Chronic Diarrhea

Question 1

Compare and contrast the presentation of small vs. large bowel diarrhea based on the following parameters:

• Volume
• Frequency
• If blood is present, the presentation of it

Answer 1

• Volume (Small bowel → large volume, large bowel → small volume)
• Frequency (Small bowel → normal to increased frequency, large bowel → increased frequency)
• If blood is present, the presentation of it (Small bowel → melena (tarry, black), large bowel → hematochezia (frank, red))

Question 2

For the following clinical signs, sort them into large vs. small bowel diarrhea:

• Flatulence
• Steatorrhea
• Mucus present in feces
• Weight loss
• Tenesmus
• Vomiting
• Pain or urgency to defecate

Answer 2

• Flatulence (Small)
• Steatorrhea (Small)
• Mucus present in feces (Large)
• Weight loss (Small, weight loss may also occur with large if d/t neoplasia or histiocytic ulcerative colitis)
• Tenesmus (Large)
• Vomiting (Small, can occur in large bowel as well but less likely)
• Pain or urgency to defecate (Large)

Question 3

(T/F) Histoplasmosis is more likely to cause large bowel diarrhea.

Answer 3

(T, would also see other C/S such as lymphadenopathy, respiratory signs, fever, and skin/ocular lesions)

Question 4

(T/F) Parasites are more likely to cause large bowel diarrhea.

Answer 4

(T)

Question 5

What are some systemic differentials for chronic small bowel diarrhea?

Answer 5

(Hypoadrenocorticism, EPI, hepatobiliary dz, and chronic renal failure)

Question 6

Both albumins and globulins are low on chem of a patient you are seeing for chronic diarrhea; they also have a mild hypocholesterolemia but all else is normal, what do they have?

A- PLE
B - PLN
C - Hepatic insufficiency

Answer 6

(PLE, globulins are normal to increased with PLN and hepatic insufficiency, there are no other signs of hepatic insufficiency on blood work besides hypocholesterolemia and PLE can explain that)

Question 7

Why is lymphangiectasia associated with inflammation and granuloma formation in the affected small bowel?

Answer 7

(Bc lymph is a local tissue irritant which will leak into the lumen of the gut and the interstitium after rupture of dilated lacteals)

Question 8

What causes secondary intestinal lymphangiectasia?

Answer 8

(Something that causes a blockage of the lymphatics → neoplasia or inflammation (IBD, parasites, food allergies))

Question 9

How do the treatments for primary and secondary intestinal lymphangiectasia differ?

Answer 9

(Primary → focused on decreasing fat in diet, may need anti-inflammatories to calm the gut down enough to allow for healing), secondary → will need the diet temporarily but focus is on treating the cause whether that be IBD (steroids), parasites (dewormer), or food allergies (hydrolyzed diet))

Question 10

What type of fat can be supplemented for a dog with either primary or secondary intestinal lymphangiectasia, usually done if they are having difficulty gaining weight on the low-fat diet?

Answer 10

(Medium chain triglycerides)

Question 11

(T/F) Steroids are contraindicated for a case of histiocytic ulcerative colitis.

Answer 11

(T, tx for boxer colitis is enrofloxacin)

Question 12

Describe the presentation of irritable bowel syndrome.

Answer 12

(Episodic large bowel diarrhea associated with stress)