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Medicine II > Acute Vomiting and Diarrhea > Flashcards

Acute Vomiting and Diarrhea Flashcards

1
Q

Obj: For Idiopathic diseases:

  • Identify disease risk factors
  • Distinguish between idiopathic and infectious disease based on common laboratory and examination findings
  • Develop a treatment plan based on severity of clinical signs and etiology of disease, including the need for hospitalization and appropriate ancillary therapies
A
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2
Q

Obj: For Infectious diseases:

  • List major routes of transmission, tissues affected, SI/LI clinical signs
  • Based on a case scenario, prioritize differentials based on the above and unique systemic or laboratory findings and choose the best diagnostic test
  • For a specific patient, decide whether treatment is needed and formulate a treatment plan
A
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3
Q

What are some of the common Idiopathic Acute GI diseases of small animals?

A
  • Acute Gastroenteritis
  • Acute Hemorrhagic Diarrhea Syndrome (AHDS)
  • Parasitic:
    • Toxocara infection
    • Hookworm infection
    • Whipworms
  • Viral
    • Canine Enteric Parvovirus
    • Feline Panleukopenia
    • Canine Distemper
  • Bacterial
    • Neoricettsia Helminotheca
    • Campylobacter
    • Salmonella
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4
Q

What is Acute Gastroenteritis?

A
  • Acute Vomiting due to sudden gastric mucosal irritation or inflammation
    • Exact underlying trigger is often unknown
    • Proposed causes: Dietary indiscretion, foreign material, drugs/toxins
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5
Q

How is Acute Gastroenteritis Diagnosed?

A
  • Rule out obstruction, surgical conditions, infectious, and systemic disease based on patient clinical signs and physical examination
  • Lab work:
    • Assessment of hydration (PCV/TS)
    • +/- complete blood work if severe signs
  • Radiographs, patient-dependent
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6
Q

What is the Treatment for Acute Gastroenteritis?

A
  • Supportive based on severity of clinical signs and examination
  • Outpatient:
    • Anti-emetics (one dose)
    • Easily digestible (low-fat) diet
      • offered in small amounts every 4-6hrs
      • Transition back to normal diet over 5-7 days once clinical signs resolved
    • +/- Subcutaneous fluids
  • Inpatient
    • IV fluids
    • Anti-emetics
    • Easily digestible (low-fat) diet
  • Ancillary therapies:
    • Probiotics
    • Fiber supplementation
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7
Q

What is Acute Hemorrhagic Diarrhea Syndrome (AHDS)?

A
  • Syndrome of acute onset, severe bloody diarrhea +/- vomiting
    • Associated with increased GI permeability
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8
Q

What is the pathophysiology of AHDS?

A
  • Incompletely understood
  • Potential predisposing factors include:
    • Dietary Type 1 hypersensitivity reaction
    • Clostridium toxins (enterotoxin, NetF)
      • Normal flora, most animals are asymptomatic
      • Not all dogs w/ AHDS are positive for NetF toxin
        • finding NetF does not confirm it as cause of disease
      • Even in dogs with AHDS, presence of NetF toxin does not confirm the need for antimicrobials
      • Diagnosis of Clostridium - fecal culture + toxin PCR in a symptomatic patient.
        • fecal smears for Clostridia spores should not be performed
          • do not correlate with toxin production
    • Gastrointestinal microbiome dysbiosis
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9
Q

What are the clinical signs of AHDS?

A
  • Severe, bloody diarrhea (hematochezia)
  • +/- vomiting, hematemesis
  • Hypovolemic shock if not treated early
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10
Q

How is AHDS diagnosed?

A
  • Diagnosis of exclusion
  • Blood work:
    • Severe hemoconcentration with normal total protein
    • Thrombocytopenia 50%
    • Leukopenia, neutropenia if progression to sepsis/DIC
    • Prolonged clotting times if progression to DIC
  • Blood pressure: hypotension due to hypovolemia
  • Abdominal radiographs - normal or diffuse ileus
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11
Q

How is AHDS treated?

A
  • Intensive IV Fluid Therapy
  • Antibiotics NOT needed unless signs of systemic inflammation/sepsis
    • Leukopenia, degenerative left shift
    • Fever >103F
    • Non-responsive hypotension or hyppoglycemia
    • Coagulopathy
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12
Q

What species round worms can cause acute vomiting/diarrhea?

A
  • Toxocara canis - dogs
  • Toxascaris leonina - dogs, cats
  • Toxocara cati - cats
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13
Q

How are roundworms transmitted?

A
  • T. canis: Placental, milk/nursing, ingestion of ova-contaminated material or infected paratenic hosts (rodents)
  • T. cati: milk/nursing, ingestion of ova-contaminated material or infected paratenic hosts (rodents)
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14
Q

What are the clinical signs of an acute roundworm infection?

A
  • Usually young animals
  • Small Intestinal Diarrhea
  • Non-specific:
    • Weight loss
    • failure to thrive
    • poor haircoat
    • pot-belly
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15
Q

How are roundworm infections diagnosed?

A
  • Fecal flotation
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16
Q

How is a roundworm infection treated?

A
  • Deworm at 2, 4, 6, 8, 12, and 16 weeks of age
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17
Q

What species of hookworms cause acute vomiting/diarrhea in Small Animals?

A
  • Ancylostoma caninum - dogs
  • Ancylostoma tubaeformae - Cat
  • Ancylostoma braziliense - Dog
  • Uncinaria stenocephala - Dogs
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18
Q

How are hookworms transmitted?

A
  • In utero
  • nursing
  • ingestion of larvae
  • skin penetration by larvae
  • ingestion of paratenic host
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19
Q

What are the clinical signs of a hookworm infection?

A
  • Hemorrhagic diarrhea - can be acute & severe
  • Vomiting
  • Anemia and panhypoproteinemia with severe infections
  • Clinical disease rare in cats
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20
Q

How are hookworm infections diagnosed?

A
  • fecal floatation
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21
Q

How are hookworm infections treated?

A
  • Resistant infections have been noted, with subsequent response to combination therapy,
    • Monthly topical moxidectin + pyrantel/febantel/praziquantel until negative fecal tests are achieved
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22
Q

what species of whipworms can cause Acute vomiting/diarrhea in small animals

A
  • Trichuris vulpis - dogs
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23
Q

How are whipworms transmitted?

A

fecal-oral

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24
Q

What are the clinical signs of a whipworm infection?

A
  • Acute or chronic large intestinal diarrhea:
    • fucoid feces
    • hematochezia
    • tenesmus
25
Q

How are whipworm infections diagnosed?

A
  • Fecal flotation: intermittent shedding
    • risk of false negatives
  • Pseudo-Addisonian electrolyte changes: hyperkalemia, hyponatremia
26
Q

What causes Canine Enteric Parvovirus?

A
  • Canine Parvovirus 2
27
Q

What tissues does Canine Parvovirus infect?

A
  • Localization to rapidly dividing cells:
    • intestinal crypts
    • bone marrow
    • lymphoid tissue
28
Q

How is Canine Enteric Parvovirus transmitted?

A
  • Fecal-oral
    • fecal shedding 10-14 days after illness onset
    • stable in the environment for months
29
Q

What are the clinical signs of Canine Enteric Parvovirus?

A
  • Onset 4-7 days post-infection
    • GI signs w/in 24-48hrs of initial clinical signs
  • Severe, often bloody diarrhea
  • Vomiting
  • Myocarditis - infection in utero or perinatal period
  • Non-specific:
    • Anorexia
    • Depression
    • Dehydration
    • Fever
30
Q

How is Canine Enteric Parvovirus diagnosed?

A
  • Cage-side: Fecal SNAP ELISA test
  • PCR: can confirm negative ELISA results in dogs w/ clinical signs of CPV-2 if there is concern for a false-negative SNAP result
  • Blood work:
    • CBC - severe leukopenia (neutropenia)
    • Chem:
      • +/- Hypoglycemia
      • Hypoalbuminemia
      • electrolyte abnormalities
31
Q

What is the treatment for Canine Enteric Parvovirus?

A
  • Supportive care:
    • IV fluids +/- potassium and dextrose supplementation
    • Prophylactic antibiotics
  • Early enteral nutrition: consider nasogastric tube placement
  • Treatment of concurrent infections:
    • Giardia, cryptosporidium
32
Q

What are the possible complications of Canine Enteric Parvovirus?

A
  • Sepsis due to increased GI permeability and low WBC
  • Anemia - Need for transfusion
  • Severe hypoalbuminemia, which can lead to edema/effusion
  • Intussusception - need for surgery
    • concern in patients whose vomiting acutely worsens or whose abdomen becomes painful
33
Q

What is the prognosis for Canine Enteric Parvovirus?

A
  • <10% survival w/out treatment
  • <50% survival w/ out-patient care
  • >80-90% survival w/ hospitalization
34
Q

What are the negative prognostic indicators for Canine Enteric Parvovirus?

A
  • Leukopenia on presentation
  • Evidence of systemic inflammatory response (SIRS)
  • Younger age (< 7-12 weeks)
35
Q

How can the transmission of Canine Enteric Parvovirus be prevented

A
  • Isolation of affected animals, especially from unvaccinated or incompletely vaccinated dogs
  • Disinfection: dilute bleach solution
  • Vaccination
36
Q

What causes Feline Panleukopenia?

A

Feline Parvovirus

37
Q

What are the clinical signs of Feline Panleukopenia?

A
  • Severe acute diarrhea, often bloody
  • Vomiting
  • Fever in early course of infection
  • In utero infection or live vaccine in pregnant queens causes Cerebellar hypoplasia
38
Q

How is Feline Panleukopenia diagnosed?

A
  • Clinical signs
  • CBC: leukopenia
  • Viral detection:
    • canine parvovirus antigen SNAP ELISA (presumptive)
    • Fecal or blood PCR - variable sens/spec
    • Electron microscopy - not widely available
    • Histopathology - necropsy
39
Q

What is the treatment for Feline Panleukopenia?

A
  • Supportive care:
    • IV fluids +/- potassium and dextros supplementation
    • Prophylactic antibiotics
40
Q

What is the prognosis for Feline Panleukopenia?

A
  • high mortality w/ GI disease in young kittens 50-90%
41
Q

What is the pathogenesis of Neorickettsia helminotheca?

A
  • Ingestion of raw salmon containing the fluke Nanophyteus salmincola
    • fluke contains Neorickettsia
42
Q

What are the clinical signs of Neorickettsia helminotheca infection

A
  • Acute onset, hemorrhagic diarrhea ~1wk post-ingestion
  • Vomiting
  • High Fever
  • Lymphadenomegaly
  • Ocular/nasal discharge
43
Q

How is Neorickettsia helminotheca diagnosed?

A
  • Clinical signs + history of raw fish ingestion in endemic geographic region
    • Norther west coast US
    • Brazil
  • Fecal: Operculated fluke eggs
  • Lymph node cytology: intracytoplasmic inclusion bodies
44
Q

What is the treatment for Neorickettsia?

A

Doxycycline + Praziquantel

45
Q

What is the prognosis for Neorickettsia?

A
  • Grave w/out treatment
  • Good with prompt, intensive therapy
46
Q

What is Campylobacter?

A

Gram negative bacteria

47
Q

What are the clinical signs of a Campylobacter infection?

A
  • Asymptomatic or transient
  • Young, immunocompromised or patients w/ co-infections
    • Acute enterocolitis: watery, mucoid, hemorrhagic diarrhea
    • Vomiting
    • Tenesmus
    • Fever
48
Q

How is a Campylobacter infection diagnosed?

A
  • Microscopy (fecal): Seagull-shaped bacteria
    • Presumptive but not confirmatory (Present in >50% of healthy dogs/cats
    • may appear similar to fecal spirochetes (normal flora)
  • Culture: Misleading, often not species-specific
  • PCR: Species-specific information
  • Rule out:
    • Giardia
    • Parvovirus
    • Idiopathic Inflammatory bowel disease
      • C. coli associated with neutrophilic intestinal inflammation in cats
49
Q

What is the treatment for a campylobacter infection?

A
  • None in healthy or mildly affected animal
    • treatment can lead to chronic carrier state
  • Acutely, severely affected animals w/ no other cause:
    • Erythromycin or fluoroquinolones
      • Antibiotic resistance is reported
50
Q

What is the prognosis for a Campylobacter infection?

A
  • Good - usually self-limiting
  • Chronic carrier state possible
51
Q

Why is Campylobacter an important pathogen?

A

zoonotic

52
Q

What are the clinical signs of Salmonellosis?

A
  • Transient, asymptomatic
  • Acute Gastroenteritis (dogs)
    • More common in young animals, those with concurrent disease, immunocompromised or high-density kennel conditions
    • Severe bloody diarrhea
    • High fever
    • Non-specific: Anorexia, dehydration, abdominal pain
  • Systemic bacteremia
    • invasion and translocation of organism through GI barrier
    • Endotoxemia → DIC → Death
  • Cats:
    • Rare GI signs
    • Fever
    • Conjunctivitis
    • Leukocytosis
53
Q

What species of salmonella commonly affects cats? how are they affected?

A
  • S. typhimurium
  • seasonal - infection following ingestion of songbirds
  • Acute diarrhea with fever
54
Q

How is Salmonellosis diagnosed?

A

Culture of feces or blood (sepsis)

55
Q

What is the treatment for Salmonellosis?

A
  • None in healthy/mildly affected patients
    • promotes chronic carrier state
  • Severely affected (those with: Depression, severe diarrhea, persistent fever, shock, sepsis):
    • Antibiotics - ideally based on culture
      • Empirically fluoroquinolones for 10 days
56
Q

What is the prognosis for salmonellosis

A
  • Good unless septic
57
Q

What are the negative prognostic indicators for Salmonellosis

A
  • Peracute disease
  • Fever >104F
  • Degenerative left shift
  • hypoglycemia
58
Q

How common are chronic carriers of Salmonellosis in dogs/cats

A
  • 30% healthy dogs
  • 20% healthy cats

Medicine II (46 decks)

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