17. Diagnostic approach of diarrhoea. Principles of treatment

Question 1

definition of diarrhoea

Answer 1

increase in fecal fluidity

Question 2

4 different pathomenchanisms of diarrhoea

Answer 2

osmotic diarrhoea
secretory diarrhoea
exudative diarrhoea
dysmobility

Question 3

how can diarrhoea be clinically categorised

Answer 3

temporally : acute / chronic
aetiologically : intestinal / extraintestinal
anatomically : small / large bowel
Severity : acute - self limiting / acute life threatening

Question 4

extraintestinal causes of diarrhoea

Answer 4

Diseases of non GI digestive organs
Toxic effect
Metabolic Derangements
Systemic Failure
Circulatory failure
Disorders affecting peristalsis
Metastatic Tumour

Question 5

What metastatic tumour can cause diarrhoea

Answer 5

haemagiosarcoma

Question 6

what non gi digestive organ diseases can cause diarrhoea

Answer 6

Pancreatitis
EPI
Cholestasis
PSS

Question 7

What toxic and metabolic derangements can cause diarrhoea

Answer 7

liver failure
kidney failure
endotoxaemia
addison’s
NSAIDS, AB, heavy metals

Question 8

What systemic infections can cause diarrhoea

Answer 8

distemper
leptospirosis
FIP
FeLV
FIV

Question 9

What circulatory diseases can cause diarrhoea

Answer 9

RS- HF
PSS
IMHA

Question 10

What disorders can affect peristalsis

Answer 10

peritonitis
pancreatitis
hyperthyroidism

Question 11

history of diarrhoea patients

Answer 11

Young animal —- infectious
Older — Neoplsatic
symptoms, duration
environment, diet,
Previous therapies

Question 12

Primary clinical signs of diarrhoea

Answer 12

diarrhoea

Question 13

secondary clinical signs of diarrhoea

Answer 13

vomitting
anorexia
hypovolemic shock
abdo discomfort
abdo pain
hypothermia
pain
dehydration
hypovolemia
polyphagis
weight loss

Question 14

Faeces of small bowel diarrhoea

Answer 14

Large watery stool volume
rarely mucus
Melena
Sometimes fat / undigested food

Question 15

Faeces of Large Bowel diarrhoea

Answer 15

Small dense stool volume
mucus is common
fresh blood
no fat / undigested foor

Question 16

Defecation of small bowel diarrhoea

Answer 16

rarely tenesmus
no urgency
normal frequency

Question 17

Defecation of large bowel disease

Answer 17

Tenesmus is common
Urgency is common
Increased frequency

Question 18

Is vomitting more common in large or small bowel diarrhoea

Answer 18

Small > large

Question 19

Is gas more common in large or small diarrhoea

Answer 19

small

Question 20

Is weight loss more common in small or large bowel diarrhoea

Answer 20

small

Question 21

Why use Lab D in diarrhoea patietns

Answer 21

to rule out extraintestinal causes

Question 22

Lab D of diarrhoea

Answer 22

Serum Albumin <20mg/l –> PLE
Lipase
TLI
ACTH
T4
FeLV
FIV

Question 23

If PLE is present then you need to excluse

Answer 23

renal & hepatic causes

Question 24

If PLE is not present, you need to excluse

Answer 24

EPI

Question 25

Causes of decreased cobalmin

Answer 25

EPI distal SID dysbiosis SIBO

Question 26

Causes of decreased folate

Answer 26

Proximal SID

Question 27

causes of increased folate

Answer 27

dysbiosis

Question 28

faecal analysis

Answer 28

flotation - parasites direct smear & cytology fresh - protozoa, para eggs bacterial culture - campylobacter, salmonella, c Faecal antigen testing Inflammatory markers

Question 29

Faecal Antigen testing for viruses

Answer 29

Parvo - ELISA Cornoa - PCR

Question 30

Faecal Antigen testing for bacteria

Answer 30

Campylobacter - PCR Cl. - ELISA

Question 31

Faecal Antigen testing for protozoa

Answer 31

Giardia - ELISA Tritrichomonas - PCR

Question 32

what inflammatory markers do you check for in faecal sampling

Answer 32

calmprotectin Faecal s100a12 lactoferrin

Question 33

diagnostic imaging of diarrhoea

Answer 33

contrast radiography abdominal US endoscopy ex. lap intestinal biopsy

Question 34

what can an abdo US show

Answer 34

ileus, sub sileus intussusception inspection of the gi layers abdo viscera FNA, cytology, abdocentesis

Question 35

when do you use endoscopy for diarrhoea examination

Answer 35

in chronic intestinal disorders & sampling can check mucosa - friability, granularity, erosion, masses, lymphatic dilation