SI Disorders in Dogs and Cats Flashcards
Name some causes of acute diarrhoea
- 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
Where are viral, parasitic and bacterial acute infectious causes of diarrhoea most common?
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
Name some viruses that are likely to cause acute infectious diarrhoea
Parvovirus
Coronavirus
Adenovirus
(FeLV, FIV - chronic enteritis, weight loss, lymphoma in FeLV)
Rotavirus
(Norovirus)
Name some bacteria that are likely to cause acute infectious diarrhoea
Salmonella
Compylobacter
E.coli - ETEC, EHEC, EPEC
Clostridium perfingens, C.difficile
Shigella
Yersinia entercolitica - rarely reported
Mycobacteria in cats - granulomatous enteritis - not acute diseas
Name some parasites that are likely to cause acute infectious diarrhoea
Helminths
Protozoa - Giardia, Tritrichomonas
What is the problem with canine parvovirus?
How is it spread and what is its incubation period?
Virus is stable in the environment for years
Faecal oral
3-6 days incubation
Which type of dogs is parvovirus seen in?
Generally seen in young puppies with low maternal immunity (pre-vaccination), older unvaccinated dogs (breed predisposition - black and tan)
What kind of cells does canine parvovirus infect?
- 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
- 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.
What are some differential diagnoses for canine parvovirus?
- Haemorrhagic gastroenteritis -including neoplasia and idiopathic HGE
- Salmonella?
- Intussusception
- FB
- Hypoadrenocorticism
How can you diagnose canine parvovirus?
- 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
What is the management for canine parvovirus overall?
- 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
How can you use fluid therapy for the management of canine parvovirus?
- 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
What antibiotics should you use for the management of canine parvovirus?
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
What anti-emetics can you use for the managment of canine parvovirus?
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
Why should you use antacid drugs and ulcer coating medication for the management of canine parvovirus?
Severe gastritis can develop along with reflux oesophagitis and strictures
How can you use immunomodulators and ancillary therapies for the management of canine parvovirus?
- 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
How should you use fluids/nutrient replacement for the management of canine parvovirus?
- 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
How can you prevent canine parvovirus?
- 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
What is haemorrhagic gastroenteritis?
Syndrome of acute haemorrhagic diarrhoea
What is the cause of haemorrhagic gastroenteritis in most cases?
What is a DD?
- 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
What clinical signs will you see with haemorrhagic gastroenteritis?
- 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
What is haemoconcentration with regards to haemorrhagic gastroenteritis?
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
What is the treatment for haemorrhagic gastroenteritis and what is the prognosis?
- 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
What is feline panleucopaenia?
What is the transmission and clinical signs?
- 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
- Transmission and signs as CPV
What is canine caronavirus?
What age of dogs is it seen in?
What part of the bowel is it predominantly seen in?
- 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
What is feline coronavirus?
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
What the problem with campylobacter in animal faeces?
Public health hazard
Which animals is bacterial enteritis most common in?
Young animals
Colonies/homes
What are some clinical signs of acute enterocolitis with campylobacter?
D+ +/- blood/mucus
Vomiting
Straining - large intestinal type D+
Fever, abdominal pain
Can become enteroinvasive due to host stress (IFN and noradrenaline mediated)
Which animals are most likely to get a problem with campylobacter?
It is commensal in dogs
Usually young, immunocompromised animals or those with additional infectious agents (giardia, parvo etc)
What is the diagnosis for campylobacter?
- 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
What is the treatment for campylobacter?
Treat underlying disease if present e.g. IBD
Treatment most frequently with 4-fluoroquinolones (can use erythromycin however this can lead to vomiting)
What are the four scenarios for the infected animal after infection with salmonella?
Transient asymptomatic diarrhoea
Acute gastroenteritis
Carrier state
Bacteraemia
What age is salmonella seen in?
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
What can the infection be like with salmonella?
When should you treat?
- 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
What are 2 clostridical normal anaerobic flora?
C. perfringens
C. difficile
When does clostridial casue diarrhoea?
They are normal anaerobic flora
Diarrhoea generally due to enterotoxin production
Needs a trigger - diet change, hospitalisation etc
What is the treatment for clostridial enteritis?
Spores?
Treat with metronidazole as first choice with ampicillin and tylosin alternatives (less effective)
Environmental spires are very resistant - hypochlorite with no fomites
What is E.coli enteritis?
- 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??
Name some nematodes and cestodes in dogs and cats

What are some clinical signs of ascarid infestations?
Fail to gain weight
Pot bellied appearance
Vomiting and small bowel diarrhoea
Obstruction of GIT in large burdens along with respiratory disease when migrating
What are some clinical signs of hookworms infestations?
Kennelled dogs most commonly identified
Diarrhoea
Weight loss
Anaemia wirh Ancylostoma?
Interdigital dermatitis/perineal irritation
How can you diagnose a helminth infestation?
Clinical signs and history
Faecal examination
What is the treatment for a helminth infestation?
- 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
Name some coccidian (protozoan) infestation in dogs and cats
Isospora canis - dog
I.felis, I. rivolta - cat
cryptosporidium
giardia
tritrichomonas foetus
What is the diagnosis and treatment for coccidia (protozoa)?
- 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
What kinds of animals are more likely to contract cryptosporidium?
How is it diagnosed?
What is the treatment?
- 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
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?
- 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
What animals is tritrichomonas foetus usually found in?
What do you see with it?
Diagnosis?
Treatment?
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
What was Mr Mark Dunnings tip for searching for foreign bodies?
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
What is the maintenance of fluid balance in acute diarrhoea?
- 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
What are adsorbants with regards to acute diarrhoea?
- 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
- Efficacy not proven
- May reduce diarrhoea
What is the treatment of diarrhoea of non-specific origins in cats and dogs?
Kaogel VP oral suspension
An off white oral suspension, containing 0.99g Kaolin Light per 5ml
What are peridale granules for acute diarrhoea?
What are the indications for use?
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
What is the difference between a prebiotic and probiotic?
- 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
What are synbiotics?
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 *
Give some examples of antimotility drugs
- 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
When are spasmolytics indicated in small animals?
What products are licensed?
- 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
- These are rarely indicated in small animals
When are prokinetics used in small animals?
Give some examples?
- 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
- Coordinate motility and reduce ileus if present
What are the indications for use of antimicrobials in acute diarrhoea?
- 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
What is the cause or effect of haematology in acute diarrhoea?
Effect
- Anaemia if blood loss/inflammatory disease
- Lymphopaenia –lymphangiectasia
Cause
- WBC evidence of infection/parasitism?
- Lymphocytosis & eosinophilia –hypoadrenocorticism
- Neutropaenia –complication of systemic disease