Diarrhea

Question 1

Problem based approach with diarrhea

Answer 1

Define the problem, location, system, then lesion

Question 2

Alteration in normal pattern of defecation

Answer 2

Soft, unformed stools
↑ fecal water content
↑ frequency of defecation

Question 3

Defining the location

Answer 3

Small bowel, large bowel or mixed

Question 4

Small bowel diarrhea characteristics

Answer 4

Large amount
Melena or partial digestion of blood
WL with chronic
Borborygmus and flatulence
If unwell dehydrated

Question 5

Large bowel diarrhea

Answer 5

Small amounts frequently with inflamed bladder
Mucus (hallmark) and fresh blood
Tenesmus (straining)

Question 6

Secondary GI disorders causing diarrhea

Answer 6

Hepatic disease, pancreatic insufficiency, pancreatitis, hyperthyroidism, hypoadrenocorticism, renal disease

Question 7

Large bowel or mixed bowel diarrhea as major presenting signs indicates _____________

Answer 7

Primary GI lesion

Question 8

Secondary GI disease most frequently has characteristics of _____________

Answer 8

small bowel disease

Question 9

Parasites and protozoa causing acute small bowel diarrhea

Answer 9

Parasites- ascarids, hookworms
Protozoa - giardia, coccidia

Question 10

Diet related causing acute small bowel diarrhea

Answer 10

Overeating (pups)
Dietary change
Spoiled food
Garbage

Question 11

Bacterial disease causing acute small bowel diarrhea

Answer 11

Campylobacter (young only, mixed bowel, zoonotic)
Salmonella (raw food, zoonotic)
Clostridium difficile
E. coli

Question 12

Infection causing acute small bowel diarrhea

Answer 12

Viral enteritis- parvo, corona and rota

Question 13

Acute Hemorrhagic diarrhea syndrome (AHDS)/ Hemorrhagic Gastroenteritis (HGE)

Answer 13

Acute onset of bloody diarrhea (small bowel)
Significant hemoconcentration (↑ PCV) with normal or low plasma protein
Typically in small breeds

Question 14

What is Acute Hemorrhagic diarrhea syndrome (AHDS) caused by?

Answer 14

Novel necrotising toxin produced by Type A Clostridia perfringens (antimicrobial therapy doesn’t work)

Question 15

Parasites causing chronic small bowel diarrhea

Answer 15

Toxocara- roundworms
Ancylostoma (hookworms)
Visceral larval migrans

Question 16

Diet related causing chronic small bowel diarrhea

Answer 16

Lactose intolerance (common)
Gluten intolerance (uncommon)
Dietary hypersensitivity/ intolerance (common)

Question 17

Bacteria and protozoa causing chronic small bowel diarrhea

Answer 17

Campylobacter
Clostridium
Giardia
Cryptosporidium (immunocompromised)
Coccidia (young)

Question 18

Dietary hypersensitivity

Answer 18

Chronic intermittent diarrhea, vomiting and pruritus
Allergens

Question 19

Pruritus species variation

Answer 19

Cats: ears, face
Dog: axillary region, feet

Question 20

Allergens species differences

Answer 20

Dog: beef, lamb, chicken, wheat (gluten)
Cat: fish, milk, diary

Question 21

Types of Chronic Enteropathy (IBD)

Answer 21

Diet response CE (most common)
Antibiotic response CE
Immunosuppressive responsive CE (real IBD)
Non-responsive CE

Question 22

Antibiotic responsive CE

Answer 22

Abnormal/unbalanced bacterial population
Abnormal gut reaction to normal bacterial population

Question 23

Chronic Enteropathy dietary trial

Answer 23

Novel protein or hydrolyzed (@ least 2 or 3 diets)
Total compliance
2-10 weeks a response
Harder in cats, keep them indoors

Question 24

Chronic Enteropathy treatment trials

Answer 24

If no response to dietary trial use metronidazole or tylosin
↑ fiber

Question 25

Neoplasia causing small bowel diarrhea

Answer 25

Diffuse lymphosarcoma Adenocarcinoma Mastocytoma

Question 26

Other diseases causing chronic small bowel diarrhea

Answer 26

Lymphangiectasia (primary or secondary) Brush order enzyme biochemical defects

Question 27

Protein losing enteropathy (PLE)

Answer 27

When diffuse small intestinal disease results in excessive loss of serum proteins into the gut causing hypoproteinemia

Question 28

Causes of protein losing enteropathy

Answer 28

Immunosuppressive- responsive or non-responsive chronic enteropathy (IBD) Lymphangiectasia Lymphoma

Question 29

Most common clinical signs for protein losing enteropathy

Answer 29

GI signs (V/D) WL Ascites, pleural effusion, peripheral edema

Question 30

Parasites causing large bowel diarrhea

Answer 30

Trichuris vulpis (dogs) Ancylostoma caninum (cutaneous larval migrans)

Question 31

Protozoa causing large bowel diarrhea

Answer 31

Giardia Entamoeba spp. Tritrichomonas foetus (cats)

Question 32

Bacteria causing large bowel diarrhea

Answer 32

Campylobacter Clostridium Salmonella spp. Granulomatous colitis (boxers, frenchies)

Question 33

Diet related large bowel diarrhea

Answer 33

Toxicity (garbage) Fiber-repsonsive Dietary hypersensitivity/intolerance

Question 34

Causes of mixed bowel diarrhea

Answer 34

Giardia Campylobacter Tritrichomonas foetus (cats) Dietary indiscretion/ intolerance/ hypersensitivity AHDS Inflammatory

Question 35

Diagnostic tools for diarrhea

Answer 35

Fecal tests (culture, float, panels, etc.) Serum trypsin like immunoreactivity (TLI) Cobalamin and folate Ultrasound Biopsy (endoscopy, laparotomy)