Diarrhea Flashcards
What is diarrhea?
Passing of loose or liquid stool secondary to disorders of the GI system
What is the normal physiology of the small intestine?
- Site of absorption of almost all nutrients
- Food has been broken down into very small partially digested particles
- Bile and pancreatic enzymes facilitate breakdown into smaller molecules which facilitates transport across the epithelium
What are three very important balances maintained by proper GI physiology?
Acid base balance
Water balance
Nutrition
What is the result of disruption of the osmosis functions of the GIT?
- Malabsorption of water dependent solutes
- Water remaining in the lumen
What is the result of disruption of secretory functions of the GIT?
- Increased secretion of water into the lumen
- Bacterial toxins and other agents open channels to allow water loss
What effect does infection have on the GIT?
- Disruption and destruction of epithelium
- Malabsorption of water and nutrients
- Exudation of serum and blood with destruction
What effect does inflammation have on the GIT?
- Secretory issues
- High rate of loss of epithelium leading to malabsorption and osmotic disruption
What effect does increased motility have on the GIT?
Increased transit time leads to decreased chance of absorption of nutrients and water
What are some clinical signs/presenting concerns for an animal with diarrhea?
Diarrhea, tenesmus, hematochezia, melena, dyschesia, inappetence, systemic signs of illness, abdominal distension, borborygmi, flatulence, vomiting, weight loss, ravenous appetite
What characterizes diarrhea as acute versus chronic?
Acute 3 weeks
What are some differentials for a patient with diarrhea?
Metabolic disorders, toxin/drug, primary intestinal disease, foreign body, environmental, organ failure, pancreatitis or EPI, neoplasia, infection
What are the questions to ask that can help narrow down your differential list?
Onset, duration, appearance and content, frequency, relationship to food, diet change, current diet/encironment/medication, medical history, weight loss, vomiting, appetite
What are some causes of melena?
Coagulopathies, immune mediated thrombocytopenia, ingestion of blood, GI erosion/ulceration, foreign body, neoplasia, drug/toxin causing bleeding, vascular anomaly, paraneoplastic, metabolic, inflammatory
What are common physical exam findings in a patient with melena?
Dehydration, abdominal pain and distension, edema, coat colour change, muscle wasting, enlarged LNs, signs of systemic illness, thickened intestines
May be totally normal- always perform a rectal exam
What should diagnostics be prioritized based on?
Severity, breed, age, environment, exam findings, history
T/F: Acute and stable diarrhea typically responds to empiric treatment.
True
Presence of what three things with diarrhea require more aggressive treatment?
Weight loss, inappetence, dehydration
What kind of diarrhea demands a more complete work up?
Chronic diarrhea
T/F: Acute non-ill diarrhea is typically self-limiting, has unremarkable findings, and requires little to no symptomatic therapy.
True
Dietary change, psyllium, or metronidazole can be tried if needed
What are the typical causes of acute diarrhea in an otherwise healthy animal?
Dietary indiscretion
What diagnostic tests can you run as minimum database for an animal that is systemically well with diarrhea?
Big 4 and fecal
How is a patient with chronic diarrhea with no systemic illness worked up?
Big four and fecal- typically unremarkable
Must differentiate between large and small bowel diarrhea to aid in diagnosis
What are some common presentations of an animal with diarrhea, acute or chronic, that is systemically unwell?
Pain or FB on abdominal palpation
Hematochezia or melena
Dehydration and weight loss
Must provide systemic support
What diagnostics should be done on an animal with diarrhea that is systemically unwell?
QATS, BP, bloodwork, UA, fecal, radiographs
