Vomiting And Diarrhea Flashcards
What are the stages of vomiting?
Nausea, Retching and Vomiting
Signs of nausea
Reduced gastric tone
Duodenal and proximal jejunal tone increased
Depression, hyper-salivation, repeated swallowing
Duodenal contents into stomach
Stages of vomiting
Glottis closed Soft palate pressed against nasopharynx Abdominal muscles and diaphragm contract Cardia opens, pylorus contracts Reverse peristalsis Cardiac rhythm disturbed Changes in colonic motility
How do you tell the difference between regurgitation and vomiting?
Vomiting: abdominal effort, nausea, bile present, acidic pH, digested material, food if vomit quickly after eating
Regurgitating: effort from shoulders, food not digested, mucous present, cough
What organs/ systems are involved in primary GI diseases?
Stomach, small intestines, and colon
What organs/ systems/ factors are involved in secondary GI diseases?
Pancreas, kidney, liver, Primary CNS, electrolyte imbalances, toxins
What diagnostic tools are most useful for primary GI disease?
Radiology, ultrasound, endoscopy
What diagnostic tools are most useful for secondary GI disease?
Hematology, biochemistry, urinalysis, radiology, ultrasound, surgical exploration
What are the signs that vomiting is due to a primary GI disease?
Vomiting with often relate in time to eating, delayed
Occur at variable times after eating in lower bowel disorders
Foreign body vomiting may occurs despite not eating
Palpable on physical exam
Paired with significant diarrhea
Vomit occurred then showed malaise, depression, anorexia
May be normal is all other aspects historically
What the signs that Vomiting is due to a secondary GI disease?
Vomiting occurs subsequent to other signs, like depression/ inappetence
Other clinical signs present, like jaundice
Patients are usually metabolically ill
Gastritis Gastric foreign bodies Gastric ulceration Pyloric disorders Abnormal motility Enteritis Intestinal obstruction IBD Neoplasia Are all...
Common primary GI disease lesions
The most common primary GI causes of vomiting are:
Gastritis
Spoiled food, dietary indiscretion, food intolerance
Viral infection
Parvovirus, corona, rota
Foreign body
GI neoplasmMost common causes of secondary GI vomiting?
Pancreatitis Liver disease Renal disease Endocrine disease Diabetic ketoacidosis Hyperadrencorticism Hypercalcemia
Cricopharyngeal disease Hiatal hernia Diverticula Mega esophagus Persistent right aortic arch Mediastinal lymphoma Thyroid tumors Foreign body strictures Esophagitis Intramural lesions are all?
Lesions of esophageal disorders
Break down the steps of the diagnostic approach to vomiting
Vomiting vs regurgitation
If vomit, primary or secondary, can’t tell
Investigate secondary or eliminate if appropriate
Identify organ, underlying disease
Investigate primary
Imaging, exploratory
When is symptomatic therapy appropriate for vomiting?
Primary GI disease do to transient cause, toxin, or dietary indescretion
This major presenting sign almost always indicates a primary GI lesion
Overt large bowel diarrhea, and mixed bowel diarrhea
List the lesions of ACUTE small bowel diarrhea
Overeating Dietary change Spoiled food Garbage Parasites Protozoa Infection bacterial and viral
List the primary and secondary lesions of CHRONIC small intestinal diarrhea
Secondary lesions Toxins Parasites Diet intolerances, hypersensitivities Bacteria and Protozoa Deep mycoses IBD aka Chronic Enteropathy Neoplasia Lymphangiectasia Brush border enzyme defects
Secondary lesions
Hypoadrenocorticism
Hyperthyroidism (cats)
Exocrine pancreatic insufficiency( dogs) pancreatitis (chronic)
Where do diet hypersensitivity skin lesions tend to appear in dogs vs cats?
Cats: ears and face
Dogs: auxiliary region and feet
List the lesion of both acute and chronic large bowel diarrhea
Parasites Protozoa Bacteria Diet related (toxin, fiber, intolerance, hypersensitivity) Inflammatory (idiopathic, eosinophilic, granulomatous) Neoplasia stress Strictures
List the diagnostic tools for chronic small and large bowel diarrhea
Fecal flotation and examination Hematology and biochem ( secondary) Fecal culture Fecal panel Serum trypsin like immunoreactivity ( TLI) B12 and folate panels Ultrasound Biopsy
When is it appropriate to biopsy?
Hypoproteinemia
Thicken intestinal wall or loss of layering
Significant weight loss
Hypercalcemia
Hypocobalaminemia
Neoplasia strongly suspected
O unable/ unwilling to follow diagnostic plan
Rule out parasites, dietary trials, secondary GI and treatment trial before considering
List 3 factors that contribute to the seriousness of diarrhea in farm animals
Major Economic loss
Welfare
Environmental cost
What pathogens are associated with acute diarrhea in calves?
What age are calves most affected by each and the mortality rate?
E.coli- <5days- zoonotic, enterotoxigenic can cause death
Cryptosporidia- 5-14 days- villus atrophy, often concurrent,
Rotavirus- 7-14 days( max 3 weeks)- high morbidity low mortality
Coronavirus-7-22 days- higher mortality
Coccidia-> 3 weeks- poor growth rates, colitis
Salmonella- all ages- always significant
List the caused of acute and chronic diarrhea in adult cows
acute Salmonellosis Winter dysentery ( corona virus) Acidosis ( SARA) Malignant catarrhall fever Poison Mucosal disease BVD- RARELY
Chronic
Johnes
Ostertagiasis
Fluke
List the causes of acute and chronic diarrhea in lambs under 3 weeks
Acute
Watery mouth
Poor milk production
Chronic Rotavirus Corona virus E.coli Salmonella Lamb dysentery
Most common causes of diarrhea in lambs 3-12 weeks old
Coccidiosis
Nematodirosis - sudden death
List the key factors to look into when investigating diarrhea on a farm?
Herd vs individual? Colostrum quality and time given Environment - cleaned regularly Regularly feeding (for calves) Vaccines Deworming Preventatives/ supplements
Define Johnes Disease and list the key clinical signs, and solution
Is a chronic enteritis wasting diseases caused by MAP (Mycobacterium avium subspecies Paratuberculosis). Is zoonotic and is implicated in IBD and Crohns diseases in humans. Has no treatment
Key signs
Profuse hose type diarrhea
Weight loss severe
Solution
All affected animals must be culled
What are key steps to take to diagnose and control Johne’s Disease?
Prevent young animals from getting infected
Do not house old and young animals
Do not give infected colostrum
Do not give pooled colostrum
To diagnose
Blood test ELISA ( low sensitivity, but high specificity )
Positive test is reliable
What is the most common diarrhea in horses?
Primary GI, Secondary is very rare
What are the most common causes of diarrhea in neonate foals?
Foal heat diarrhea Rotavirus Salmonella Clostridia Sepsis
Most common causes of Diarrhea in older foals (10-12months)?
Proliferation enteropathy
Rhodococcus equi colitis
Parasitic diarrhea
What are the most common causes of diarrhea in adult horses?
Salmonellosis
Clostridium is
Parasites
Antimicrobial diarrhea
Chronic
IBD
Undiagnosed
NSAID toxicity should be noted
Acute diarrhea in horses is a…
Life threatening medical emergency!!!
Diarrhea is considered chronic when…
It as persisted for at least 2 weeks
List the causes of acute diarrhea in horses?
Salmonellosis Parasitism ( cyanthostominosis, strongylosis) Clostridiosis Antimicrobial- associated diarrhea NSAID toxicity Sand enteropathy Carbohydrate overload
List the causes of chronic diarrhea in horses
Salmonellosis Parasites Sand enteropathy NSAID toxicity IBD Abnormal fermentation Neoplasia Peritonitis Abdominal abscession
What are the factors that predispose horses for diarrhea?
Young performance horses Antimicrobial or NSAID administration Stress Concurrent illness Recent deworming Exposure to other horses Poor foal hygiene
What are the main diagnostic tools for equine diarrhea?
Fecal PCR
Fecal Culture
ELISA for viruses
Mainly treat diarrhea supportively, try to find a diagnosis to rule out zoonoses
When treating diarrhea in horses what are the main aspects we should address?
Prevention of spread
Fluid and electrolyte therapy
Control endotoxemia and sepsis
Control enteric inflammation
Re establish GI flora
Specific Treatments
What steps should be taken for biosecurity in horses with diarrhea?
Isolate
Disinfect all personal equipment that comes in contact with affected animals
PPE
List the signs of dehydration and explain how it is measured?
Tachycardia, increased jugular refill time, pale mm, Increased CRT, decreased skin turgid, cool extremities, decreased urine output.
<5% = clinically normal
8-10% = moderate, CRT 3-4 sec, hypovolemic signs
> 10%= severe >4-5sec, severe hypovolemic signs
What type of fluids should be administered to horses and foals with diarrhea?
Polyionic fluids, hartmanns
10-20mls/kg horses
4-5mls/kg/hr in foals
Administer bolus’ for shock
Define endotoxemia and the clinical signs
Breakdown of physical barriers to endotoxins in intestine cause LPS to enter systemic circulation
Clinical signs
Fever,depression, pale mm, cold extremities, congested, toxic mm, prolonged CRT.
Advanced clinical signs Edema Tachycardia, low BP, prolonged CRT Lethargy, altered mentation Diarrhea Metabolic acidosis Thrombosis, and Petechial hemorrhages
List the steps of endotoxemia treatment in horses
Remove the cause Neutralize the circulating LPS Inhibition of LPS induced Inflammation Modulate coagulation system Circulatory support
Name the treatment for the following conditions
Cyathostomiasis
Clostridiosis
Sand enteropathy
Right coral enteropathy
IBD.
Cyathostomiasis- moxidectin, dexamethasone, prednisolone
Clostridiosis- metronidazole
Sand enteropthy- psyllium mucilloid and magnesium sulfate
Right dorsal colitis- misoprostal
IBD- dexamethasone, prednisolone
When doing a problem based approach to diarrhea in small animals what are the steps?
Define the: problem, location, system then lesion
The most important tool in classifying the type of diarrhea present is what?
History
How do you approach acute vs chronic diarrhea?
Acute: treat symptomatically
Chronic: investigate fully
List the characteristics of small bowel diarrhea
Consistency:Cow pie to watery Pattern: large volume and normal frequency Blood: not bright or fresh Color: ranges Weight loss if chronic Dehydration/pd Physical exam often unremarkable
What are the characteristics of large bowel diarrhea?
Small amounts and often Mucous present Fresh blood on surface Tenesmus: straining No weight loss PE often unremarkable
What are some of the secondary GI disorders that can cause small bowel diarrhea?
Hepatic disease Pancreatic insufficiency Pancreatitis Hyperthyroidism Hypoadrenocorticism ( Addison’s disease) Renal disease
What does overt large bowel diarrhea as the major presenting signs almost always indicate?
A primary GI lesion
Mixed bowel diarrhea as the major presenting sign usually is due to?
Primary GI disease
Large bowel diarrhea associated with secondary GI disease usually…
Is not the presenting complaint, and has small bowel characteristics
List the diet relates lesions that can cause acute small bowel diarrhea
Overeating
Dietary changes
Spoiled food
Garbage
List the parasites and Protozoa that can cause acute small bowel diarrhea
As raids
Hookworms
Giardia
Coccidia
List the viral and bacterial lesions that can cause acute small bowel diarrhea
Viral
Parvovirus
Coronavirus
Rotavirus
Bacteria Campylobacter Salmonella Clostridium E.coli
What are the possible primary GI lesions of chronic small bowel diarrhea?
Toxins Parasites Diet intolerances Diet hypersensitivity Bacteria and Protozoa Deep mycoses Chronic Enteropathy ( IBD) Neoplasm
What are the possible secondary GI lesions of chronic small bowel diarrhea in small animals?
Hypoadrenocorticism Hyperthyroidism Exocrine pancreatic insufficiency Chronic pancreatitis Liver disease
List the possible primary lesions of acute and chronic large bowel diarrhea
Parasites Trichuris culpis Anclostoma caninum Protozoa Giardia Entamoeba sp Tritrichomonas Bacteria Campylobacter, clostridium, salmonella, granulomatous collision Diet related Inflammatory Neoplasia Stress Stricture
List the possible diagnostic tools for working up diarrhea
Fecal flotation Fecal examination Fecal culture/ panels Ultrasound Serum trypsin like immunoreactivity (TLI) Biopsy( rule out secondary before doing) B12 and folate to determine if supplements are needed Proper dietary trial
