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Small Animal Medicine II > Small Intestinal Diseases and Diarrhea > Flashcards

Small Intestinal Diseases and Diarrhea Flashcards

1
Q

What is diarrhea?

A

Marked variation in bowel movement with increases in one or all of frequency, consistency and/or volume

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2
Q

Define acute diarrhea.

A

Less than 3 weeks, self-limiting, responds to supportive therapy, but can by systemic and potentially fatal.

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3
Q

Define chronic diarrhea.

A

Ongoing diarrhea (>3 weeks) that does not respond to supportive therapy.

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4
Q

What are some major differences between large and small bowel diarrhea?

A

Large bowel typically has tenesmus, mucus, fresh blood and no steatorrhea.
Small bowel typicall has no tenesmus, no mucus,digested blood, and maybe steatorrhea

NOTE: In chronic small bowl diarrhea, weight and protein loss also occurs

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5
Q

Which type of diarrhea has a better prognosis, large or small?

A

Large

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6
Q

How do you approach a systemically well, acute small bowel diarrhea case? (3 things)

A

Fecal
PCV and total solids (if bloody diarrhea)
Treat symptomatically

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7
Q

How do you approach a systemically unwell, acute small bowel diarrhea case?

A

Need to differentiate between GIT and extra-GIT cause and monitor patient

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8
Q

What is the most common parasitic cause of small bowel diarrhea?

A

Ancylostoma canninum

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9
Q

What are 6 causes of extra-GIT causes of acute diarrhea?

A 
Acute pancreatitis
Liver dz
Renal dz
Addison's
Sepsis
Shock
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10
Q

What are 4 severe, life-threatening GIT causes of diarrhea?

A

Viral
Bacterial
Hemorrhagic Gastroenteritis (“Acute Hemorrhagic Diarrhea Syndrome”)
Obstruction

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11
Q

What do we see with Acute Hemorrhagic Diarrhea Syndrome?

A

Acute, severe bloody diarrhea + vomiting with increase HCT, normal WBC and no fever

NOTE: NO dehydration, fluid shifts are too rapid

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12
Q

What is the suspected cause of Acute Hemorrhagic Diarrhea Syndrome?

A

Type 1 sensitivity rxn

C. perfringens

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13
Q

How is Acute Hemorrhagic Diarrhea Syndrome characterized?

A

Hemorrhagic diarrhea with hemoconcentration

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14
Q

What is the pathophysiology of hemoconcentration?

A

Loss of tight junction integrity -> Water allowed to leak out (PCV and TSP increase) -> Water AND proteins leak out (PCV increase, TSP normal/low) -> Blood leaks through

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15
Q

What will you find on your labs that point to hemoconcentration?

A

PCV >55-6

TSP normal

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16
Q

What is a major differential for Acute Hemorrhagic Diarrhea Syndrome?

A

Parvo

NOTE: absence of leukopenia and presence of hemoconcentration

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17
Q

How do you treat Acute Hemorrhagic Diarrhea Syndrome?

A

IV fluids

IV abs

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18
Q

In a case of Acute Hemorrhagic Diarrhea Syndrome, what is the fluid protocol?

A

Replace 5% dehydration over 2-6 hours and then 2x maintenance for 12-24 hours

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19
Q

In cases of Acute Hemorrhagic Diarrhea Syndrome, when do you start offering food again?

A

After diarrhea has improved (~12hrs). Use low residue diet for several days

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20
Q

Where does Parvovirus localize?

A

Crypt cells
Bone marrow
Lymphoid tissue

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21
Q

When do animals shed parvo?

A

Acute phase and 8-10 days after

NOTE: Parvo is a very stable virus, remain in environment for months

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22
Q

What age does parvo have its highest incidence?

A

Weaning to 6 months

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23
Q

What are 3 highly susceptible breeds to parvo?

A

GSD
Rottweilers
Dobermans

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24
Q

What are the 5 major clinical signs of parvo?

A 
Anorexia
Depression
Fever
Vomiting
Diarrhea

NOTE: Acute onset

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25
Q

Deffinitive diagnosis of parvo needs…?

A

Demonstration with EM and with SNAP

NOTE: SNAP very sensitive, but can get false positives 14days post-vaccination

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26
Q

T/F: The degree of neutropenia in a parvo case usually does not correlate with the severity of the disease.

A

False, degree of neutropenia DOES correlate with the severity of the disease

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27
Q

What are 4 other biochemical abnormalities you might see with Parvo?

A

HypoK
Hypoglycemia (sign of sepsis)
Prerenal azoteia
Increased liver enzymes

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28
Q

How do you manage a parvo patient?

A

STRICT ISOLATION IN HOSPITAL

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29
Q

What 3 Abx can you use to treat parvo?

A

Amoxycillin

Gentamycin/Amikacin (ONLY IF RENAL FXN NORMAL

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30
Q

What are 7 additional therapies you may use in a parvo puppy?

A 
Antiemetics (both central and peripheral)
Plasma transfusion (TSP
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31
Q

When treating for Parvo, if you have breakthrough pain, what do you need to consider?

A

Could be intussusception

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32
Q

How do you handle nutrition in a Parvo case?

A

DO NOT STARVE! Start feeding 4-5 hours after treatment is started and aim to give 1/3 of daily requirement over the next 24 hours

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33
Q

What are 6 things you should monitor daily in a parvo patient?

A

Body weight
CRT
Abdominal palpation for intussusceptions
PCV and TSP (do this several times on days 1-3)
Blood glucose (check on intake and any time demeanor changes)
Serum potassium

34
Q

What is the prognosis of parvo?

A

Most dogs recover if dehydration and sepsis treated appropriately

35
Q

What can help you with prognosis on parvo case?

A

Neutrophil count on day 3

36
Q

What is associated with a high mortality rate in parvo?

A

Severe infection and leukopenia

37
Q

What is the name for feline parvo?

A

Feline Panleukopenia

38
Q

What are 4 differentials for Feline Panleuk.?

A

Corona
FIV
FeLV
FIP

39
Q

What is chronic small intestinal diarrhea?

A

Diarrhea that persists >3 weeks

40
Q

What must you do if you have chronic small intestinal diarrhea?

A

Systemic diagnostics

41
Q

What can chronic small intestinal diarrhea lead to?

A

Malassimilation syndrome

42
Q

What is not appropriate in a case of chronic small intestinal diarrhea?

A

Withholding food

43
Q

What 4 things might you do to investigate intestinal causes of chronic small intestinal diarrhea?

A

MDB (blood and UA)
Fecal parasitology and bacteriology
Diet trial4BI biopsies

44
Q

What increases sensitivity of fecal parasitology?

A

3 consecutive samples

45
Q

If on blood work of an animal with chronic small intestinal diarrhea, we see anemia, what 2 things should be on your mind?

A

Parasites

Tumor/ulcer if older animal

46
Q

What 4 things might you see on the biochem of an animals with chronic small intestinal diarrhea?

A

Panhypoproteinemia
Hypocholesterolemia
Mild increase in liver enzymes
Evidence of dehydration

47
Q

Why is fecal bacteriology problematic?

A

Identifying an organism doesn’t mean it’s causative, don’t test unless severe signs associated with diarrhea

48
Q

What 3 scenarios would you definitely perform bacteriology?

A

Infectious cause is suspected
Pyrexia and other systemic signs
Hemorrhagic gastroenteritis present

49
Q

Campylobacter… GO!

3

A

Can be isolated from healthy dogs
Treatment not always necessary
Abx only justified in dogs with acute HGE

50
Q

Salmonella… GO!

2

A

Uncommon (more so on BARF diet)

Use fluorquinolones if isolate in acute HGE to prevent sepsis

51
Q

E.coli… GO!

1

A

Non-pathogenic

52
Q

Clostridium… GO!

2

A

HCT often exceeds 60% with neutrophilia

Acute, profuse bloody diarrhea and dehydration

53
Q

When are abdominal RADs useful in chronic small intestinal diarrhea?

A

To ID need for surgical intervention

54
Q

What is abdominal US valuable for with chronic small intestinal diarrhea?

A

ID obstructive disorders
GI motility
Assess GI walls

55
Q

What are 3 markers for absorption?

A

TLI
B12 (Cobalamin)
Folate

56
Q

What does TLI tell us?

A

Indicative of exocrine pancreatic dz

57
Q

What is cobalamin important for?

A

Enterocyte health

58
Q

What do some dogs develop as a result of B12 deficiency?

A

Hepatic encephalopathy

59
Q

What is the only way to diagnose a food sensitivity?

A

Diet trial

60
Q

What is the gold standard diet trial?

A

Hydrolysed diet (Z/D)

61
Q

How do you perform a diet trial?

A

Feed novel protein/hydrolysed diet for 2 weeks. If no response, abandon. If response, feed for at least 8 more weeks to see if clinical signs resolve.

62
Q

What 2 viruses might you test for if you have chronic small intestinal diarrhea?

A

FeLV/FIV

Coronavirus (this is a waste of time…)

63
Q

What are 3 situations where Abx would be indicated with chronic small intestinal diarrhea?

A

Hemorrhagic
Pyrexia
Inflammatory leukogram

64
Q

What is ARDS?

A

Antibiotic responsive diarrhea

NOTE: uncommon in cats, but recognized in young, large breed dogs

65
Q

How long do you perform an Abx trial for?

A

Response normally seen within 2 weeks, but continnued for at least 4 weeks

66
Q

Why is metronidazole sometimes used in Abx trials?

A

Possible immunomodulatory effects

67
Q

If all other trials fail, what would you do with a case of chronic small intestinal diarrhea?

A

Biopsy, may be looking at idiopathic or neoplastic process

68
Q

What is the only way to take a full thickness biopsy of the intestine?

A

Surgery

69
Q

What is a drawback to laparotomy to get a biopsy?

A

Can’t visualize pathology on the lumen like you can with an endoscope

70
Q

How long do you fast a patient for a GI scope?

A

> 12 hours for UPPER

>24 hours for LOWER plus multiple enemas

71
Q

What is idiopathic IBD?

A

Breakdown of normal immune tolerance?

72
Q

What is the most common form of idiopathic IBD?

A

Lymphocytic plasmacytic enteritis

73
Q

Why do cats with idiopathic IBD often vomit?

A

D/t triaditis

74
Q

What are 3 negative prognostic factors of idiopathic IBD?

A

Hypoalbuminemia
Hypocobalaminemia
Small bowel and older dog

75
Q

What is the therapy for IBD?

A

Corticosteroids

76
Q

What IBD therapy can you NOT use in cats?

A

Azathioprine

77
Q

What IBD therapy can you use in cats?

A

Chlorambucil (C for cats)

NOTE: Problem is size of cat and dosing

78
Q

What 2 treatments help to chance the consistency of the stool?

A

Kaolin

Peridale

79
Q

What is intestinal lymphangectasia?

A

Marked dilation and leakage from lymphatics, see significant PLE

80
Q

What is the characteristic of the ascites with intestinal lymphangectasia?

A

Transudate in primary

Chylous in secondary

81
Q

What is a common complication of PLE?

A

Hypercoagulability

82
Q

What are the 6 steps in a systemic, step-wise diagnostic approach?

A
  1. Rule out obvious problem
  2. Small or large intestine?
  3. PLE?
    - low albumin and systemically sick animals need aggressive diagnostics
  4. Eliminate extra-intestinal dz
  5. If no protein loss, treatment trial is acceptable
  6. Biopsy if failure to respond to trials

Small Animal Medicine II (8 decks)

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