Smallies 3 Flashcards
What anti-emetics can be used for management of a parvo case?
Metoclopramide
Maropitant
Ondansetron/Dolasetron
Why are antacids and ulcer coating medications used in the management of parvo cases?
Severe gastritis can develop alone with reflux oesophagus and strictures
How can you prevent canine parvovirus
Vaccination
What are differentials for haemorrhagic gastroenteritis?
Parvovirus enteritis
Intussusception
Pancreatitis
What are clinical signs of haemorrhagic gastroenteritis?
Vomiting +/- blood
Foetid diarrhoea including protein loss
Depression
Anorexia
What are signs of haemorrhagic gastroenteris on haematology and biochemistry?
Haemoconcentration
Hypovolaemia (fluid shift into GIT) before dehydration becomes apparent
High PCV
No leucopaenia (cf parve)
What is the treatment for haemorrhagic gastroenteritis?
Aggressive fluid therapy
Colloid/plasma/whole blood
Antimicrobials (amoxiclav, metronidazole, fluoroquinolone)
What is the prognosis for haemorrhagic gastroenteritis?
Good in most cases however severe cases where proteins are low and systemic inflammatory response develops the prognosis is guarded
What is feline panleucopenia?
Feline parvovirus
How does coronavirus cause pathology?
Mild villus destruction - enterocytes at tips
Which dogs often get campylobacter bacterial enteritis?
Commensal
Young dogs
Immunocompromised
Ones with additional infectious agents (giarda, parvo etc)
What are clinical signs of Campylobacter?
Diarrhoea +/- blood/mucus Vomiting Straining Fever Abdominal pain
How can campylobacter be diagnosed?
Faceal stain/culture
Fragile therefore best isolated from fresh faeces
Standard culture may be misleading as speciation is not performed –> need PCR
How is campylobacter treated?
4-fluoroquinolones (can use erythromycin but this can lead to vomiting)
What are the 4 scenarios of a salmonella infection?
Transient aymptomatic diarrhoea
Acute gasatroenteritis
Carrier state
Bacteraemia
What are features of severe Salmonella gastroenteritis?
Haemorrhagic diarrhoea
Pyrexia
Sepsis
What are negative prognostic indicators of a salmonella infectoin?
Hypoglycaemia
Temp >40
Degenerate left shift
What happens with ‘songbird’ fever in cats?
Caused by ingestion of birds that can lead to acute febrile illness with diarrhoea
Hoe does Clostridial enteritis generally cause diarrhoea?
Enterotoxin production
How is Clostrial enteritis treated?
Metronidazole
ampicillin and tylosin alternatives
What nematodes can cause diarrhoea in dogs?
Toxocara canis Toxascaris leonina Uncinaria stenocephala Ancylostoma canium Trichuris vulpis
What nemetodes can cause diarrhoea in cats?
Toxocara cati
Toxascaris leonina
Ancylostoma tubaeforme
What are clinical signs of an Ascarid infection?
Fail to gain weight
Pot-bellied appearance
Vomiting and small bowel diarrhoea
What are clinical signs of a Hookworm infection?
Diarrhoea Weight loss Anemia Interdigital dermatitis Perineal irritation
What dogs are often infected with Hookworm?
Kenneled dogs
What is the diagnosis of a Helminth infection based on?
Clinical signs
History
Faecal examination
How can you diagnose a Coccidia infection in dogs and cats?
Faecal exam - direct or floatation for oocysts
What is the treatment for a Coccidia infection?
Mild cases are self limiting
Removal of underlying cause
Sulphonamides or potenitated sulphonamides
Toltrauril and diclazuril can also be effective
How can you diagnose a Cryptosporidium infection in cats and dogs?
Faecal smear
IFA
PCR
What is the treatment for a Cryptosporidium infection in dogs and cats?
Self-limiting unless there is an underlying cause
Antibiotics are of limited benefit
How are protozoal infections transmitted?
Faeco-oral route
How is a Giardia infection diagnosed in dogs and cats?
Faecal smear evalulatoin (direct or floatation) SNAP test (ELISA) is available
What is the treatment for a Giardia infection?
Fenbedazole for 3-5 days (licensed)
Metronidazole, ronidazole, tinidazole
Dietary manipulation
How is a Tritichomonas infection diagnosed in dogs and cats?
Microscopy
Culture
PCR
What do you need to ask when collecting the general history for a SI disease case?
Vaccination and worming status Scavenging, diet, drugs Contact with other animals and environment Recent travel history Health of owners - zoonoses Previous illness/surgeries Other body systems involved
What do you need to establish about the SI disease when asking the owner?
Duration, progression, severity, frequency
Continuous or intermittent plus length of intervening normality
Response to treatment and diet
Which arose first (V or D)
What characteristics about the V/D do you need to ask the owner about?
Urgency/straining Blood (melaena/digested or haematochezia/fresh) Mucus Frequency Faecal volume Weight loss Steatorrhoea Flatulence/borborygmi Bloating
What might you be looking for on your clinical exam of a SI disease case?
Dehydration/CVS status
Evidence for oral ulceration/FB
Palpable thyroid in cats/dogs
Thoracic ascultation - dull with effusions
Cardiac - abnormalities if hypoadrenocorticsim/cardiac disease
Abdomen - pain, focal mass/intestinal bunching, fluid, faeces - may need dog to stand on hindlegs to get better access to abdomen
Rectal - foreign material, mucosal friability
Cutaneous exam - food sensitivity, poor coat condition
What are the 3 main outcomes from history/clinical exam findings? And what will you do?
Not worried - manage consequences of diarrhoea
Not sure - screen
Worried - investigate
What is hypertonic water loss characterised by?
Increased motility and secretion, with decreased absorption
Loss of sodium (often as bicarb)`
What symptomatic therapy can be given to patients with SI disorders?
Adsorbants e.g. Kaolin
Bulk forming agents e.g. Peridale
Pre and probiotics e.g. Lactulose (pre) or Canikur Pro (combined product - synbiotic)
Anti-motility e.g. Opiates or Spasmolytics
Prokinetics e.g. Metaclopromide
Antimicrobials
How do adsorbants work?
Alter intestinal flora/bind flora
Coat or protect mucosa
Absorb toxins
Bind water and possible antisecretory
How do bulk forming agents work?
Granules containing sterculia which take up as much as 60x its own volume of water, forming a gelatinous mass
Increases the bulk of the intestinal contents, promote peristalsis and help to ensure the easy passage of soft stool
How do prokinetics work?
Coordinate motility
Reduce ileus if present
When are antimicrobials indicated in SI disorders?
Helicobacter
Definitively diagnosed infectious diarrhoea
Loss of GI integrity
Neutropenia/immunosuppresion e.g. parvo cases
What is the minimum database of information you need to obtain for SI disorders? And what are you looking for?
Biochemistry (including electrolytes)
- renal parameters (azotaemia or GI bleeding)
- liver parameters (bile acids, ammonia, low urea, bilirubin)
- proteins (low albumin/globulin)
- electrolytes (K, Na, Cl)
Haematology
- RBC (anaemia, polycythaemia, toxic change)
- WBC (lymphocytosis/paenia, neutrophilia/paenia, esinophilia)
Urinalysis
- USG (dehydration)
- bilirubin (liver dz)
- glucose (stress, endocrinopathies, tubular disease)
- cast (renal dz)
- proteinuria (systemic inflammation/GN)
What are causes of chronic diarrhoea?
SIBO/ARD EPI Food responsive diarrhoea IBD Lymphangiectasia Neoplasia
What is SIBO/ARD?
Small intestinal bacterial overgrowth/antibiotic resistance diarrhoea
What are causes of SIBO/ARD?
Decreased gastric acid production (atrophic gastritis/antacids)
Increased SI substrates (EPI/malabsorptive dz)
Partial obstructions (strictures/neoplasia)
Anatomic disorders (resection of ileal valve/blind loops)
Motility disease
Hypothyroidism
What are the consequences of secondary bacterial overgrowth?
Utilise nutrients/interfere with absorption
Damage epithelium and microvillar enzyme dysfunction
Increase mucosal permeability/fluid loss
Deconjugate bile acids
Hydroxylate fatty acids
Stimulate colonocyte secretion
What are clinical signs of ARD/SIBO?
Chronic small bowel diarrhoea Weight loss/failure to thrive Vomiting Borborygmus Appetite changes
How is SIBO/ARD diagnosed?
History
Response to antibiotics if ruled out other underlying causes
Serum folate/B12 (cobalamin) to localise disease
- folate absorbed in proximal SI
- B12 absorbed in distal SI
Bacteria synthesis folate and bind B12
Breath hydrogen testing
Circulating unconjugated bile acids (no longer recommended)
How is SIBO/ARD treated?
Treatment of primary cause
Antibiotics for 4-6 weeks, review after 2 weeks as you may need to change the type
What are ancillary treatment approaches used for SIBO/ARD?
Dietary manipulation - highly digestable diet and low fat
Prebiotics - alter colonic flora (cats not dogs)
Probiotics - unsure of benefit
Cobalamin supplementation - essential to improve recovery rates
What is the aetiology of food responsive diarrhoea?
Adverse reaction to food category
Sub-category of IBD
How is food response diarrhoea diagnosed?
Response to food trial
Inflammation can be determined with biopsy
What is IBD?
Inflammatory bowel disease is an idiopathic condition that is not responsive to diet or antibiotics
What is the typical signalment and clinical signs of IBD?
Mainly middle aged animals Vomiting - more common in cats - can be haemorrhagic Weight loss Variable appetite Abdominal discomfort
How is IBD diagnosed?
History Clinical signs Physical exam Rule out other DDx Diagnostic imaging Biopsy
Discuss use of biopsy in the diagnosis of IBD?
Can be done before or after treatment
Duodenum often has significant changes in 30% of cases
Ileum has significant changes in 30% of cases
What are DDx of eosinophilic enteritis?
Endoparasitism Hypersensitivity disorders MCT/paraneoplastic disease Hypoadrenocorticism Hypereosinophilic syndrome in Rottweilers or cats
What is the feline triaditis complex?
IBD, pancreatitis, and cholangiohepatitis
What are baseline tests fo triaditis?
CBC Biochemistry Urinalysis Serum T4 concentrations FeLV/FIV test
What is the standard management of IBD cases?
Dietary manipulation Antiparasiticides e.g. Fenbendazole Vitamin supplementations e.g. Cobalamin Antibiotics e.g. Oxytetracycline Immunosuppressive therapies e.g. Prednisolone Pre/pro biotics
What is lymphangiectasia?
Pathologic dilation of lymph vessels in the intestine
What can lymphangiectasia be secondary to?
Generalised primary conditions of lymphatics e.g. breed predispositions or lipogranulomatous changes
Blocked C. chyli/thoracic duct
what is the outcome of lymphangiectasia?
Lipid malabsorption - chronic small bowel diarrhoea
- PLE
- dramatic weight loss
- protein-rich ascites
What is the diagnostic approach to lymphangiectasia?
Bloods - low albumin/globulin/cholesterol/WBC/Ca/Mg
Ultrasound - mucosal striations
Endoscopy - white spots on villus tips, white nodules or plaques
Biopsy
What is the treatment for lymphangectasia?
Treat primary cause e.g. neoplasia, IBD Ultra low-fat diet Fluid therapy Albumin/colloid for hypoproteinaemia Diuretic for effusions
What are examples of intestinal tumours?
Lymphoma Adenocarcinoma Leiomyoma/leiomyosarcoma MCT Fibrosarcoma Haemangiosarcoma
What are risks of focal intestinal tumours?
Obstructions
What are the clinical signs of gapeworm in chickens?
Coughing
Emaciation
Weakness
Gaping
What is the diagnosis of gapeworm?
PM examination
Faecal egg cout
Clinical signs
What are DDx for gapeworm?
Mycoplasmosis
Aspergillosis
What is the treatment and management for gapeworm?
Flubendazole, levamisole, piperazine salts
How can gapeworm be prevented?
Prevent contaminatino of feeders and drinkers with faeces
Pasture rotation
Regular treatment
Where is Heterakis gallinarum found?
Caecum in the chicken
What clinical signs are seen with caecal worms?
Usually harmless with no clinical signs but it can carry black head (histomonus meleagridis) Bright yellow diarrhoea Dullness Sudden death Black head
What is the diagnosis of caecal worm?
Adults seen in caecal contents at PM
Eggs seen in faeces
Clinical signs
How are caecal worms treated?
Flubendazole
Levamisole
How aare caecal worms prevented?
Never keep chickens and turkeys together
Worm flock every 3 months
What species and organs are affected by hairworm (capillaria spp)
Chickens, turkeys, pigeons, wild birds
SI, crop, oesophagus
How is hairworm transmitted?
Bird to bird
Earthworms can be intermediate hosts
What are clinical signs of hairworm in birds?
Diarrhoea Anaemia Hunched Dull Weight loss Regurgitation Oral necrotic plaques Preduced egg production
How is diagnosis of hairworm done?
Faecal floatation for eggs
PM to idenfiy GI epithelium enteritis
When can fenbendazole be given to a pregnant bitch?
Used from day 40 til day 2 after whelping
When is fenbendazole given to puppies?
2 weeks, 5 weeks at at weaning
Then monthly
What is the function of the LI?
Fluid and electrolyte balance
Hosts a large population of bacteria
Faecal storage
No role in the absorption of nutrients (no villi)
Goblet cells prodcue mucis for lubrication
Is weight loss a clinical feature of SI and LI disease?
SI - common
LI - rare
What is faecal consistency like in SI and LI disease?
SI - watery, soft, bulky, undigested food, variable colour
LI - variable, colour unchanged
What is the faecal volume like in SI and LI disease?
SI - increased
LI - normal or decreased
Is borborygmi/flatulence a clinical feature of SI and LI disease?
SI - common
LI - absent
What is the frequency of defaecation in SI and LI disease?
SI - 1-3x a day, increased urgency if severe or acute
LI - >6x a day with increased urgency
Is tenesemus a clinical feature of SI and LI disease?
SI - aabsent
LI - present
Is mucus a clinical feature of SI and LI disease?
SI - absent
LI - present
IS blood a clinical feature of SI and LI disease?
SI - melaena
LI - fresh blood
What are DDx for LI diarrhoea?
Dietary indiscretion Inflammatory/colitis (IBD) Infections Secondary to fat maldigestion in the SI Secondary to portal hypertension Local irritation e.g. pancreatitis, mass, FB Colonis polyps Colonic neoplasia Motility disorder
What do you need to establish from the history of a LI disease case?
Vaccination and worming history Diet - changes, scavenging Medication In contacts affected Previous or concurrent illness
What should you llook for in a perineal exam?
Perineal rupture Wounds/swelling/mass Faecal incontinence Anal sac disease Self trauma Anal furunculosis
What are you feeling for in a rectal exam?
Rectal mucosa - smooth/rough or masses Evidence of a stricture Lumbar (medial iliac) LN Prostate in males Pelvic urethra (urethral calculs)
