Small Animal Diarrhoea

Question 1

What are the different ways diarrhoea can be defined/refined?

Answer 1

Acute vs. chronic and small intestine vs. large intestine

Question 2

What is important to note if the diarrhoea is acute?

Answer 2

The presence of other clinical signs that may indicate the presence of disease

Question 3

What type of diarrhoea does melaena indicate?

Answer 3

Small intestinal or upper gi bleeding as it indicates digested blood.

Question 4

When is diarhoea defined as chronic?

Answer 4

When it has lasted for 3 weeks or more

Question 5

What are the ways in which small intestinal diarrhoea is differentiated from large intestinal and how is the diagnostic approach fundamentally different?

Answer 5

n.b. si diarrhoea can have GI or extra GI causes whereas LI diarrhoea is pretty much always confined to problems with the colon

Question 6

What are the following diarrhoea types?

Answer 6

A) Large Intestinal

B) Most likely small but worth asking other questions at history to be certain. As it could be both!

Question 7

What are the DDx for acute SI diarrhoea with no systemic signs?

What is a possible treatment protocol?

Answer 7

• Diet
• Helminths
• Protozoa
• Iatrogenic

Fasting is an appropriate method in dogs, cats can’t tolerate fasting for too long so bear this in mind.

Question 8

List the DDx for acute SI diarrhoea with systemic signs. Describe the work up for each group.

Answer 8

• Bacterial
  
  • Salmonella
  • Campylobacter —–Faecal culture
• Viral
  
  • Distemper
  • Parvo ——Faecal Ag tests
  • Fpv
• Toxins ——history?
• Heamorrhagic gastroenteritis (dogs) —-high PCV and dehydration signs
• Acute Pancreatitis —ultrasound and pancreatic lipase

Question 9

What are the differentials for acute LI diarrhoea?

How would you work these up?

Answer 9

• Clostridia
• Whipworms
• Giardia
• Campylobacter

Faecal culture and examination

Question 10

What are the most common extra-GI causes of chronic small intestinal diarrhoea?

Answer 10

• Metabolic
  
  • Hepatic disease (Portosystemic shunts)
  • Hyperthyroidism (cats)
  • Addisons (dogs)
  • Renal Insufficiency
• Pancreatic
  
  • EPI
  • Chronic Pancreatitis

Question 11

What are the most common DDx for Primary small intestinal diarrhoea?

Answer 11

• Giardia
• Chronic partial obstruction
• Lymphangiectesia
• Neoplasia (Lymphosarcoma)
• Food-responsive disease
• IBD
  
  • Will see lympho-plasmacellular inflammation

Question 12

What are the DDx for chronic large intestinal diarrhoea?

Answer 12

• IBD
  
  • Lympho-plasmacellular
  • Ulcerative colitis
• Polyps
• Food responsive disease
• Neoplasia
• Chronic partial obstruction
• Tritrichomonan foetus (cats)

Question 13

Outline the investigatic approach for chronic diarrhoea.

Answer 13

1. Feacal exam
2. Bloods and urinanalyis
3. SI : consider serum tests e.g. TLI, PLI
4. Abdominal ultrasound
5. Elimination diet treatment
6. Biopsies

Question 14

Is a full thickness biopsy approach (i.e. ex lap) neccesary?

Answer 14

No, in fact it is a lot more dangerous than endoscopy and LI biopsies should not really be taken by this method. Cats don’t do well after this type of surgery.

Question 15

How is food-responsive diarrhoea treated?

Answer 15

Elimination or hydrolysed diet for 6-8 weeks. The animal should respond within the first 2 weeks. Have to be very strict and not give treats!

Question 16

When are you likely to see antibiotic responsive diarrhoea? Should ABs be administered?

Answer 16

In young German Shepherd Dogs. Metronidazole 15mg/kg po bid is the dosage for 4 weeks. However there is often relapse so it is likely ABs would be required long time which is not good in terms of AB resistance.

Question 17

How is IBD diagnosed?

Answer 17

By clinical exclusion

Question 18

What lesions are associated with IBD?

Answer 18

Lympho-plasmacellular

Eosinophilic (rare)

Ulcerative colitis

Question 19

Outline the treatment protocol for IBD in dogs

Answer 19

Elimination diet

Metronidazole 10-15mg/kg bid 3-4 weeks

then if neccesary: prednisolone 2.2mg/kg/d for 10 days then taper dose

azathioprine or cyclosporine is prednisolone unsuccessful.

Question 20

Outline the treatment protocol for IBD in cats.

Answer 20

Elimination diet (harder in cats)

prednisolone 2mg/kg/d for 10-14d then taper

chlorambucil if unsuccessful

Cobalmin supplementation is key to success.

Question 21

Describe the clinical picture of a dog with protein losing enteropathy.

How is it diagnosed?

Answer 21

Diarrhoea, vomiting, annorexia and weight loss

Low TP both albumin and globulins

Third spacing

Biopsy is very important early on!