Diarrhoea and Vomiting Flashcards
(23 cards)
pathophysiology of diarrhoea
osmotic
secretory
increased gut mucosa permeability
abnormal gut motility
acute < 3 weeks, chronic >3 weeks persistent or intermittent
small intestinal diarrhoea
normal to large volume
watery
melaena
borbyrgmi
weight loss +/- vomiting
inappetance
large intestine
urgency/increased frequency
straining
fresh blood
small volume more often
mucous
incontinence
parasites
always essential to rule out
shedding not continuous
protozoa - giardia - SNAP (3-5 stool sample)
helminths - fecal floation
therapeutic trial - give fenbendazole for 5 days and see if it goes away
diet
GI diet - highly digestible, low fat, little and often
supports mucosal barrier function
promotes normal motility
decreases inflammation
incorporate nutrients with positive effect on small intestinal flora
adsorbants
pectin, chalk, activate charcoal
may help, not sure
aim to bind intestinal flora, protect mucosa, absorb toxins and bind water
fecal analysis
giardia - SNAP
parvo - SNAP
culture for salmonella, campylobacter, clostridia
fecal flotation - nematodes and cestodes
antibiotics
only if significant immunosuppression, breached mucosal barrier, or if a bacteria identified that we know responds well (narrow spectrum)
diet trial
elimination
hypoallergenic, hydrolysed protein
chronic diarrhoea and unwell
hematology - non regnerative anemia
biochem - panhyproteinemia - protein losing enteropathy
urinalysis - proteinuria
basal cortisol
B12
TLI/PLI - pancreatitis, exocrine pancreatic insufficiency
biopsy - indicated if previous tests and treatment failed, if hypoporteinemia and significant weight loss, or if suspected neoplasia
vomiting
active expulsion, protective function not necessarily GI disease
regurgitation
passive, unexpected, usually undigested
dysphagia
dysfunction in swallowing, gagging, retching, exagerrated swallowing, feat of eating
stages of vomiting
prodromal -
nausea - hypersalvation, loss of appetite, lip licking
excessive swallowing
retching -
duodenal contractions
rythmic inspiratory movements against closed glottis
dilation of cardia and low oesophageal sphincter
expulsion -
reduced oesophageal and phryngeal tone
contraction of abdominal muscles
vomiting reflex
2 separate centres -
CRTZ - humoral pathway - stimulated by chemical stimuli
vomiting centre in brainstem - nerve impulses from central and peripheral pathways, also input from vestibular apparatus
causes of vomiting
diet - change, spoiled food, intolerence, allergy, immune mediated
stomach - inflammation, foreign body, outflow obstruction, motility disorder, neoplasia
intestinal - IBD, foreign body, intussuception, volvulus, ileus dysfunction, neoplasia
endocrine - pancreatitis, peritonitis, liver disease, renal disease, pyo, prostatic disease, hyperthyroidism, uremia, addisions, diabetic ketoacidosis
bacterial -
salmonella, clostridium, e coli, campylobacter
viral - parvo, feline panleukopenia, FELV/FIV/FIP, distemper, adenovirus
worms - toxocara, taenia, trichuris
protozoa - isisopra, crypto, giardia, tritrichomonas
toxins - ethylene glycol, grapes, ivy, daffodils, lilies, conkers, acorns
drugs - antibiotics, NSAIDs, cyclosporine
CNS - motion sickness, vestibular disease, encephalitis, neoplasia
vomiting - signallment
puppies/kittens - infectious disease of intussusception
young dogs - foreign body, dietary indiscretion
older dogs - neoplastic, pyo
older cats - hyperthyroidism, CKD
concern in vomiting
weak, collapsed
dry/tacky, pale or congested mm
tachycardia, bradycardia or arryhtmia
weak and threay pulses
hypothermia or pyrexia
abdominal pain or distension
melaena, haemorrhagic diarrhoea
primary vs secondary GI disease
primary = problem with GI itself
secondary = metabolic problem causing GI effects
primary GI disease
palpable abnormality in gut
concurrent diarrhoea
normal history otherwise
vomiting before other signs of malaise
vomiting consistently related to time of eating
diagnostics -
radiographs
abdominal ultrasound
endoscopy
ex lap
secondary GI disease
vomiting intermittent and unrelated to eating
evidence of abnormalities in other systems
not bright, alert and happy generally
ill before vomiting started
diagnostics -
biochem
hematology
urinalysis
imaging
anti-emetics
maropitant - blocks peripheral and central pathways - visceral analgesia in cats
metoclopramide - more central pathways, prokinetic effect
megaoesophagus
myasthenia gravis or induced by anaesthesia/sedation/other drugs
persistent abnormal dilation of oesophagus
contrast radiography
tensilon test
