EM of fresh feces histopath of intestines Tissue immunofluorescence Fecal ELISA viral load may be too low if clinical signs are very advanced recently vaccinated patient (with mod live vacc) will test positive

isolate replacement fluid therapy plasma for coag issues or anemia parenteral abx cephalosporin or aminoglycoside anti-emetics tamiflue NPO till zero puke for 24 hours liquid diet during vx/diarrhea control parasites

immunity for 20mo to 1 yr post infection VACCINATION

common in 2-4 yr olds, minis and toys depression, vx +/- blood, diarrhea (dysentary) dehydration, tachycardia, +/- N skin turgor severely inc PCV \> 60%, normal TP thrombocytopenia and metabolic acidosis usually a one-time episode

Fluids and electrolytes antiemetics +/- abx stop food and water feed 12-24 hours after resolution clin signs recovery usually in 1-2 days

Small animal GI Learning objectives (6: acute diarrhea; 7: clin app to diarrhea; 8/9: chron diarrhea dx) Flashcards by Jessica Fuller

Classification of acute diarrhea

self-resolving small bowel diarrhea
life-threatening small bowel diarrhea
self-resolving large bowel diarrhea
life-threatening large bowel diarrhea - rare

* Do a fecal in all cases

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Infectious causes of acute diarrhea

Parasites, bacteria, virus

whipworms - large bowel diarrhea
tritrichomonas - large bowel diarrhea in cats
hookworms
- more severe diarrhea + anemia
Salmonella and Campylobacter
- salmonella considered when on raw food diet
Clostridium

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Causes of Acute diarrhea

infectious
hemorrhagic gastroenteritis
obstructive
toxin and drug-induced
dietary
extraintestinal

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Pathogenesis of canine parvovirus

very contagious (dogs and cats)
attacks rapidly dividing cells
some breeds more susceptible: dobies, rotties
caused by epitheliotropic enterovirus
Type 1 parvo: abortion
Type 2 parvo: severe enteritis, FeLeuk
- four evolving subtypes
tx fecal-oral, hard to kill
subclinical infections with shedding possible
Morbidity: 20-90%; mortality: 0-50%

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Clinical signs of parvo

leukopenia
dehydration
diarrhea
vomit
fever
abd pain
anorexia
lethargy

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DX parvo

EM of fresh feces
histopath of intestines
Tissue immunofluorescence
Fecal ELISA
- viral load may be too low if clinical signs are very advanced
- recently vaccinated patient (with mod live vacc) will test positive

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TX parvo

isolate
replacement fluid therapy
plasma for coag issues or anemia
parenteral abx
- cephalosporin or aminoglycoside
anti-emetics
tamiflue
NPO till zero puke for 24 hours
- liquid diet during vx/diarrhea
- control parasites

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Prevention parvo

immunity for 20mo to 1 yr post infection
VACCINATION

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Clinical signs HGE

common in 2-4 yr olds, minis and toys
depression, vx +/- blood, diarrhea (dysentary)
dehydration, tachycardia, +/- N skin turgor
severely inc PCV > 60%, normal TP
thrombocytopenia and metabolic acidosis
usually a one-time episode

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TX HGE

Fluids and electrolytes
antiemetics
+/- abx
stop food and water
feed 12-24 hours after resolution clin signs
recovery usually in 1-2 days

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eleven aspects to eval in chronic diarrhea patient

duration
diet
progression
appetite (inc, ravenous, pica)
weight loss: SI
appearance of feces
- large volume: SI
- small volume: LI
frequency of defecation
- near normal: SI
- inc: LI
- urgen: LI
presence of vomiting: usually upper, can be any
tenesmus: involvement of distal rectum, colon or anus
environment animal stays in
- parasites, working animals, indoor/outdoor, recent change, boarding, travel
animals breed and character
- GSD and EPI

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Small bowel dz

Feces

Defecation

Other

Feces
- normal to inc volume
- mucus rare
- melena rare
Defecation
- urgency uncommon
- tenesmus absent
- frequency normal to mild inc
- dyschezia increased (2-3x)
Other
- weight loss common
- vomiting can occur
- flatulence can occur
- halitosis can occur

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Large bowel dz

Feces

Defecation

Other

Feces
- normal or decreased
- mucus common
- hematochezia common
Defecation
- urgency common
- tenesmus common
- frequency moderately to severely increased
- dyschezia increarsed (> 3x)
Other
- weight loss rare
- vomiting uncommon
- flatulence absent
- halitosis absent

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Diagnostic approach to chronic diarrhea patient

Complete fecal exam (macro and micro)
cobalamin/folate
imaging
biopsy
diet trial

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comp of complete fecal exam

centrifugation
saline smear (mobile things)
cytology
culture (not great)
check for C. Perfringens (can be normal)
Giardia and Tritrichomonas (ELISA)
IDEXX PCR panel

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Folic acid

absorbed in SI
higher levels may indicate antibiotic responsive diarrhea

Cobalamin

absorbed in distal SI and impaired with intestinal dz
low serum conc suggest
- severe mucosal dz or
- distal intestinal bact overgrowth or
- both

Clinical presentation IBD

varied
middle aged to older animals

clinical signs IBD

dogs

diarrhea
PLE
hypoproteinemia
- peripheral edema - large breed
- ascites - small breed
GSD

clinical signs IBD

Cat

vomiting
- clear fluid/bile
more intermittant than with dogs
can be acute or chronic
stress
triaditis
lethargy
inc problems with hairballs
hematochezia
weight loss
Rarely PLE

DX IBD

DX of exclusion
low cobalamin in cats
mild-mod inc of liver enzyme activity in dogs and cats
normal x-rays
- no barium unless suspect obstruction

When diagnosing IBD, r/o

intestinal pathogens/parasites
intestinal obstruction
systemic disorders
exocrine pancreatic insufficiency
abx resp dz
food resp dz

DX IBD by bx

mild, moderate or severe cell infiltration
villus atrophy or fusion
fibrosis
epithelial erosion
lymphangiectasia

DDX IBD (10)

Exocrine pancreatic insufficiency (dog)
food responsive dz
abx responsive dz
intestinal tumors
- esp: diffuse, intestinal lymphoma
hyperthyroidism (cats older than 5yo)
Giardiasis in cats and dogs
FIP in cats
pancreatitis
drug rxn
colon fungal infection

lymphangiectasia - about

* small intestinal disorder of dog * marked dilatation of mucosal and submucosal intestinal lymphatics * anatomic or physiologic obstruction of lymphatic drainage from intestines * progression * lacteals dilatate, absorb lipid and lipoprotein, then rupture * release lymph into intestinal lumen

Clinical signs of lymphangiectasia

* diarrhea * weight loss * edema * ascites * pleural effusion * panhypoproteinemia

DX of lymphangiectasia

* clinical signs * lab findings that exclude hepatic or renal dz * visualization lacteals on endoscopy or laparotomy

TX lymphangiectasia

* low fat diet and address underlying causes

pathogenesis and tx of histiocytic ulcerative colitis comp to other forms of IBD

* form of large intestine dz * characterized by hematochezia and tenesmus * seems to be infectious * **NEVER USE STEROIDS**

Tx of lymphoplasmocytic colitis in dogs and cats

* **main sign: tenesmus and mucus in feces** * frequent urgency (accidents) * TX dogs * dietary therapy initially (high fiber, new protein) * TX cats * sulfasalazine 7-10 days * Prednisone when other treatments don't work