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Small Animal Final Year > SI Disorders in Dogs and Cats > Flashcards

SI Disorders in Dogs and Cats Flashcards

1
Q

Name some causes of acute diarrhoea

A
  • Diet - acute gastroenteritis
    • Change, allergy, intolerance, scavenging
    • Food poisoning –suggests infectious agent
    • Toxins –usually through dietary indiscretion
  • Drugs - antimicrobials, chemotherapy etc.
    • Antibiotics andcats particularly D+
  • Infections –viral, bacterial, parasitic
    • Usually acute diarrhoea
  • Inflammatory disease -IBD, Pancreatitis
    • More of a chronic diarrhoea but has to start somewhere
  • Metabolic disease –hypoadrenocorticism
    • Waxing and waning acute diarrhoea
  • Anatomic disease -intussusception
  • Neoplasia –peracutelymphoma, paraneoplasia
  • Anomalous -Stress/anxiety –usually mixed/large bowel
  • NB in ~80% humans the cause of acute diarrhoea is unknown
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2
Q

Where are viral, parasitic and bacterial acute infectious causes of diarrhoea most common?

A

More common in young animals or very old - immunocompromised

Common in colonies/homes where there are lots of individuals

Mixed infections are worse - parasites PLUS viruses etc

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3
Q

Name some viruses that are likely to cause acute infectious diarrhoea

A

Parvovirus

Coronavirus

Adenovirus

(FeLV, FIV - chronic enteritis, weight loss, lymphoma in FeLV)

Rotavirus

(Norovirus)

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4
Q

Name some bacteria that are likely to cause acute infectious diarrhoea

A

Salmonella

Compylobacter

E.coli - ETEC, EHEC, EPEC

Clostridium perfingens, C.difficile

Shigella

Yersinia entercolitica - rarely reported

Mycobacteria in cats - granulomatous enteritis - not acute diseas

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5
Q

Name some parasites that are likely to cause acute infectious diarrhoea

A

Helminths

Protozoa - Giardia, Tritrichomonas

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6
Q

What is the problem with canine parvovirus?

How is it spread and what is its incubation period?

A

Virus is stable in the environment for years

Faecal oral

3-6 days incubation

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7
Q

Which type of dogs is parvovirus seen in?

A

Generally seen in young puppies with low maternal immunity (pre-vaccination), older unvaccinated dogs (breed predisposition - black and tan)

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8
Q

What kind of cells does canine parvovirus infect?

A
  • Infects rapidly dividing cells
    • Gut crypts, bone marrow, lymphoid tissue, (myocytes and CNS in some neonates) –if prenatal, end up with cardiac involvement or CNS involvement, then you get everything else –the dehydration etc.
      • Vomiting
      • Haemorrhagic diarrhoea –profuse and foetid, mucosal sloughing
      • Rapid dehydration
      • Panleucopaenia
      • Depressed, anorexic, pyrexic
      • Loss of mucosal barrier –septicaemia /endotoxaemia and shock/DIC
      • Ileus
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9
Q

What are some differential diagnoses for canine parvovirus?

A
  • Haemorrhagic gastroenteritis -including neoplasia and idiopathic HGE
  • Salmonella?
  • Intussusception
  • FB
  • Hypoadrenocorticism
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10
Q

How can you diagnose canine parvovirus?

A
  • Signalment and clinical signs strongly supportive
  • Faecal analysis –EM for virus, Ag tests (SNAP) or PCR
    • Care with positive results after MLV vaccination (SNAP ok….)
    • Severe necrosis of GIT can lead to false negative Ag tests
  • Haematology and biochemistry –consequences of disease
    • Panleucopaenia–consequence of viral replication
    • Azotaemia, acid-base disturbance, electrolyte disturbances, liver enzymes abnormal
  • Clotting times may be prolonged if severe systemic consequences present
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11
Q

What is the management for canine parvovirus overall?

A
  • Fluid therapy
    • LRS (lactated ringer solution?) –be aggressive, maintain electrolytes via supplementation –requires monitoring of blood pressure, COP if necessary and regular assessment of weight
    • Acid-base status assessment –can be severe imbalance
    • Colloid/plasma/whole blood
  • Antibiotics
    • Broad spectrum due to GI translocation of bacteria -Clav-amox, metronidazole, +/-quinolone –care with age of patient, gram negative coverage is difficult in young animals
  • Anti-emetics
    • important as marked nausea –metoclopramide, maropitant and ondansetron/dolasetron
    • These are vomiting a lot, once ruled out FB and intussusception –need to take away the nausea
  • Antacid drugs and ulcer coating medication
    • severe gastritis can develop along with reflux oesophagitis and strictures
  • Immunomodulators and ancillary therapies
  • Begin oral fluids/nutrients ASAP
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12
Q

How can you use fluid therapy for the management of canine parvovirus?

A
  • Fluid therapy

LRS (lactated ringer solution?) –be aggressive, maintain electrolytes via supplementation –requires monitoring of blood pressure, COP if necessary and regular assessment of weight

Acid-base status assessment –can be severe imbalance

Colloid/plasma/whole blood

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13
Q

What antibiotics should you use for the management of canine parvovirus?

A

Antibiotics

  • Broad spectrum due to GI translocation of bacteria -Clav-amox, metronidazole, +/-quinolone –care with age of patient, gram negative coverage is difficult in young animals
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14
Q

What anti-emetics can you use for the managment of canine parvovirus?

A

Anti-emetics

  • important as marked nausea –metoclopramide, maropitant and ondansetron/dolasetron
  • These are vomiting a lot, once ruled out FB and intussusception –need to take away the nausea
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15
Q

Why should you use antacid drugs and ulcer coating medication for the management of canine parvovirus?

A

Severe gastritis can develop along with reflux oesophagitis and strictures

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16
Q

How can you use immunomodulators and ancillary therapies for the management of canine parvovirus?

A
  • Recombinant feline interferon (VirbagenOmega)
    • For the reduction in mortality and clinical signs of parvovirosis(enteric form) in dogs from one month of age.
    • Treatment of cats infected with FeLV and/or FIV, in non-terminal clinical stages, from the age of 9 –evidence for this is lacking
  • CSFs to encourage BM recovery
  • Osteltamivir(Tamiflu) –limited evidence that improved weight and leucopaenia
  • These are of unclear benefit and have been reported in small studies only
  • They are expensive and must be discussed thoroughly with owners prior to use
  • THEY ARE NOT A SUBSTITUTE FOR POOR SUPPORTIVE THERAPY
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17
Q

How should you use fluids/nutrient replacement for the management of canine parvovirus?

A
  • Begin oral fluid/nutrients ASAP
    • Enteric support is crucial
    • Aggressive anti-emetic use
    • May require assisted feeding, care with reflux and aspiration
      • E.g.Naso-oesophageal tubes
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18
Q

How can you prevent canine parvovirus?

A
  • Vaccination –various protocols
    • Early vaccination and late vaccination in susceptible breeds and environments
    • Case this AM
  • Cleaning and disinfection –bleach/Virkon
  • Resistant to some disinfectants
  • A major reason for not taking unvaccinated puppies outside
  • Must make sure its clean other risk of reinfection
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19
Q

What is haemorrhagic gastroenteritis?

A

Syndrome of acute haemorrhagic diarrhoea

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20
Q

What is the cause of haemorrhagic gastroenteritis in most cases?

What is a DD?

A
  • Idiopathic in most cases.
  • Aetiology may be type I intestinal hypersensitivity reaction or the result of Clostridium perfringens enterotoxin production
  • DD: parvovirus enteritis/intussception/pancreatitis
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21
Q

What clinical signs will you see with haemorrhagic gastroenteritis?

A
  • Vomiting+/- blood
  • Foertid diarrhoea - inc protein loss - brown water
  • Depression, anorexia - very poorly
  • Haemoconcentration
    • fluid shift into GI means severe hypovolaemia before clinical dehydration is apparent
    • PCV high
    • TP not so high as GI loss of blood
    • No leucopenia
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22
Q

What is haemoconcentration with regards to haemorrhagic gastroenteritis?

A

Haemoconcentration

  • fluid shift into GI means severe hypovolaemia before clinical dehydration is apparent
  • PCV high
  • TP not so high as GI loss of blood
  • No leucopenia
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23
Q

What is the treatment for haemorrhagic gastroenteritis and what is the prognosis?

A
  • Fluid therapy –must be aggressive as with CPV
  • Colloid/plasma/whole blood
    • Depends on degree of haemorrhage and complications
  • Antimicrobial
    • Potential for clostridial infection and sepsis
    • Four quadrant cover –G+, G-, aerobes and anaerobes
      • Clav-amox, metronidazole, fluoroquinolone
  • Prognosis is good in most cases however severe cases where proteins are low and systemic inflammatory response develops is guarded –keep them well enough that they don’t develop systemic sequealea
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24
Q

What is feline panleucopaenia?

What is the transmission and clinical signs?

A
  • Feline parvo –similar to canine
    • Transmission and signs as CPV
      • Kittens/colonies
      • Widespread in feral cats
      • Cats can be infected by CPV-2
      • Diagnosis same as for CPV
    • Feline vaccine used in early CPV outbreaks as there seems to be cross protection
    • Reproductive failure/cerebellar hypoplasia
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25
Q

What is canine caronavirus?

What age of dogs is it seen in?

What part of the bowel is it predominantly seen in?

A
  • Dog
    • Young dogs (age related immunity?), highly contagious
    • Mild villus destruction –enterocytes at tips –Usually subclinical but strain related and co-infection can worsen disease
    • Predominantly small bowel but can be mixed
      • If severe –v+ and watery/mucoid d+
      • Treatment –supportive IVFT and nutritional support for GI tract
26
Q

What is feline coronavirus?

A

Cat –FECV

  • Signs as dog - mild villus destruction - enterocytes at tips
  • NB link to FIP –mutates to FIP-causing coronavirus (see FIP lecture) –FIP complex disease seen as s result of certain strains or genetic background or mutation of a particular coronavirus
27
Q

What the problem with campylobacter in animal faeces?

A

Public health hazard

28
Q

Which animals is bacterial enteritis most common in?

A

Young animals

Colonies/homes

29
Q

What are some clinical signs of acute enterocolitis with campylobacter?

A

D+ +/- blood/mucus

Vomiting

Straining - large intestinal type D+

Fever, abdominal pain

Can become enteroinvasive due to host stress (IFN and noradrenaline mediated)

30
Q

Which animals are most likely to get a problem with campylobacter?

A

It is commensal in dogs

Usually young, immunocompromised animals or those with additional infectious agents (giardia, parvo etc)

31
Q

What is the diagnosis for campylobacter?

A
  • Faecal stain/culture
    • Fragile, therefore best isolated from fresh faeces
    • Slender motile seagull-shaped bacteria
    • Standard culture may be misleading as speciation is not performed, need PCR
32
Q

What is the treatment for campylobacter?

A

Treat underlying disease if present e.g. IBD

Treatment most frequently with 4-fluoroquinolones (can use erythromycin however this can lead to vomiting)

33
Q

What are the four scenarios for the infected animal after infection with salmonella?

A

Transient asymptomatic diarrhoea

Acute gastroenteritis

Carrier state

Bacteraemia

34
Q

What age is salmonella seen in?

A

Mainly seen in young and immunocompromised animals or those with contaminant infections

It is a commensal in many dogs - raw food fed dogs have more frequency of salmonella in faeces

35
Q

What can the infection be like with salmonella?

When should you treat?

A
  • Infection can be mild or severe with haemorrhagic diarrhoea, pyrexia and sepsis (due to translocation across gut wall)
    • Negative prognostic indicators –hypoglycaemia, temp >40 ° C, degenerate left shift
    • SIRS and DIC –RIP
    • Cats –usually mild D+ but songbird fever when ingest birds (migration season) can lead to acute febrile illness with diarrhoea
  • Only treat if severe sepsis and shock and only on basis of culture results
    • NOT if patient is well/mild d+ as unlikely to be significant
36
Q

What are 2 clostridical normal anaerobic flora?

A

C. perfringens

C. difficile

37
Q

When does clostridial casue diarrhoea?

A

They are normal anaerobic flora

Diarrhoea generally due to enterotoxin production

Needs a trigger - diet change, hospitalisation etc

38
Q

What is the treatment for clostridial enteritis?

Spores?

A

Treat with metronidazole as first choice with ampicillin and tylosin alternatives (less effective)

Environmental spires are very resistant - hypochlorite with no fomites

39
Q

What is E.coli enteritis?

A
  • Common gut commensal and faecal isolate
  • Histiocytic ulcerative colitis in boxers newly discovered attaching and invasive isolate
    • Can develop rapid resistance however 4-fuoroquinolone treatment or metronidazole is effective in many cases
  • Various strains present –clear that plasmid genes code for pathogenicity (labs are able to test for these)
    • Important aspect are ESBL (impart resistance to 3 rd generation cephalosporins and quinolones) and wider dissemination to G-ve bacteria
    • ETEC
      • Shiga-toxin
      • Heat labile (LT) enterotoxin and Heat stable (ST) enterotoxin
      • Secretory diarrhoea?
    • EPEC
      • Attaching-effacing -microvillous effacement
    • EHEC -??in dog
      • Attaching-effacing
      • O157 –reverse zoonosis??
40
Q

Name some nematodes and cestodes in dogs and cats

A
41
Q

What are some clinical signs of ascarid infestations?

A

Fail to gain weight

Pot bellied appearance

Vomiting and small bowel diarrhoea

Obstruction of GIT in large burdens along with respiratory disease when migrating

42
Q

What are some clinical signs of hookworms infestations?

A

Kennelled dogs most commonly identified

Diarrhoea

Weight loss

Anaemia wirh Ancylostoma?

Interdigital dermatitis/perineal irritation

43
Q

How can you diagnose a helminth infestation?

A

Clinical signs and history

Faecal examination

44
Q

What is the treatment for a helminth infestation?

A
  • Heavy importance for treatment due to public health considerations (VLM and OLM)
    • Toxocara and cestodes
  • Treatment does not remove encysted larvae
  • Occult parasitic infestation should be considered in animals being investigated for IBD
  • This treatment for intestinal parasites should form part of the initial therapy in these cases
45
Q

Name some coccidian (protozoan) infestation in dogs and cats

A

Isospora canis - dog

I.felis, I. rivolta - cat

cryptosporidium

giardia

tritrichomonas foetus

46
Q

What is the diagnosis and treatment for coccidia (protozoa)?

A
  • Diagnosis: with faecal exam - direct or flotation for oocysts
  • Treatment - mild disease is self-limiting
    • if underlying cause present will resolve when this is resolved
    • Sulphonamides or potentiated sulphonamides
    • Toltrazuril and diclazuril can also be effective
    • Studies however indicate shedding can recur after treatment
47
Q

What kinds of animals are more likely to contract cryptosporidium?

How is it diagnosed?

What is the treatment?

A
  • Dogs and cats usually infected by host specific crypto
  • Pups/kittens, poor conditions etc (need to steam clean environment to control)
  • Many animals infected but few develop diarrhoea
    • Malabsorptive and secretory diarrhoea
  • Co-infection with giardia or tritrichomonas increased severity of signs
  • Diagnosis by feacal smear, IFA or PCR
  • Self limiting unless underlying cause
  • Treatment determine underlying cause
    • Dietary manipulation and neutraceuticals
    • Antibiotics of limited benefit –tylosin, azithromycin and paromomycin
  • Zoonotic potential
48
Q

What animals are most likely to be affected by giardia?

What kind of clinical signs do you see?

What is the diagnosis?

What is the treatment?

A
  • Colony/home problem most commonly or secondary
  • Surface of small bowel: dog (duodenum) and cat (ileum) –faecal-oral transmission, can be subclinical infection in many animals
  • Acute –chronic, usually mild (soft watery with mucus –iemixed bowel characteristics)
  • Can result in severe, chronic disease with weight loss
    • Via liberation of toxins, development of dysbiosis, induction of IBD, dysmotility, inhibition of enterocyte function
  • Dx–faecal smear evaluation (direct smear evaluation or flotation techniques) also SNAP test (ELISA) available –for faecal antigen along with IFA (this is poorly specific)
  • Tx
    • Fenbendazole 3-5 days –LICENSED
    • metronidazole, ronidazoleand tinidazole
    • fibre may help, unclear benefit of neutraceuticals
49
Q

What animals is tritrichomonas foetus usually found in?

What do you see with it?

Diagnosis?

Treatment?

A

Tritrichomonas foetus (strictly this is a large intestinal parasite)

  • Cat (rarely dog) –common in pedigrees that are in multicat households etc., often a secondary problem due to overcrowding and stress
  • Large bowel diarrhoea
  • Colonies/breeders
  • Common (30% of cats with d + ?)
  • Often present as secondary pathogen
  • Microscopy, culture, PCR
  • Difficult to treat -ronidazole
50
Q

What was Mr Mark Dunnings tip for searching for foreign bodies?

A

FB tip –animals with FB, esp deep chested, after you have done basic physical exam, get the O to have them standing up and have them at an incline and then feel again –can cause things to move and can feel foreign body more easily sometimes

51
Q

What is the maintenance of fluid balance in acute diarrhoea?

A
  • Balanced isotonic solution (Hartmann’s –also has buffering capacity) or 0.9% saline
  • Choice should be based on evaluation of electrolytes or acid base status.
  • However SOME fluid is better than no fluid!
  • IVFT rates based on dehydration factor, ongoing losses and maintenance requirements
  • Weigh animals regularly to determine if achieving goals of IVFT or measure ins and out
52
Q

What are adsorbants with regards to acute diarrhoea?

A
  • Adsorbants
    • May reduce diarrhoea
      • Efficacy not proven
        • Kaolin
        • Pectin
        • Chalk
        • Bismuth subsalicylate
        • Magnesium aluminium silicate
        • Activated charcoal
      • Alter intestinal flora/bind flora
      • Coat or protect mucosa
      • Absorb toxins
      • Bind water and possibly antiscretory
53
Q

What is the treatment of diarrhoea of non-specific origins in cats and dogs?

A

Kaogel VP oral suspension

An off white oral suspension, containing 0.99g Kaolin Light per 5ml

54
Q

What are peridale granules for acute diarrhoea?

What are the indications for use?

A

Peridale 98 % w/w Granules

  • Orange-coloured granules containing sterculia 98 %
  • Bulk promoting agent.
  • The sterculia takes up as much as 60 times its own volume of water, forming a gelatinous mass.
  • Increases the bulk of the intestinal contents, promotes peristalsis and helps to ensure the easy passage of a soft stool.

Indications in dogs:

  • Management of infected anal sacs.
  • Control of stool consistency following surgery.
  • Control of specific and non-specific diarrhoea.
  • Constipation.

Nutritional approaches with vegetables that are rich in different fibre types e.g. sweet potato and butternut squash

55
Q

What is the difference between a prebiotic and probiotic?

A
  • Prebiotic –selective substrate used by beneficial species and can alter the intestinal flora –mostly lactulose, inulin, FOS
  • Probiotics –living organisms that exert benefit beyond nutrition, e.g. antagonistic to pathogens, modulate mucosal immune response.
    • Species specific effects are apparent
56
Q

What are synbiotics?

A

Combined products are synbiotics (pre and probiotics)

  • Canikur Pro (Boehringer)
    • Enterococcus faecium *
  • Promax (VetPlus)
    • proven probiotic combined with prebiotic, natural immune stimulants and binding agents form a protective lining on the gut mucosa to facilitate digestive tract health.
  • Pro-Kolin + and Prokolin enterogenic (Protexin)
    • Kaolin, Pectin, FOS, gum arabic, source of butyrate
    • Enterococcus faecium E1707 *
57
Q

Give some examples of antimotility drugs

A
  • Opiates (avoid in cats)
    • Loperamide/diphenoxylate
    • Morphine –increases contractions (segmental) but decreases propulsion –increased large intestinal tone; overall leads to constipation
    • Codeine similar effect to morphine
    • They decrease intestinal secretion and promote absorption
    • Care in breeds with MDR-1 mutation due to CNS side effects
    • Contraindicated in animals with suspected FB or infectious conditions
    • Care when suspect ileus as this can be exacerbated 2.16.5.16
58
Q

When are spasmolytics indicated in small animals?

What products are licensed?

A
  • Antimotility (spasmolytics)
    • These are rarely indicated in small animals
      • No licensed product
      • Safe and effective doses yet to be determined
      • musculotropic antispasmodics (direct action on gut muscles causing relaxation)
        • Mebeverine and pinaverine
      • muscarinic antagonists (care with SI Diarrhoea)
        • Butylscopolamine (hyoscine) and metamizole (dipyrone -caution)
        • Aminopentamide –less risks
59
Q

When are prokinetics used in small animals?

Give some examples?

A
  • Prokinetics –rarely indicated in acute diarrhoea
    • Coordinate motility and reduce ileus if present
      • Metaclopramide –upper GIT
      • Erythromycin –encourages gastric emptying
        • Releases motilin
      • Ranitidine
        • Anti-cholinesterase activity
      • Lidocaine for Small intestinal motility
        • Also good visceral analgesic
60
Q

What are the indications for use of antimicrobials in acute diarrhoea?

A
  • Antimicrobials
    • Not routine “symptomatic”
    • Indications
      • Helicobacter –of questionable significance –triple therapy
      • Definitively diagnosed infectious diarrhoea
      • Loss of GI integrity
      • Neutropaenia/immunosuppression
        • E.g. parvo/post chemotherapy
    • SIBO/ARD –selective use of strategic antibiotics
61
Q

What is the cause or effect of haematology in acute diarrhoea?

A

Effect

  • Anaemia if blood loss/inflammatory disease
  • Lymphopaenia –lymphangiectasia

Cause

  • WBC evidence of infection/parasitism?
  • Lymphocytosis & eosinophilia –hypoadrenocorticism
  • Neutropaenia –complication of systemic disease

Small Animal Final Year (317 decks)

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