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Medicine II > Acute Vomiting and Diarrhea > Flashcards

Acute Vomiting and Diarrhea Flashcards

(58 cards)

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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?

Study These Flashcards
A
  • Acute or chronic large intestinal diarrhea:
    • fucoid feces
    • hematochezia
    • tenesmus
25
How are whipworm infections diagnosed?
* Fecal flotation: intermittent shedding * risk of false negatives * Pseudo-Addisonian electrolyte changes: hyperkalemia, hyponatremia
26
What causes Canine Enteric Parvovirus?
* Canine *Parvovirus 2*
27
What tissues does Canine Parvovirus infect?
* Localization to rapidly dividing cells: * intestinal crypts * bone marrow * lymphoid tissue
28
How is Canine Enteric Parvovirus transmitted?
* Fecal-oral * fecal shedding 10-14 days after illness onset * stable in the environment for months
29
What are the clinical signs of Canine Enteric Parvovirus?
* 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
How is Canine Enteric Parvovirus diagnosed?
* 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
What is the treatment for Canine Enteric Parvovirus?
* Supportive care: * IV fluids +/- potassium and dextrose supplementation * Prophylactic antibiotics * Early enteral nutrition: consider nasogastric tube placement * Treatment of concurrent infections: * *Giardia, cryptosporidium*
32
What are the possible complications of Canine Enteric Parvovirus?
* **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
What is the prognosis for Canine Enteric Parvovirus?
* \<10% survival w/out treatment * \<50% survival w/ out-patient care * \>80-90% survival w/ hospitalization
34
What are the negative prognostic indicators for Canine Enteric Parvovirus?
* Leukopenia on presentation * Evidence of systemic inflammatory response (SIRS) * Younger age (\< 7-12 weeks)
35
How can the transmission of Canine Enteric Parvovirus be prevented
* Isolation of affected animals, especially from unvaccinated or incompletely vaccinated dogs * Disinfection: dilute bleach solution * Vaccination
36
What causes Feline Panleukopenia?
Feline *Parvovirus*
37
What are the clinical signs of Feline Panleukopenia?
* 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
How is Feline Panleukopenia diagnosed?
* 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
What is the treatment for Feline Panleukopenia?
* Supportive care: * IV fluids +/- potassium and dextros supplementation * Prophylactic antibiotics
40
What is the prognosis for Feline Panleukopenia?
* high mortality w/ GI disease in young kittens 50-90%
41
What is the pathogenesis of *Neorickettsia helminotheca?*
* Ingestion of raw salmon containing the fluke *Nanophyteus salmincola* * fluke contains *Neorickettsia*
42
What are the clinical signs of *Neorickettsia helminotheca* infection
* Acute onset, hemorrhagic diarrhea ~1wk post-ingestion * Vomiting * High Fever * Lymphadenomegaly * Ocular/nasal discharge
43
How is *Neorickettsia helminotheca* diagnosed?
* 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
What is the treatment for Neorickettsia?
Doxycycline + Praziquantel
45
What is the prognosis for Neorickettsia?
* Grave w/out treatment * Good with prompt, intensive therapy
46
What is Campylobacter?
Gram negative bacteria
47
What are the clinical signs of a Campylobacter infection?
* Asymptomatic or transient * Young, immunocompromised or patients w/ co-infections * Acute enterocolitis: watery, mucoid, hemorrhagic diarrhea * Vomiting * Tenesmus * Fever
48
How is a Campylobacter infection diagnosed?
* 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
What is the treatment for a campylobacter infection?
* 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
What is the prognosis for a Campylobacter infection?
* Good - usually self-limiting * Chronic carrier state possible
51
Why is Campylobacter an important pathogen?
zoonotic
52
What are the clinical signs of Salmonellosis?
* 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
What species of salmonella commonly affects cats? how are they affected?
* *S. typhimurium* * seasonal - infection following ingestion of songbirds * Acute diarrhea with fever
54
How is Salmonellosis diagnosed?
Culture of feces or blood (sepsis)
55
What is the treatment for Salmonellosis?
* 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
What is the prognosis for salmonellosis
* Good unless septic
57
What are the negative prognostic indicators for Salmonellosis
* Peracute disease * Fever \>104F * Degenerative left shift * hypoglycemia
58
How common are chronic carriers of Salmonellosis in dogs/cats
* 30% healthy dogs * 20% healthy cats

Medicine II (46 decks)

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