Logical Approach to Diarrhea in Dogs and Cats Flashcards
What can diarrhea commonly be confused with (by owner usually)?
Can be confused with constipation (straining)
How do you classify diarrhea?
Acute vs Chronic
Small bowel vs. large bowel vs. mixed
How do you usually treat acute diarrhea?
Symptomatically
How do you usually treat chronic diarrhea? What proportion of cases are in specialty vs general practice?
Requires investigation - complicated causes
Small proportion in GP, high proportion in specialty
Why is a thorough history essential for patients with diarrhea?
Physical exam often unremarkable
Describe small bowel vs. large bowel diarrhea consistency/appearance/color
Small bowel - soft, typical diarrhea, MUCOUS (irritation), NO FRANK BLOOD, digested blood (melena)
Large bowel - frank blood indicates large bowel issue,
Is frank blood or melena a sign of a bigger issue?
MELENA - BIG PROBLEM
Weight loss in small bowel vs. large bowel diarrhea?
Small bowel - can occur, but doesn’t have to
Large bowel - no weight loss, as digestion of nutrients occurs in SI (in small animals)
*Opposite in horses
Vomiting in in small bowel vs. large bowel diarrhea?
Small bowel - vomiting receptors in SI, common
Large bowel - usually no, but can be associated with inflammatory bowel disease
What are some physical signs seen in the patient in small bowel vs. large bowel diarrhea?
Small bowel - borborygmus, flatulence
Large bowel - tenesmus (straining, very uncomfortable) *can also occur in SI diarrhea
Frequency in small bowel vs. large bowel diarrhea?
Small bowel - can be small amounts frequently or large amounts infrequently
Large bowel - easier to recognize - small amounts frequently
How is need to defecate triggered in large bowel diarrhea?
When colon is inflamed receptors in tissue send signal to poo over and over again (similar to cystitis) - animal feels need to defecate frequently, but there is little formed stool in colon = diarrhea
- Defecation reflex not triggered by amount of feces in colon, but by irritation of receptors in the colon
Appetite in small bowel vs large bowel diarrhea?
Small bowel - can be increased or decreased
Large bowel - normal
Water balance in small bowel vs large bowel diarrhea?
Small bowel - Water lost in diarrhea/vomit
Large bowel - usually not (absorption in small bowel)
Physical exam in small bowel vs large bowel diarrhea?
Small bowel - history key! Often unremarkable
Large bowel - also unremarkable, uncomfortable on rectal exam
What is the difference between primary vs secondary GI disease?
Primary - Structural
Secondary - Functional
How does secondary GI disease usually present?
Diarrhea usually not the primary presenting complaint (except exocrine pancreatic insufficiency)
Usually has same characteristics as small bowel disease
If Large bowel diarrhea is the main presenting sign, what should you think of as the cause?
Primary GI lesion
If mixed bowel diarrhea is the major clinical sign what should you think of as the cause?
Primary GI disease
Is BW usually helpful in diagnosing chronic GI disease? What can you use to help you diagnose the cause of diarrhea?
BW usually not helpful - No “easy” blood tests
Must rule out secondary GI disease
Fecal exam, therapeutic trials, and biopsy can all help
What are the causes of acute small bowel diarrhea?
Diet-related
Parasites
Infection (viral, bacterial)
AHDS (Acute Hemorrhagic Diarrhea Syndrome)
What are the causes of chronic small bowel diarrhea?
Toxins
Parasites
Diet-related
Bacteria/Protozoa
Deep Mycoses (fungal disease)
Dietary hypersensitivity
Neoplastic
Lymphangiectasia
Brush border enzyme biochemical defects
IBD
Give examples of the following causes of acute small bowel diarrhea:
- Diet-related
- Parasites
- Protozoa
- Viral
- Bacterial
Give examples of the following causes of chronic small bowel diarrhea:
- Parasites
- Diet-related
- Bacteria
- Protozoa
- Fungal disease
