Term
| What are the functions of the SI? |
|
Definition
-digestion
-absorption
-Gut-assoc lymphoid tissue |
|
|
Term
| REVIEW SI VS LI DIARRHEA CHART ON SLIDE 3 |
|
Definition
|
|
Term
| True or False: Absence of diarrhea precludes the possibility of signifiant GI dz. |
|
Definition
| -FALSE, does NOT preclude significant GI dz |
|
|
Term
| What are the 5 categories of diarrhea? |
|
Definition
-Osmotic
-secretory
-permeability (exudative)
-dysmotility
-mixed |
|
|
Term
| True or FAlse: Melena may be absent even when upper GI bleeding is present. |
|
Definition
|
|
Term
| What are some of the common causes of melena? |
|
Definition
-ulcers
-neoplasia
-hookworms
-coagulopathy
-swallowing blood |
|
|
Term
| What are the metabolic consequences of mild diarrhea? |
|
Definition
|
|
Term
| What are the metabolic consequences of severe diarrhea? |
|
Definition
-dehydration
-hypokalemia
-hyponatremia
-hypochloridemia
-metabolic acidosis |
|
|
Term
| HOw does species affect approach to diarrheic patient? |
|
Definition
| -dietary indiscretion more likely in dogs than cats |
|
|
Term
| HOw does age affect approach to diarrheic patient? |
|
Definition
-INfectious and FB in young
-immune-mediated in adutls |
|
|
Term
| What are some criteria that may indicate acute diarrhea as life-threatening? |
|
Definition
-fever
-severe dehydration or lethargy
-abdominal pain, mass, or dilated bowel loop on palpation
-hemorrhagic stools: melena hematochezia
-other systemic signs of illness
-an outbreak situation |
|
|
Term
| Describe symptomatic care fo acute diarrhea. |
|
Definition
-mild = SC fluids
-mod-severe dehydration = IV fluids
-feed small amounts of highly digestible diet
-transition to normal diet over 5d after diarrhea resolves
-Abx if fever, neutropenia, bleeding, or sepsis |
|
|
Term
| HOw long do we give anti-diarrheal drugs if we give them? |
|
Definition
|
|
Term
| What are opiates as an anti-diarrheal drugs? |
|
Definition
-inc segmental contractions and some anti-secretory, may promote absorption of toxins
-not well tolerated by cats |
|
|
Term
| HOw do parasympatholytics work as anti-diarrheal drugs? |
|
Definition
|
|
Term
| How does pepto-bismol help with diarrhea? Concerns? |
|
Definition
-anti-inflammatory due to anti-PGeffect
-may be nephrotoxic
-unpalatable & turns stool black |
|
|
Term
| What diagnostics do we run on feces? |
|
Definition
-Sz sulfate flotation
-direct fecal exam or cytology
-fresh saline slide: giardia if aroudn other dogs |
|
|
Term
| What diagnostics do we add for diarrhea in cats? |
|
Definition
-FeLV & FIV
-serum T4 for older cats |
|
|
Term
| Why do we look at albumin and globulin w/ diarrhea? |
|
Definition
|
|
Term
| What do we look for on abdominal U/S for diarrhea cases? |
|
Definition
| -evaluate for lymphadenopathy or thickening/loss of layering in intestine |
|
|
Term
| What do we look for w/ serum TLI for dogs w/ diarrhea? |
|
Definition
|
|
Term
| Why would we do upper GI endoscopy or laparotomy w/ a diarrhea case? |
|
Definition
|
|
Term
| What are the advantages & disadvantages of upper GI endoscopy? |
|
Definition
-Advantages: quick, non-invasive, cheap, fast recovery
-Disadvantages: less morbidity, superficial biopsies, stomcah and duodenum only |
|
|
Term
| What are the advantages & disadvates of laparotmy? |
|
Definition
-Advantages: full exam, full-thicness biopsies, entire intestines & other organs
-Disadvantages: expensive, complications, etc |
|
|
Term
| Why do we look at serum folate & cobalamin *vit b12) levels? |
|
Definition
| -severe intestinal dz can interfere w/ absorption of both, causing high (eventually) folate and cobalamin |
|
|
Term
| What is intestinal dysbiosis? |
|
Definition
-shift in GI microbiome away from beneficial organisms and towards harmful organisms
-like IBD in humans |
|
|
Term
| How do we symptomatically care for chronic diarrhea? |
|
Definition
-attempt w/ dietary intolerance or allergy
-NOT appropriate for patients w/ marked hypoalbuminemia
-elim diet fed for 4-6w
-alternatively, consider inc fiber or highly digestible diet |
|
|
Term
| What elimination diet do we use for chronic diarrhea symptomatic care? |
|
Definition
-novel protein soruce or hydrlyzed protein
-easily digestible
-NO OTHER FOODS |
|
|
Term
| What is hemorrhagic gastroenteritis (HGE)? What does it look like? |
|
Definition
-disorder of small, middle aged dogs
-raspberry jam due to life-threatening vomiting and diarreha |
|
|
Term
| What clinical signs do we see w/ HGE? |
|
Definition
-hemoconcentration
-inc blood viscosity, sludging, hypoxia
-acute profuse hemorrhagic diarrhea
-vomiting +/- hematemesis
-become severely dehydrated eventually
-leads to hypovolemic shock and sepsis from bacterial translocation |
|
|
Term
|
Definition
| -PCV > 55% + raspberry jam |
|
|
Term
|
Definition
| -aggressive IV luids + abx (can get septic) |
|
|
Term
| What is hte prognosis of HGE? |
|
Definition
| -depends on response to treatment but relapses uncommon |
|
|
Term
| Are bacterial infections usually assoc w/ acute or chronic diarrhea? |
|
Definition
|
|
Term
| HOw is parvo transmitted? When does it manifest clinically? |
|
Definition
-fecal-oral
-signs in 5-12d |
|
|
Term
|
Definition
| -maternal Ig may inactivate vaccine leabing puppies susceptible up until 18w of age despite proper vx schedule |
|
|
Term
| HOw does parvo affect the body? |
|
Definition
| -attacks rapdily dividing cells: intestinal crypt epi + bone marow precursors |
|
|
Term
| What is the concrn w/ Fecal ELISA tests for parvo? |
|
Definition
-negative in first 48h
-MLV vx may cause false positives for 5-15 days |
|
|
Term
| What does CBC show w/ parvo? |
|
Definition
| -neutropenia: super supportive in como w/ CS |
|
|
Term
| Supportive care is key w/ parvo! Describe it. |
|
Definition
-stirct isolation
-NPO until 24h after vomiting stops
-introduce small amoutns of water
-introduce food: b/c need to get intestines moving and give nutrition for intestinal cells
-aggressive IV fluids |
|
|
Term
|
Definition
-IV abx: Ampicillin or cefazolin or ceftiofur
-antiemetics: avoid phenothiazines b/c hypotension
-plasma or colloids if needed
- |
|
|
Term
| How do we monitor dehydration w/ parvo? |
|
Definition
|
|
Term
| How do we monitor hypokalemia w/ parvo? |
|
Definition
|
|
Term
| How do we monitor hypoproteinemia w/ parvo? |
|
Definition
|
|
Term
| How do we monitor anemia w/ parvo? |
|
Definition
|
|
Term
| How do we montiro hypoglycemia w/ parvo? |
|
Definition
| -blood glucose (dec = sepsis) |
|
|
Term
| How do we monitor sepsis w/ parvo? |
|
Definition
|
|
Term
| How do we monitor intussusception w/ parvo? |
|
Definition
| -abdominal palpation, rads, U/S |
|
|
Term
| What are our recommendations w/ parvo puppies going home? |
|
Definition
-isolate for 4w after discharge
-disinfect w/ dilute bleach |
|
|
Term
| What causes Feline parvoviral enteritis? |
|
Definition
|
|
Term
| True or FAlse: Parvo vx seems to be more protective for cats than dogs. |
|
Definition
|
|
Term
| Which cells are affected by canine coronaviral enteritis? Age predilection? |
|
Definition
-mature villus epi cells
-6-12w of age |
|
|
Term
| What are the clinical signs of canine coronaviral enteritis? |
|
Definition
-adults are often asymptomatic
-CS usually less severe: mild diarrhea, vomiting, fever |
|
|
Term
| HOw do we diagnose canine caronaviral enteritis? |
|
Definition
-usually on suscpicion alone
-however, in dogs concurrent parvo infection ma occur |
|
|
Term
| Which age group of cats is usually affected by feline coronaviral enteritis? |
|
Definition
|
|
Term
| What are the clinical signs of feline coronaviral enteritis? |
|
Definition
-usually mild: diarrhea, vomiting, fever
-adults uusally asymptomatic |
|
|
Term
| How do we treat feline coronaviral enteritis? |
|
Definition
|
|
Term
| What is our major concern w/ feline coronaviral enteritis? |
|
Definition
-affected cats will beocme seropositive for corona virus => mutation of virus causes FIP
-FIP can cause granulomas in SI (chronic dz) |
|
|
Term
| Describe intestinal dz due to whipworm. |
|
Definition
-T. vupis
-ova ingested => adults burrow in colonic and cecal mucosa => inflamm, bleeding, protein loss
-large bowel diarrhea and PLE
-dogs > cats
-dx on fecal float
-Tx: fenbendazole |
|
|
Term
| Describe intestinal dz due to roundworms. |
|
Definition
-Dogs: T. canis & Cats: T. cati & both: T. leonine
-adults live in SI = inflamm
-CS: diarrhea, poor growth, or asymptomatic (worms sometimes vomited)
-Dx: egss on fecal float
-Tx: pyrantel OR fenbendazole |
|
|
Term
| What are the hookworms we see in SA? |
|
Definition
| -Anyclostoma spp & Uncinaria spp |
|
|
Term
| Describe hookworm intestinal dz. |
|
Definition
-dogs > cats
-adults in SI attached to mucosa (extend to LI in severe cases)
-CS: diarrhea, melena, frank blood, poor growth, iron deficiency anemia, or asymptomatic
-Dx: egg on fecal float
-Tx: pyrantel or enbendazole |
|
|
Term
| Describe tapeworm intestinal dz. |
|
Definition
-Dipylidium caninum
-via eating IH (flea)
-often in SI, but do not cause but may cause anal irritation
-segments seen on perineum or in feces
-Tx: praziquantel + prevention w/ flea control |
|
|
Term
| Describe intestinal dz due to Strongyloides stercoralis. |
|
Definition
-puppies, usually in crowded situation
-larva penetrate skin and mucosa
-CS: mucoid, hemorrhagic diarrhea
-larvae found w/Baermann
-Tx: fenbendazole |
|
|
Term
| Describe intestinal dz due to coccidia. |
|
Definition
-mostly Isospora spp
-young cats & dogs
-may be asymptomatic (especially adults)
-ingest oocysts or PH (mice)
-cocidian invade and destroy villus epi
-Dx: oocysts on fecal floatation
-may cause diarrhea +/- blood
-Tx: sulfadimethoxine |
|
|
Term
| Describe intestinal dz due to Cryptospoiridum parvum. |
|
Definition
-occurs in immunosuppressed patients
-its a coccidian
-ingest sporulated cysts in water
-infects SI => diarrhea
-Dx: ELISA for Ag in feces, flotation, histopath
-Tx: Paromomycin (unreliable) |
|
|
Term
| Describe intestinal dz due to Giardia. |
|
Definition
-protozoan
-cyst ingested in water
-infects SI
-dogs > cats
-causes diarrhea: acute, small bowel usually but may be asymtpomatic |
|
|
Term
| HOw do we diagnose giardia? |
|
Definition
-cysts on Sn sulfate
-motile trophozoites on saline smear or duodenal wash
-ELISA for Ag in feces |
|
|
Term
|
Definition
-Metronidazole or fenbendazole (not always effective)
-vaccines do not prevent infection (prevents CS and lessens shedding) |
|
|
Term
| Describe intestinal dz due to Histoplasmosis. |
|
Definition
-HIstoplasma capsulatum
-occurs only in endemic areas
-infiltrative dz of SI and LI (including rectum)
-Dx: rectal scraping, urine Ag test, endsocopic/surgical biopsies
-Tx: Fluconazole or Itraconazole and/or amphotericin B (months of tx) |
|
|
Term
| Describe intestinal dz due to Tritrichomonas. |
|
Definition
-flagellated protozoan
-infests the distal ileum and colon of cats
-fecal-ora transmission
-chronic or recurrent large bowel diarrhea: mucus, tenesmus, hematochezia, flatulence, and fecal incontinence
-Dx: direct smear, fecal culture, PCR, histopath
-Tx: Ronidazole (can cause neurotoxicity) |
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