Approach to chronic diarrhoea and constipation Flashcards
(37 cards)
List the 6 steps in the approach to diarrhoea
- History & physical examination
- Symptomatic therapy
- Laboratory investigations
- Diagnostic imaging
- Gastrointestinal biopsy
- Therapeutic trials
List the DDx for alimentary diseases that cause diarrhoea
- Adverse reactions to food: allergy, poisoning
- Inflammatory bowel disease
- Antibiotic responsive diarrhoea
- Lymphangiectasia
- Lymphoma/tumours
- Infectious diarrhoea
- Obstructions
What is Lymphangiectasia?
Lymphatic system within the SI is obstructed -> dilation of the lacteal
Diarrhoea due to protein loss into the intestine
List the DDx for systemic causes of diarrhoea
Liver disease
Renal disease
Pancreatic disease
Endocrine disease
- Addison’s disease
- Diabetes mellitus
- Hyperthyroidism
Describe the information which should be gathered when you are presented with a dog with diarrhoea
Gastrointestinal signs
Systemic signs
Diet history
Vaccine history etc
Verify vomiting vs regurgitation
Classify the diarrhoea - SI vs LI
Grade the severity of signs
Why should you check the tongue in the physical exam?
To check for a linear foreign body
Define haematochezia
Fresh blood in the stool
Why is it important to classify diarrhoea? How is this done?
- Helps with localisation
- Ask owner to bring in a sample of faeces
- Photo of the faeces
Describe the features of diarrhoea and clinical signs that enable it to be localised to the small intestine
- Increased volume
- Colour change
- Normal to slight increase in frequency
± Weight loss
± Flatulence, borborygmi, halitosis
Describe the features of diarrhoea and clinical signs that enable it to be localised to the large intestine
- Decreased volume
- Increased frequency
- Urgency & tenesmus
- Mucus & haematochezia
- Dyschezia: pain on defaecation
- Constipation ± variable consistency
- No weight loss?
What is the main function of the LI?
To act as a storage organ for appropriate defaecation, enabling the individual to make a conscious decision on when to defecate
Describe diffuse diarrhoea
Watery with some solid components
Fresh blood
Melaena is a sign of…?
Upper GI disease
Blood loss from stomach or SI -> blood gets digested
Dark stool – tar/black
Fibre supplementation is used for diarrhoea localised where?
Large intestine
How should a patient be managed/prepared before a colonoscopy?
Starve 48 hours
Poly-ethylene glycol:
- 3 doses, 4h apart
- Use Stomach tube
Followed by 2x warm water enemas
Which laboratory test is carried out first in diarrhoea cases?
Faecal analysis
What is being assessed on faecal analysis?
Parasites
Bacteria
Name 3 parasites which may be seen on a faecal analysis
- Giardia
- Cryptosporidia
- Tritrichomonas foetus (cats)
Describe the disease caused by Tritrichomonas foetus
- Poor bodily condition
- Chronic diarrhoea
- Most commonly affects pedigree cats and cats in colonies
- Causes SI diarrhoea in cats and LI diarrhoea in dogs
How is Tritrichomonas foetus diagnosed?
Faecal preparation in saline
Culture
Polymerase chain reaction
Describe the stage 2 laboratory tests carried out for diarrhoea cases
Haematology
Serum biochemistry
Urinalysis
Mainly used to rule out systemic diseases - Liver disease, Kidney disease, etc
Describe the endocrine tests used in diarrhoea cases
ACTH stim test/ Basal cortisol - hypoadrenocorticism
Total thyroxine - hyperthyroidism
What is the trypsin-like immunoreactivity test used for?
Exocrine pancreatic insufficiency
Which test could you carry out to diagnose pancreatitis?
Total lipase or pancreatic lipase
