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Small Animal Medicine II > Small Intestinal Diseases and Diarrhea > Flashcards

Small Intestinal Diseases and Diarrhea Flashcards

1
Q

What is diarrhea?

A

Marked variation in bowel movement with increases in one or all of frequency, consistency and/or volume

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2
Q

Define acute diarrhea.

A

Less than 3 weeks, self-limiting, responds to supportive therapy, but can by systemic and potentially fatal.

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3
Q

Define chronic diarrhea.

A

Ongoing diarrhea (>3 weeks) that does not respond to supportive therapy.

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4
Q

What are some major differences between large and small bowel diarrhea?

A

Large bowel typically has tenesmus, mucus, fresh blood and no steatorrhea.
Small bowel typicall has no tenesmus, no mucus,digested blood, and maybe steatorrhea

NOTE: In chronic small bowl diarrhea, weight and protein loss also occurs

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5
Q

Which type of diarrhea has a better prognosis, large or small?

A

Large

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6
Q

How do you approach a systemically well, acute small bowel diarrhea case? (3 things)

A

Fecal
PCV and total solids (if bloody diarrhea)
Treat symptomatically

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7
Q

How do you approach a systemically unwell, acute small bowel diarrhea case?

A

Need to differentiate between GIT and extra-GIT cause and monitor patient

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8
Q

What is the most common parasitic cause of small bowel diarrhea?

A

Ancylostoma canninum

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9
Q

What are 6 causes of extra-GIT causes of acute diarrhea?

A 
Acute pancreatitis
Liver dz
Renal dz
Addison's
Sepsis
Shock
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10
Q

What are 4 severe, life-threatening GIT causes of diarrhea?

A

Viral
Bacterial
Hemorrhagic Gastroenteritis (“Acute Hemorrhagic Diarrhea Syndrome”)
Obstruction

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11
Q

What do we see with Acute Hemorrhagic Diarrhea Syndrome?

A

Acute, severe bloody diarrhea + vomiting with increase HCT, normal WBC and no fever

NOTE: NO dehydration, fluid shifts are too rapid

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12
Q

What is the suspected cause of Acute Hemorrhagic Diarrhea Syndrome?

A

Type 1 sensitivity rxn

C. perfringens

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13
Q

How is Acute Hemorrhagic Diarrhea Syndrome characterized?

A

Hemorrhagic diarrhea with hemoconcentration

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14
Q

What is the pathophysiology of hemoconcentration?

A

Loss of tight junction integrity -> Water allowed to leak out (PCV and TSP increase) -> Water AND proteins leak out (PCV increase, TSP normal/low) -> Blood leaks through

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15
Q

What will you find on your labs that point to hemoconcentration?

A

PCV >55-6

TSP normal

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16
Q

What is a major differential for Acute Hemorrhagic Diarrhea Syndrome?

A

Parvo

NOTE: absence of leukopenia and presence of hemoconcentration

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17
Q

How do you treat Acute Hemorrhagic Diarrhea Syndrome?

A

IV fluids

IV abs

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18
Q

In a case of Acute Hemorrhagic Diarrhea Syndrome, what is the fluid protocol?

A

Replace 5% dehydration over 2-6 hours and then 2x maintenance for 12-24 hours

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19
Q

In cases of Acute Hemorrhagic Diarrhea Syndrome, when do you start offering food again?

A

After diarrhea has improved (~12hrs). Use low residue diet for several days

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20
Q

Where does Parvovirus localize?

A

Crypt cells
Bone marrow
Lymphoid tissue

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21
Q

When do animals shed parvo?

A

Acute phase and 8-10 days after

NOTE: Parvo is a very stable virus, remain in environment for months

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22
Q

What age does parvo have its highest incidence?

A

Weaning to 6 months

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23
Q

What are 3 highly susceptible breeds to parvo?

A

GSD
Rottweilers
Dobermans

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24
Q

What are the 5 major clinical signs of parvo?

A 
Anorexia
Depression
Fever
Vomiting
Diarrhea

NOTE: Acute onset

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25
Deffinitive diagnosis of parvo needs...?
Demonstration with EM and with SNAP NOTE: SNAP very sensitive, but can get false positives 14days post-vaccination
26
T/F: The degree of neutropenia in a parvo case usually does not correlate with the severity of the disease.
False, degree of neutropenia DOES correlate with the severity of the disease
27
What are 4 other biochemical abnormalities you might see with Parvo?
HypoK Hypoglycemia (sign of sepsis) Prerenal azoteia Increased liver enzymes
28
How do you manage a parvo patient?
STRICT ISOLATION IN HOSPITAL
29
What 3 Abx can you use to treat parvo?
Amoxycillin | Gentamycin/Amikacin (ONLY IF RENAL FXN NORMAL
30
What are 7 additional therapies you may use in a parvo puppy?
``` Antiemetics (both central and peripheral) Plasma transfusion (TSP ```
31
When treating for Parvo, if you have breakthrough pain, what do you need to consider?
Could be intussusception
32
How do you handle nutrition in a Parvo case?
DO NOT STARVE! Start feeding 4-5 hours after treatment is started and aim to give 1/3 of daily requirement over the next 24 hours
33
What are 6 things you should monitor daily in a parvo patient?
Body weight CRT Abdominal palpation for intussusceptions PCV and TSP (do this several times on days 1-3) Blood glucose (check on intake and any time demeanor changes) Serum potassium
34
What is the prognosis of parvo?
Most dogs recover if dehydration and sepsis treated appropriately
35
What can help you with prognosis on parvo case?
Neutrophil count on day 3
36
What is associated with a high mortality rate in parvo?
Severe infection and leukopenia
37
What is the name for feline parvo?
Feline Panleukopenia
38
What are 4 differentials for Feline Panleuk.?
Corona FIV FeLV FIP
39
What is chronic small intestinal diarrhea?
Diarrhea that persists >3 weeks
40
What must you do if you have chronic small intestinal diarrhea?
Systemic diagnostics
41
What can chronic small intestinal diarrhea lead to?
Malassimilation syndrome
42
What is not appropriate in a case of chronic small intestinal diarrhea?
Withholding food
43
What 4 things might you do to investigate intestinal causes of chronic small intestinal diarrhea?
MDB (blood and UA) Fecal parasitology and bacteriology Diet trial4BI biopsies
44
What increases sensitivity of fecal parasitology?
3 consecutive samples
45
If on blood work of an animal with chronic small intestinal diarrhea, we see anemia, what 2 things should be on your mind?
Parasites | Tumor/ulcer if older animal
46
What 4 things might you see on the biochem of an animals with chronic small intestinal diarrhea?
Panhypoproteinemia Hypocholesterolemia Mild increase in liver enzymes Evidence of dehydration
47
Why is fecal bacteriology problematic?
Identifying an organism doesn't mean it's causative, don't test unless severe signs associated with diarrhea
48
What 3 scenarios would you definitely perform bacteriology?
Infectious cause is suspected Pyrexia and other systemic signs Hemorrhagic gastroenteritis present
49
Campylobacter... GO! 3
Can be isolated from healthy dogs Treatment not always necessary Abx only justified in dogs with acute HGE
50
Salmonella... GO! 2
Uncommon (more so on BARF diet) | Use fluorquinolones if isolate in acute HGE to prevent sepsis
51
E.coli... GO! 1
Non-pathogenic
52
Clostridium... GO! 2
HCT often exceeds 60% with neutrophilia | Acute, profuse bloody diarrhea and dehydration
53
When are abdominal RADs useful in chronic small intestinal diarrhea?
To ID need for surgical intervention
54
What is abdominal US valuable for with chronic small intestinal diarrhea?
ID obstructive disorders GI motility Assess GI walls
55
What are 3 markers for absorption?
TLI B12 (Cobalamin) Folate
56
What does TLI tell us?
Indicative of exocrine pancreatic dz
57
What is cobalamin important for?
Enterocyte health
58
What do some dogs develop as a result of B12 deficiency?
Hepatic encephalopathy
59
What is the only way to diagnose a food sensitivity?
Diet trial
60
What is the gold standard diet trial?
Hydrolysed diet (Z/D)
61
How do you perform a diet trial?
Feed novel protein/hydrolysed diet for 2 weeks. If no response, abandon. If response, feed for at least 8 more weeks to see if clinical signs resolve.
62
What 2 viruses might you test for if you have chronic small intestinal diarrhea?
FeLV/FIV | Coronavirus (this is a waste of time...)
63
What are 3 situations where Abx would be indicated with chronic small intestinal diarrhea?
Hemorrhagic Pyrexia Inflammatory leukogram
64
What is ARDS?
Antibiotic responsive diarrhea NOTE: uncommon in cats, but recognized in young, large breed dogs
65
How long do you perform an Abx trial for?
Response normally seen within 2 weeks, but continnued for at least 4 weeks
66
Why is metronidazole sometimes used in Abx trials?
Possible immunomodulatory effects
67
If all other trials fail, what would you do with a case of chronic small intestinal diarrhea?
Biopsy, may be looking at idiopathic or neoplastic process
68
What is the only way to take a full thickness biopsy of the intestine?
Surgery
69
What is a drawback to laparotomy to get a biopsy?
Can't visualize pathology on the lumen like you can with an endoscope
70
How long do you fast a patient for a GI scope?
>12 hours for UPPER | >24 hours for LOWER plus multiple enemas
71
What is idiopathic IBD?
Breakdown of normal immune tolerance?
72
What is the most common form of idiopathic IBD?
Lymphocytic plasmacytic enteritis
73
Why do cats with idiopathic IBD often vomit?
D/t triaditis
74
What are 3 negative prognostic factors of idiopathic IBD?
Hypoalbuminemia Hypocobalaminemia Small bowel and older dog
75
What is the therapy for IBD?
Corticosteroids
76
What IBD therapy can you NOT use in cats?
Azathioprine
77
What IBD therapy can you use in cats?
Chlorambucil (C for cats) NOTE: Problem is size of cat and dosing
78
What 2 treatments help to chance the consistency of the stool?
Kaolin | Peridale
79
What is intestinal lymphangectasia?
Marked dilation and leakage from lymphatics, see significant PLE
80
What is the characteristic of the ascites with intestinal lymphangectasia?
Transudate in primary | Chylous in secondary
81
What is a common complication of PLE?
Hypercoagulability
82
What are the 6 steps in a systemic, step-wise diagnostic approach?
1. Rule out obvious problem 2. Small or large intestine? 3. PLE? - low albumin and systemically sick animals need aggressive diagnostics 4. Eliminate extra-intestinal dz 5. If no protein loss, treatment trial is acceptable 6. Biopsy if failure to respond to trials

Small Animal Medicine II (8 decks)

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