
  • Toxins
  • Heamorrhagic gastroenteritis (dogs only)
  • Acute pancreatitis
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15
Q

How are bacterial GI infections diagnosed?

A

Feacal culture

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16
Q

How common are bacterial causes of diarrhoea?

A

Rare

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17
Q

How are viral GI infections diagnosed?

A

Feacal Ag test

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18
Q

How do dogs with haemorrhagic gastroeneteritis present? What is the Tx?

A

^PCV, dehydrated

- Fluid therapy fixes most cases!

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19
Q

Give 4 DDx for acute LI diarrhoea. How may these be diagnosed?

A
  • Whipworms
  • Clostridia
  • Giardia
  • Campylobacter
    > faecal examination and culture
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20
Q

How is chronic diarrhoea initially refined?

A 
Same as acute - SI/LI/mixed? 
Physical exam (though this is usually unremarkable)
- weight loss/stinted growth possible
21
Q

What are the broad DDx categories for chronic SI diarrhoea? Which should be ruled out first?

A

1* (GI) and 2* (extra GI) -rule out 2* first

22
Q

Give 6 DDx for 2* chronic SI diarrhoea. What broad categories do these fall into?

A 
> Metabolic 
- hepatic disease (PSS)
- Hyperthyroidism (cats) 
- Addisons disease (dogs) 
- Renal sufficiency 
> Pancreatic 
- EPI
- Chronic pancreatitis
23
Q

How would metabolic causes of chronic SI diarrhoea be differentiated from GIT 1* casues?

A

Usually other symptoms accompanying them - ie.

  • PSS: CNS signs
  • Hyperthyroidism: Polyphagia
  • Renal insufficiency: PUPD
24
Q

Give 6 DDx for chronic small intestinal diarrhoea

A
  • giardia infection (may initially be acute then -> chronic)
  • chronic partial obstruction
  • lymphangiectasia
  • Neoplasia: Lymphosarcoma most common
  • Food-responsive disease
  • IBD (Lympho-plasmacellular infiltration most common)
25
Q

Give 6 DDx for chronic LI diarrhoea - is this likely to be 1* or 2*

A

Almost always 1* (ie. colon pathology)

  • IBD (lympho-plasmacellular or ulcerative collitis in Boxers)
  • Polyps
  • Food-responsive disease
  • Neoplasia (adenocarcinoma most common)
  • Chronic partial obstruction
  • Cats: tritrichomonas foetus (causes abortion in cows, recently spread to cats)
26
Q

Which pathogen has recently jumped species to cause chronic LI diarrhoea?

A

Tritrichmonas foetus - causes abortion in cattle, recently spread to cats

27
Q

Outline 6 invenstigation techniques for chronic diarrhoea? What can each rule out?

A
  1. feacal exam (flotation, culture) - rules out parasites, bacterial infection [campylobacter, salmonella]
  2. heamatology, biochem, UA - rules out renal failure, hepatic disease
  3. If SI diarrhoea do serum tests: Trypsin like immunoreactivity TLI [EPI], Pancreatic lipase PLI [pancreatitis], cobalamin [ileal disease if cobalamin low (should be absorbed in ileum)]
  4. Abdo ultrasound - locate lesion, blockage?
  5. Treat with elimination/hyposensitive diet - food-responsive disease
  6. If no response: BIOPSY (endoscopy or full thickness)
28
Q

What 2 ways may biopsies be taken?

A 
- Endoscopy:
Gastroscopy - Stomach, SI
Colonoscopy - ileum, colon 
- Ex lap
Stomach and SI only
NOT colon
29
Q

What are the advantages and disadvantages of endoscopic biopsy?

A

+ non invasive (excpet GA)
+ direct visualisation of mucosa
+ conclusive in majority of cases
- difficult for Dx intestinal lymphoma, lymphangiectasia as not full thickness biopsy

30
Q

What are the advantages and disadvantages of ex lap biopsy?

A
  • invasive (esp problematic in sick animals, v albumin -> ^ risk dehiscence)
  • only take 2-3 biopsies from stomach and SI
  • cannot be used in colon
  • expensive and painful
  • ^ mortality rates (20% v 2% for endoscopy)
31
Q

Where should intestinal biopsies NOT be taken from?

A

Peyers patches - will show lyphocyte infiltration and look like IBD

32
Q

What are the MAIN causes of chronic SI diarrhoea in the dog?

A
  • food responsive disease
  • antibiotic responsive diarrhoea
  • IBD (lyphoplasmacellular enteritis or colitis)
  • neoplasia
33
Q

How can food-responsive disease be ruled out?

A 
- elimination/hyposensitivity diet 
> should improve within 2 weeks
> keep feeding 6-8 weeks 
> NO treats!
> can be switched back onto normal diet
34
Q

What does ARD stand for? What was it formerly known as?

A

ARD: antibiotic responsive diarrhoea
SIBO: (Small intestinal bacterial overgrowth) - studies done in vitro to give this name, studies in vivo disputed hence name change.

35
Q

What breed disposition does ARD show?

A

young GSD

36
Q

What are the clinical signs of ARD?

A

chronic SI / mixed diarrhoea

37
Q

How is ARD treated?

A

Metronidazole 15mg/kg po BID for 4 weeks
BUT should try and avoid ABs as will usually relapse
Manage diet - hydrolysed protein (hyposensitivity) diet

38
Q

How is IBD diagnosed?

A

> CLinical exclusion- it is the most common chronic enteropathy in dogs
Histopathology - lympho-plasmacellular most comon
- eosiniphilic rare
- ulcerative colitis (LI) in boxers, rare

39
Q

How is ulcerative colitis treated?

A

Enrofloxacin

- fine to treat this using ABs (unlike ARD where you should try and avoid ABs)

40
Q

What is the pathogenesis of IBD?

A

PRRs on dendritic cells in gut mutate to recognise commencals as pathogens -> inflammatory T17 response

41
Q

What is the “sequential treatment protocol for therapy of chronic enteropathies/IBD in dogs?

A
  1. Elimination diet / hydrolysed protein diet
  2. metrodinazole 10-15mg/kg BID for 3-4 weeks
  3. Prednisolone 2.2mg/kg/d for at least 10d, taper dose to e.o.d
  4. Azathioprine or cyclosporine if steroids poorly tolerated/unsuccessful
42
Q

What side effects may steroids have? In which species are these more severe?

A

Cushings like symtoms - PUPD, polyphagia etc.

- common in dogs, cats have less side effects

43
Q

What is the therapy protocol for IBD in cats?

A
  1. Elimination diet
  2. Prednisolone 2mg/kg/day for 10-14 days, slow taper
  3. Chlorambucil
    > Cobalamin supplementation necessary ALWAYS - v cobalamin in serum decreases efficacy of treatement
44
Q

Why is metronidazole not given to cats@?

A

Bitter tasting and too difficult to give!

45
Q

What is the definition of a protein losing enteropathy?

A
  • SYNDROME of intestinal disease

- non-selective protein loss -> low albumin, +- low globulins in serum

46
Q

What may cause protein losing enteropathies?

A
  • IBD
  • lymphangiectasia
  • neoplasia (commonly lymphoma)
47
Q

Which species most commonly develops protein losing enteropathy?

A

Dogs

48
Q

What are the clinical signs (“picture”) associated with protein losing enteropathies?

A
  • VD+
  • anorexia
  • weight loss
  • ascites, pleural effusion, peripheral oedema
  • serum total protein low
    > biopsy early on in workup to distinguish!

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