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Module 16 > Diagnosis and Management of Large Intestinal Disease in Dog and Cat > Flashcards

Diagnosis and Management of Large Intestinal Disease in Dog and Cat Flashcards

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1
Q

what are the clinical manifestations of large intestinal disease

A
  1. fecal tenesmus: straining to defecate
  2. dyschezia: difficult or painful defecation
  3. diarrhea: large intestinal characteristics
  4. hematochezia: passage of fresh blood on feces
  5. constipation: infrequent, difficult passage of feces
  6. fecal incontinence: involuntary passage of feces
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2
Q

What are categories of causes of tenesmus and dyschezia (5)

A
  1. colorectal diseases
  2. prostatic diseases
  3. perianal and perineal diseases
  4. urogenital disease
  5. miscellaneous
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3
Q

what are colorectal diseases that cause tenesmus and dyschezia (8)

A
  1. parasitic colitis
  2. infectious colitis
  3. inflammatory bowel disesase
  4. fibre responsive diarrhea
  5. neoplasia or rectal polyp
  6. colorectal stricture
  7. constipation
  8. impaction and foreign material
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4
Q

hat are causes of parasitic colitis (3)

A
  1. Giardia
  2. Trichuris (c)
  3. Tritrichomonas fetus (f)
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5
Q

wjat are causes of infectious colitis (3)

A
  1. clostridium
  2. histoplasma (USA)
  3. prototheca (rare)
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6
Q

what are the types of inflammatory bowel disease (2)

A
  1. idiopathic
  2. granulomatous
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7
Q

What prostatic diseases can cause tenesmus and dyschezia (3)

A
  1. benign prostatic hyperplasia
  2. prostatitis
  3. prostatic neoplasia
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8
Q

what are urogenital diseases that cause tenesmus and dyschezia (3)

A
  1. cystitis, urethritis, vaginitis
  2. urolithiasis
  3. urinary tract neoplasia
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9
Q

what perianal and perineal diseases can cause tenesmus and dyschezia (3)

A
  1. anal sacculitis, impaction, abscess, neoplasia
  2. anal furnuculosis/perianal fistula
  3. perineal hernia
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10
Q

what are miscellaneous causes of tenesmus and dyschezia (2)

A
  1. caudal abdominal or pelvic mass
  2. pelvic fracture
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11
Q

what is tenesmus

A

spurious feeling of the need to evacuate the bowels, with little or no stool passed

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12
Q

what is dyschezia

A

constipation associated with a defective reflex for defecation.

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13
Q

how would you investigate a patient with tenesmus/dyschezia as well as diarrhea (5)

A
  1. fecal parasitology (giardia, trichuris. ancylostoma, tritrichomonas in cats)
  2. fecal culture
  3. rectal cytology: may identify infectious agents (ex. fungal)
  4. diagnostic imaging: rule out extraluminal disease, intussusception, lymphadenopathy, bowel thickening
  5. colonoscopy and mucosal biopsy
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14
Q

what is idiopathic colitis

A

idiopathic inflammation of the colon

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15
Q

how is idiopathic colitis diagnosed

A

diagnosis of exclusion plus compatible histopathological changes

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16
Q

how is idiopathic colitis managed (4)

A
  1. dietary modification
  2. antibiotics
  3. anti-inflammatory drugs
  4. immunosuppressive therapy
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17
Q

what diet would be suitable to manage diopathic colitis

A

hydrolyzed protein diets or supplemental fibre

butyrate levels in the colon can reduce the level of inflammation

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18
Q

what antibiotic is used to manage diopathic colitis

A

metronidazole to reduce the clinical signs

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19
Q

what anti inflammatory drugs can be used to manage idiopathic colitis

A

sulfasalazine (5-ASA)

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20
Q

what immunosuppressive drugs are used to manage idiopathic colitis (4)

A

prednisolone (1st line)

azathioprine (2nd line in dogs)

cyclosporine (2nd line in dogs)

chlorambucil (2nd line in cats)

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21
Q

what is granulomatous colitis

A

segmental, thickened, partially obstructed segment of bowel (ileum and colon most commonly) characterized by macrophages and bacterial invasion of the intestinal wall

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22
Q

what breed is granulomatous colitis typically seen in

A

boxers

french bulldogs

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23
Q

how is granulomatous colitis managed

A

Current treatment recommendations for GC require antimicrobials effective against E coli and that penetrate intracellularly, such as enrofloxacin (10–15mg/kg, PO, daily), with reassessment every 2 weeks and total treatment duration of 8 weeks.

fluroquinolones

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24
Q

at what age is idiopathic large intestinal diarrhea in dogs commonly reported

A

median age of 6 years old

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25
what are the clinical signs of idiopathic large intestinal diarrhea in dogs
intermittent diarrhea characterized by increasing frequency, fecal mucus, hematochezia, and tenesmus +/- concurrent vomiting
26
how is idiopathic large intestinal diarrhea in dogs diagnosed
CBC, serum biochem, fecal parasitology NAD colonic mucosa often normal during colonoscopy but decreased numners of lymphoid follicles histopathological evaluation = WNL
27
how is idiopathic large intestinal diarrhea in dogs managed
respond to increased dietary fibre (psyllium)
28
what does tritrichomonas fetus infection cause
colitis in cats
29
what are the signs of tritrichomonas fetus infection
causes a mild to moderate lymphoplasmacytic and neutrophilic colitis asymptomatic to signs of large intestinal inflammation fecal incontinance
30
at what age is tritrichomonas fetus infection commonly
in cats \<1 year
31
what breeds is tritrichomonas fetus infection more common in
common in pedigrees bengal siamese maine coon and multicat households/resuce centres
32
how is tritrichomonas fetus infection diagnosed
PCR for tritrichomonas DNA is highest sensitivity in pouch culture ~65% sensitivity fecal we prep sensitvitiy \<20%
33
what organisms are in a fecal PCR panel in cats for enteropathogens (8)
1. tritrichomonas fetus 2. giardia spp 3. cryptosporidium spp 4. toxoplasma gondii 5. salmonella spp 6. clostridium perfringens enterotoxin A gene 7. feline coronavirus (FeCoV) 8. feline panleukopenia virus
34
how is tritrichomonas fetus infection managed (4)
1. high fibre diet 2. ronidazole (antiparasitic) 3. probiotics 4. treatment of concurrent infections?
35
how would your investigation differ when fecal tenesmus is associated with constipation rather than diarrhea
less infectious causes of constipation
36
what are causes of constipation (6)
1. mechanical obstruction 2. neuromuscular dysfunction 3. metabolic/endocrine disease 4. inflammation 5. environmental 6. pharmacological/drug induced
37
what mechanical obstructions can cause constipation (3)
1. intraluminal 2. intramural 3. extramural
38
what are intraluminal causes of constipation (3)
impaction with 1. bones/hair 2. rectal stricture 3. perineal hernia (diverticulum)
39
what are intramural causes of obstruction
neoplasia
40
what are extramural causes of obstruction
1. pelvic fractures/stenosis 2. neoplasia 3. prostatic disease
41
what neuromuscular dysfunction can cause constipation (3)
1. lumbosacral disease 2. hypogastric or pelvic nerve disorders 3. colonic smooth muscle dysfunction
42
What are metabolic/endocrine diseases that can cause constipation (5)
1. dehydration 2. hypokalemia 3. hypercalcemia 4. hypothyroidism 5. obesity
43
what inflammatory diseases can cause constipation (2)
1. anal sac disease 2. anal furunculosis/perianal fistula
44
what are environmental causes that can lead to constipation (2)
1. soiled litter tray 2. inactivity/hospitalization
45
what neuromuscular dysfunction can cause constipation (3)
1. lumbosacral disease 2. hypogastric or pelvic nerve disorders 3. colonic smooth muscle dysfunction
46
What lumbosacral diseases can cause constipation (2)
1. cauda equina syndrome 2. sacral spinal cord deformaties
47
what hypogastric or pelvic nerve disorders can cause constipation
dysautonomia
48
what drugs can cause constipation (3)
1. opioids 2. anticholinergics 3. diuretics
49
how would you investigate tenesmus/dychezia with constipation (6)
1. rectal examination 2. neurological assessment 3. serum biochemistry 4. thyroid function tests (T4:TSH) 5. abdominal radiography +/- ultrasonography 6. colonoscopy (or barium-contrast enema)
50
what is a common large intestinal disorder that is particularily in the male cat
feline constipation, obstipation, megacolon
51
what is obstipation
severe or complete constipation
52
what would be the presentation usually of feline constipation, obstipation and megacolon (7)
1. typically there is a chronic history of reduced production of feces +/- fecal tenesmus and dyschezia 2. intermittent hematochezia and mucoid diarrhea 3. systemic signs of inappetance 4. malaise 5. vomiting 6. weight loss 7. may be a history of RTA/pelvic trauma
53
what can be found on physical exam with feline constipation
distended colon
54
what is the pathway that leads to megacolon
constipation --\> obstipation --\> dilative megacolon or hypertrophic megacolon
55
what is the rad showing
megacolon
56
how do you diagnose feline constipation, obstipation, megacolon (4)
exclusion of other causes 1. serum biochem 2. T4 (juvenile-onset hypothyroidism) 3. abdominal radiography +/- ultrasonography 4. colonoscopy (or barium-contrast enema) to rule out inflammatory lesions, strictures, etc
57
what is the most common cause of obstipation in cats
idiopathic megacolon (62%) pelvic canal stenosis (23%) nerve injury (6%) or sacral deformity (5%)
58
what are the aims of therapy of feline constipation, obstipation and megacolon (4)
1. achieve normal hydration 2. remove impacted feces 3. increase dietary fibre 4. pharmacologic manipulation of colonic function (laxatives, prokinetics)
59
how can feline constipation, obstipation and megacolon be managed (4)
1. removal of impacted feces 2. diet 3. laxatives 4. colonic prokinetics agents
60
how can removal of feces in feline constipation, obstipation and megacolon be done (2)
1. enemas 2. manual evacuation
61
how can diet manage feline constipation, obstipation and megacolon (2)
1. high fibre for mild constipation 2. low residue diets for obstipation/megacolon
62
what laxatives can be used to manage feline constipation, obstipation and megacolon (4)
1. dietary fibre supplements 2. lubricant laxatives 3. hyperosmotic laxatives 4. stimulant laxatives
63
what colonic prokinetic agents can be used to manage feline constipation, obstipation and megacolon (3)
1. 5HT4 serotonergic agnoists 2. H2 receptor antagonists 3. ? prostaglandin analogues
64
what is used to perform enemas
microlax lactulose
65
what are examples of colonic prokinetic agents (2)
1. cisapride 2. ranitidine
66
what are examples of laxatives
1. psyllium 2. lactulose
67
what are the consequences of feline constipation, obstipation and megacolon (2)
1. mucosal ulceration and inflammation 2. colonic perofration
68
what can be done if there is recurring feline constipation, obstipation and megacolon
(sub-total) colectomy +/- pelvic osteotomy (if megacolon is secondary to pelvic canal stenosis)
69
what is anal furunculosis/perianal fistula
chronic inflammatory disease resulting in ulceration and fistulous tracts in the anal and perianal areas
70
what breeds are predisposed to anal furunculosis/perianal fistula
GSDs predisposed (middle aged dogs)
71
what may concurrently occur with idiopathic colitis
anal furunculosis/perianal fistula
72
what are the clinical signs of anal furunculosis/perianal fistula (2)
1. inflammation and pain associated with lesions 2. anal stricture may develop or fecal incontinence
73
how are anal furunculosis/perianal fistulas treated (4)
1. cleaning to reduce contamination 2. antibiotics to treat secondary infection (metronidazole/clindamycin) 3. analgesia 4. stool softeners
74
what immunosuppressive therapy can be used to manage anal furunculosis/perianal fistula (2)
1. ciclosporin (oral) (+/- ketoconazole) 2. tacrolimus (topical)
75
what is a common cause of straining
perineal hernia
76
what causes perineal hernias
loss of lateral support to rectum deviation of rectum into subcutaneous hernia
77
what are the signs of perineal hernias
pernieal swelling
78
what is the signalment commonly of perineal hernias
older entire male dogs
79
how do you treat perineal hernias
surgical repair
80
what causes decreased or absent anal tone
lower motor neuron dysfunction
81
what diseases cause decreased or absent anal tone (3)
1. lumbosarcal disease 2. caudal equina syndrome 3. degenerative myelopathy (GSDs and other breeds)
82
with upper motor neuron dysfunction are the anal tone and reflexes normal
normal
83
what are the disease that upper motor neuron dysfunction cause (3)
1. thoracic, cervical or central lesions 2. arachnoid cysts 3. IVDD, FCE, neoplasia
84
what is sphincter incontinence caused by (4)
1. neurological dysfunction 2. trauma to external anal sphincter 3. aging (geriatric dogs) 4. behavioural disorders
85
what is reservoir incontinence caused by
failure of the large bowel to accommodate the colorectal content
86
what is reservoir incontinence due to (3)
1. colorectal irritability 2. reduced capacity/compliance 3. increased volume of feces 4. acute or chronic proctitis 5. rectoanal neoplasia 6. diffuse colitis 7. diarrhea
87
how is sphincter incontinence managed
usually permanent and untreatable loperamide may be useful in the management of mild fecal incontinence (increases the anal canal pressure and attenuates the rectosphincter relaxation reflex)
88
how is reservoir incontinence treated
identify and treat the underlying disorders

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