Approach to chronic diarrhoea (Yr 4)

Question 1

what defines chronic diarrhoea?

Answer 1

diarrhoea that has been occurring for over 2 weeks

Question 2

what are some differentials for alimentary disease that may cause diarrhoea?

Answer 2

adverse food reactions
inflammatory bowel disease
antibiotic responsive diarrhoea
lymphangiectasia
lymphoma/tumours
infectious diarrhoea
(partial) obstructions

Question 3

what is a linear foreign body?

Answer 3

long foreign body such as string (can get stuck in the mouth and then extend into the intestine)

Question 4

what is haematochezia?

Answer 4

fresh blood in faeces

Question 5

what does it suggest about the lesion if there is localised blood in the stool?

Answer 5

the lesion must be at the same point (rectal polyp)

Question 6

what are the features of small intestinal diarrhoea?

Answer 6

increased volume
colour change
normal or slightly increased frequency
(possible weight loss)
(possible flatulence, halitosis, borborygmi)

Question 7

why does small intestinal diarrhoea have colour changes with increased volume?

Answer 7

most of the digestion occurs in SI if, if food isn’t being digested properly water is held in the lumen meaning an increased volume of faeces

Question 8

what do the features of small intestinal diarrhoea relate to?

Answer 8

malabsorption/digestion

Question 9

what are the features of large intestinal diarrhoea?

Answer 9

decreased volume
increased frequency/urgency
tenesmus
mucus/heamatochezia
dyschezia
variable consistency (constipation)
(no weight loss)

Question 10

what do the features of large intestinal diarrhoea relate to?

Answer 10

large intestine is mainly for storage of faeces

Question 11

if melaena is present, where is the bleeding?

Answer 11

before the small intestine (it has been digested) unless there is so much bleeding the digestion is overwhelmed

Question 12

how do you prepare a patient for a colonoscopy?

Answer 12

starve for 48 hours
laxatives (poly-ethylene glycol)
warm water enemas

Question 13

is fibre good for small or large intestinal diarrhoea?

Answer 13

large intestinal

Question 14

what symptomatic treatment may be considered in chronic diarrhoea early in your investigation?

Answer 14

dietary trial
anthelmintic medication

Question 15

what can you analyse faeces for in chronic diarrhoea cases?

Answer 15

parasites
bacteria

Question 16

what parasites could you isolate from faeces?

Answer 16

giardia
cryptosporidium
Tritrichomonas foetus (cats)

Question 17

what are the two most common bacteria causing chronic diarrhoea?

Answer 17

Salmonella
Campylobacter

Question 18

what cats are usually infected by Tritrichomonus foetus?

Answer 18

young
pedigrees
colonies
(causes large intestinal diarrhoea)

Question 19

what parasite is a top differential for large intestinal diarrhoea in cats?

Answer 19

Tritrichomonas foetus

Question 20

what disease does ACTH stimulation test for?

Answer 20

hypoadrenocorticism

Question 21

what endocrine tests could you run for cases of chronic diarrhoea?

Answer 21

ACTH stimulation test (hypoadrenocorticism)
total thyroxine (hyperthyroidism)

Question 22

what test is done for exocrine pancreatic insufficiency?

Answer 22

trypsin-like immunoreactivity

Question 23

what test is done to look for possible pancreatitis?

Answer 23

total lipase or pancreatic lipase

Question 24

what blood tests can be run to look for malabsorption?

Answer 24

folate and cobalamin

Question 25

what are folate and cobalamin?

Answer 25

B vitamins (tell us about the intestinal absorption)

Question 26

where is folate absorbed?

Answer 26

proximal small intestine

Question 27

where is cobalamin absorbed?

Answer 27

distal small intestine

Question 28

if the patient has hypocobalaminaemia, what is the likely outcome?

Answer 28

worse (this is a poor prognostic indicator)

Question 29

what is done if the patient has hypocobalaminaemia?

Answer 29

supplement with cobalamin (SC or oral)

Question 30

what would be the last diagnostic test to do for chronic diarrhoea?

Answer 30

intestinal biopsy

Question 31

what is the difference between a sample taken through endoscopy and coeliotomy?

Answer 31

ceoliotomy is full thickness (possibly more representative and diagnostic)

Question 32

which way would you biopsy a cats intestine?

Answer 32

coeliotomy (they often get hepatitis and pancreatitis at the same time so can assess these at the same time)