17. Diagnostic approach of diarrhoea. Principles of treatment Flashcards

1
Q

4 types of diarrhoea and categorys?

A

Diarrhoea is defined as an ↑ in faecal fluidity

Categorised by 4 different pathomechanisms

§ Osmotic diarrhoea

§ Secretory diarrhoea

§ Exudative diarrhoea (↑ Permeability)

§ Dysmotility (Altered peristalsis)

They can be categorised clinically too

§ Temporally: Acute / Chronic

§ Aetiologically: Intestinal / Extraintestinal

§ Anatomically: Small bowel / Large bowel; Diffuse

§ Severity: Acute-Self-limiting / Acute-life threatening

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2
Q

Extraintestinal causes?

A

EXTRAINTESTINAL CAUSES

Diseases of non-GI digestive organs

§ Pancreas → Pancreatitis; EPI

§ Liver; Bile duct → Cholestasis; PSS

Toxic effect & Metabolic derangements

§ Liver failure; Kidney failure (Uraemia)

§ Endotoxemia (Peritonitis; Pyometra)

§ Addison’s disease

§ Toxins: Drugs (NSAID; Abx); Chemicals; Heavy metals;

Plants

Systemic infection: Distemper; Leptospirosis; FIP; FeLV; FIV

Circulatory failure

§ RS-HF

§ Portal hypertension (PSS)

§ IMHA (Immune-mediated haemolytic anaemia)

Disorders affecting peristalsis

§ Abdominal cavity infections (Peritonitis; Pancreatitis)

§ Hyperthyroidism

Metastatic tumours: Hemangiosarcoma

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3
Q

Signalment?

A
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4
Q

Clinical signs?

A
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5
Q

Lab D?

A

LAB. D

Normally used to exclude extraintestinal causes of diarrhoea

CBC; Biochemistry; Urinalysis

Note the serum albumin level: If it is <20mg/L, it could indicate

protein-losing enteropathy

§ If PLE ✓ → Exclude renal & hepatic causes

§ If PLE ✗ → Exclude EPI (TLI test)

Dogs

§ cPL (canine pancreatic lipase)

§ TLI (trypsin-like immunoreactivity) (to test for EPI)

§ ACTH-test

Cats

§ fPL (feline pancreatic lipase)

§ T4 test (thyroxine level – Test for hyperthyroidism)

§ FeLV

§ FIV

Depending on the severity, therapeutic interventions may be required

which are dependent on lab. D exams:

§ Acid-base § PCV

§ Ionogram § TP

§ Blood glucose § CRP (dogs)

§ Cobalamin § Folate

Causes of cobalamin ↓: EPI; Distal SID; Dysbiosis; SIBO

Causes of Folate ↓: Proximal SID

Causes of Folate ↑: Dysbiosis

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6
Q

Faecal analysis?

A

FAECAL ANALYSIS

Direct smear & cytology

§ Fresh sample: Protozoa; Parasite eggs

§ Special staining: RBC; WBC; Bacterial

§ Exfoliative cytology of rectum: Neoplasia; Histoplasma

Faecal floatation: Parasites

Bacterial culture

§ Campylobacter spp.; Salmonella spp.; Clostridium spp.

§ Only diagnostic if accompanied with CSx (asymptomatic

carriers)

Faecal antigen testing
§ Viruses: Parvo (ELISA); Corona (PCR)
§ Bacteria: Campylobacter spp.; C. perfringens; C. difficile
(PCR); Clostridium spp. enterotoxins (ELISA)
§ Protozoa: Giardia spp. (ELISA); Tritrichomonas spp.
(PCR)
Inflammatory markers (severity & monitoring)
§ Calprotectin
§ Faecal S100A12
§ Lactoferrin

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7
Q

Diagnostic imaging?

A
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