Diarrhea in SA

Question 1

Defintion of Diarrhea

Answer 1

Question 2

Classification of Diarrhea

Answer 2

Question 3

Defining the Location and Why is this Important?

Answer 3

Question 4

Small Bowel Diarrhea

Answer 4

Question 5

Large Bowel Diarrhea

Answer 5

Question 6

Defining the System

Answer 6

Question 7

Define the Lesion

Answer 7

Question 8

Acute Small Bowel Diarrhea

Answer 8

Question 9

Chronic Small Bowel Diarrhea

(weeks to years)

Answer 9

Question 10

Large Bowel Diarrhea

Answer 10

Question 11

Diagnostic Approach

(4)

Answer 11

Question 12

Diagnostic Approach

(Small Bowel Only)

Answer 12

Question 13

Diagnostic Approach

(US, Biopsy, Therapeutic Trials)

Answer 13

Question 14

Exocrine Pancreatic Insufficiency

(EPI)

Answer 14

• Exocrine pancreatic insufficiency (EPI) is a condition characterized by deficiency of the exocrine pancreaticenzymes, resulting in the inability to digest food properly, or maldigestion
• If the pancreas fails to produce enough of these digestive enzymes, exocrine pancreatic insufficiency, or EPI, develops. EPI may affect adog’s gastrointestinal system, as well as general nutrition, and can cause problems such as weight loss and chronic diarrhea
• Can lead to fatty and yellow looking feces
• Diarrhea may be likely the primary complaint - unlike other Secondary (Metabolic) GI Disease causing diarrhea - ex: pancreatitis, hepatic/renal disease

Question 15

Proctoscopy

Answer 15

• Proctoscopy is a common medical procedure in which an instrument called a proctoscope (also known as a rectoscope, although the latter may be a bit longer) is used to examine the anal cavity, rectum, or sigmoid colon

Question 16

Tenesmus

Answer 16

• a continual or recurrent inclination to evacuate the bowels, caused by disorder of the rectum or other illness
• Straining to defecate

Question 17

Dietary Hypersenisitity in SA

Answer 17

• Adverse reactions to food or dietary hypersensitivity are frequently seen problems in companion animal medicine and may be difficult to differentiate from inflammatory bowel disease (IBD)
• Dietary hypersensitivity can be divided into two subgroups: immunological and nonimmunological problems
• Non-immunological problems can be subdivided into food intolerance, food poisoning, and dietary indiscretion.
• The immunological group can be subdivided into true food allergy (IgE mediated) and anaphylaxis (non-IgE mediated)

Question 18

Mycoses

Answer 18

• Mycoses are common and a variety of environmental and physiological conditions can contribute to the development of fungal diseases.
• Inhalation of fungal spores or localized colonization of the skin may initiate persistent infections; therefore, mycoses often start in the lungs or on the skin
• Deep mycoses causing diarrhea in SA are not very common to the UK

Question 19

Dysbiosis

Answer 19

• Dysbiosis (also called dysbacteriosis) is a term for a microbial imbalance or maladaptation on or inside the body, such as an impaired microbiota
• The cause of dysbiosis syndrome in dogs varies, but it is almost always due to diet or medications, such as antibiotics or non-steroidal anti-inflammatory drug (NSAIDS).
• The condition itself is due to the destruction of the good bacteria in the intestinal tract, giving the bad bacteria the chance to take over. Risk factors for this disorder include a diet high in processed foods and grains, stress, antibiotics, corticosteroids, and NSAIDS.

Question 20

Lymphangiectasia

Answer 20

• pathologic dilation of lymph vessels.
• When it occurs in the intestines of dogs, and more rarely humans, it causes a disease known as “intestinallymphangiectasia”.
• This disease is characterized by lymphatic vessel dilation, chronic diarrhea and loss of proteins such as serum albumin and globulin

Question 21

Hemorrhagic Gastroenteritis

Answer 21

• Hemorrhagic gastroenteritis (HGE) is a disease of dogs characterized by sudden vomiting and bloody diarrhea.
• The symptoms are usually severe, and HGE can be fatal if not treated.
• HGE is most common in young adult dogs of any breed, but especially small dogs such as the Toy Poodle and Miniature Schnauzer

Question 22

Cystitis

Answer 22

• Cystitis is inflammation of the bladder, usually caused by a bladder infection.
• Similar problem as LB D+

Question 23

Big 3 Indicators for LB D+

(first things you should ask to try and eliminate)

Answer 23

• Mucus?
• Frequent and in Samll Amounts?
• Fresh Blood?

Question 24

Lactose Intolerance

(Often Chronic SB D+)

Answer 24

• The most common outward signs of lactose intolerance in dogs are abdominal pain, bloating, nausea, vomiting and diarrhea – fairly typical indications of gastrointestinal distress.
• This is not surprising, because the animal’s gastrointestinal system is missing a key enzyme necessary to digest the sugars in milk
• Leads to somewhat grey feces

Question 25

Chronic Enteropathy

Answer 25

• New name for IBD - is the same thing!
• a cause of Chronic SB D+
• Not a single disease

Question 26

If you are taking a biopsy for D+ issues, what Q are you really trying to answer?

Answer 26

mainly want to answer the question: with the infiltrative disease suspected, is it inflammatory or neoplastic??

• COnsider AB trial and Proper Dietary Trial first

Question 27

The key questions to be answered by GI biopsy

Answer 27

Question 28

If there is weight loss along with the D+

(If there is WL even though appetite is unaffected)

Answer 28

• the 3 Mal’s
• Maldigestion, Malabsorption, Malutilisation?

Question 29

Does large bowel diarrhoea usually lead to weight loss?

Answer 29

No - all nutrients have been assimilated by the time they reach the large bowel so large bowel diarrhoea per se does not cause malassimilation.

Weight loss can occur, however, if the pathology itself causes malutilisation

e.g. very severe inflammation as in Boxer colitis, severe infection (Tritrichomonas foetus - though most cats with this infection do not lose weight) or neoplasia.

Question 30

If large bowel diarrhoea does not usually result in weight loss what could be the explanation for weight loss?

Answer 30

• Problem has been incorrectly defined (patient is eating less than the owner realises)
• The pathology involves more than the large bowel → malabsorption
• The large bowel lesion is causing malutilisation - neoplasia would be the most likely pathology to cause this in a cat
• There is a 2nd unrelated problem causing malutilisation

Question 31

Ancylostoma caninum

Answer 31

• Hookworm
• always worm patients with LB D+ for this!!

Question 32

Possible Diagnostic Plans for a patient with chronic LB D+ ?

(with WL despite normal appetite)

Answer 32

Question 33

Small Cell Lymphoma in Cats and IBD

Answer 33

• be aware that small cell lymphoma in cats can be difficult to differentiate from severe IBD in cats and that sometimes even full thickness biopsies won’t help

Question 34

Neoplastic v. Non neoplastic causes of LB D+

Answer 34

• Most non neoplastic causes of large bowel disease respond to symptomatic management – novel protein or increased fibre diet, metronidazole, fenbendazole etc
• Treatment trials are logical and appropriate for most cases
• Treatment trials can take weeks to reach a satisfactory conclusion
• e.g.response to steroids may have been considered evidence of inflammatory bowel disease and a reasonable prognosis given
• But if there is weight loss despite a good appetite that needs to be logically and appropriately considered?
• Neoplasia could be the most likely diagnosis prompting an earlier biopsy than might otherwise have been considered