Diarrhoea in the cat and dog Flashcards Preview

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Flashcards in Diarrhoea in the cat and dog Deck (22):
1

Define haematoxhezia

Fresh blood in stool

2

Define diarrhoea

Increased frequency, volume or fluidity

3

Differentiate acute and chronic diarrhoea

ACUTE 3 weeks, could be intermittent signs, investigate

4

How do you distinguish SI/LI/mixed?

HISTORY!
SI - primary or secondary GI disease
LI - confined to colon

SI PROBLEMS: volume, weight loss, V (both), general condition
LI PROBLEMS: mucus, frequency, tenesmus, dyschezia

5

Define dyschezia

Difficult or painful defecation

6

Differential diagnoses - acute SI diarrhoea, NO systemic signs - 4

-Diet (fast animals to determine if this is cause but be careful with cats as they don't tolerate this well!)
-Helminths
-Protozoa - giardia
-Iatrogenic - drugs

7

Differential diagnoses - acute SI diarrhoea, WITH systemic signs - 5

-BACTERIA- salmonella or campylobacter (FAECAL CULTURE)
- VIRAL - distemper and parvo (dogs), panleukopaenia (cats) (do a faecal antigen test)
TOXINS
-HAEMORRHAGIC GASTROENTERITIS (dogs; high PCV, dehydrated)
-ACUTE PANCREATITIS (test - ultrasound and pancreatic lipase)

8

Differential diagnoses - acute LI diarrhoea, NO systemic signs - 4

-Whipworms
-Clostridia
-Giardia
-Campylobacter
RUN FAECAL EXAM AND CULTURE

9

DDx - chronic SI diarrhoea, EXTRA-GIT - 2 (with examples of each) and GIT - 8

EXTRA-GIT:
-METABOLIC: hepatic disease (PSS), hyperthyroidism (cats), addison's disease (dogs), renal insufficiency
-PANCREATIC: EPI or chronic pancreatitis


GIT:
-Giardia
-chronic partial obstruction
-lymphagiectasia
-neoplasia - lymphosarcoma
-food-responsive disease
-IBD (lympho-plasmacellular)

10

DDx - chronic LI diarrhoea, GIT signs

GIT:
-IBD (lympho-plasmacellular, ulcerative colitis in boxers)
-polyps
-food-responsive disease
-neoplasia - usually adenocarcinomas
-chronic partial obstruction
-Cats: Tritrichomonas foetus

11

6 investigations for CHRONIC diarrhoea (order important)

-Faecal exam (flotation, culture) - excludes parasites/bacteria
-Heamatology, biochemistry and urinalysis (UA) - excludes systemic disease
-if SI diarrhoea: TLI (for EPI), pancreatic lipase/PLI (for pancreatitis), cobalamin (low levels indicate disease of ileum)
-Abdominal ultrasound - where is lesion? obstruction?
-Empiric treatment with elimination diet - food responsive disease
-if no response, biopsy/endoscopy

12

Advantages - endoscopy

-multiple biopsies from stomach, prox SI, ileum and colon possible
-non-invasive (except GA)
-direct visualisation of mucosa
-gives diagnosis (majority of cases)
-Difficult to diagnose intestinal lymphoma or lymphagiectasia as you only take a partial thickness biopsy

13

Disadvantages of biopsies via exp. lap. 4

-Invasive - caution in sick animals/cats/animals with decreased albumin levels
-only 2-3 biopsies from stomach and SI, not for colonic biopsies!
-more expensive and painful
-20% mortality vs 2% mortality with endoscopy

14

Main causes for CHRONIC SI Diarrhoea in dogs - 4

-Food-responsive disease
-AB-responsive diarrhoea
-IBD (lympho-plasmacellular enteritis/colitis)
- Neoplasia

15

Define food-responsive disease

Diarrhoea gets better when given elimination diet (protien that animal has never eaten before, in reality this is pretty difficult so in fact a hydrolysed diet is given when the proteins are already broken down into oligopeptides). Usually better within first 2 weeks. Keep on this for at least 6-8 weeks. Then the animal can often be switched back on to original diet without clinical signs.

16

Define ARD

Antibiotic Responsive Diarrhoea (formerly SIBO).
Most commonly seen in young GSDs
Chronic SI or mixed diarrhoea
Give metronidazole for 4 weeks. Usually relapse though despite an initial quick recovery.

17

How do you diagnose IBD? Frequency? What do you seen on histopathology? What is the mechanism of IBD?

-By clinical exclusion! Most common enteropathy in dogs.
-Histopathology --> lymphoplasmacellular (most common), eosinophilic (rare), ulcerative colitis (only LI, rare, Boxers)/

-MECHANISM: IBD involves a mutated PRR (enterocytes and/or DCs in GIT) that wrongly identify commensal bacteria as pathogenic bacteria. The immune response to the 'pathogenic bacteria' is augmented meaning there is a massive increase in Th17 cells leading to massive mucosal inflammation. The anti-inflammatory cytokines produced by Tregs are insufficient to counter/balance this.

18

List the therapies for chronic enteropathies/IBD in DOGS (in a sequential treatment protocol) - 3

1.) Elimination diet
2.) METRONIDAZOLE for 3-4 weeks
3.) If inadequate response: PREDNISOLONE for at least 10 days then taper dose (i.e. an immuno-suppressive drug). If this steroid doesn't work or is poorly tolerated, then use AZATHIOPRINE or CYCLOSPORINE.

19

List the therapies for chronic enteropathies/IBD in CATS (in a sequential treatment protocol) - 4

1.) Elimination diet
2.) PREDNISOLONE (10-14d then slow taper)
3.) If no response - CHLORAMBUCIL
4.) COBALAMIN supplementation: most cats with SI diarrhoea have low cobalamin levels.Studies show if you don't give this PN, other treatments won't work.

20

Define protein losing enteropathy

Syndrome of intestinal diseases. Non-selective protein loss - albumin low, +/- globulins low (both indicative of loss through GIT).

21

Causes - protein losing enteropathy - 3

-IBD
-Lymphagiectasia
-Neoplasia (lymphoma)

22

Clinical signs - protein losing enteropathy - 5 What must you do quickly?

-Diarrhoea
-Vomiting, anorexia
-Weight loss
-Ascites, pleural effusion (due to low albumin/globulin --> oedema), peripheral oedema
-Usually albumin and globulin serum concentrations low

-Take biopsy early!