Small Ani. Med 2- Vomiting and Diarrhea

wilsbach's version from 2016-02-26 19:43

types, acute diarrhea

Question Answer
Vomiting stuff is same slides as in stomach powerpointSo....know things
what is the definition of diarrhea? (3 things)(1) low consistency (2) increased frequency (3) increased quantity
Diarrhea means intestinal disease BUT lack of diarrhea does NOT..exclude small intestinal disease
in diarrhea, the excess fecal water can result from what two processes?(1) Decreased absorption (2) inc secretion
classifying diarrhea: Options for duration, location, pathophys, and pathology? (list)(1) Acute vs chronic. (2) Small vs large intestine. (3) pathophys: osmotic vs secretory vs permeability vs motility. (4) path: inflammation vs hypersensitivity vs infection vs neoplasia
Acute diarrhea cause? How long does acute diarrhea last?Usually idiopathic (often garbage ingestion or something of the like). and self limiting within 3-5 days.
why is 3 days like the magic number for intestinal problems?takes about 3 days for vili to recover or regenerate
If you have an acute diarrhea case, you should do what test for sure, and **what two things do you def wanna exclude?Do a FECAL EXAM to look for parasites, parvo, etc.... and then make sure to exclude sepsis and ileus!
what is therapy for acute diarrhea? (4 things)IV FLUIDS, electrolyte balance, fenbendazole, metronidazole
Should you withhold food with acute diarrhea? why?NO!!!! because withholding food leads to loss of semipermeability, resulting in an inc of bacterial toxins. If possible, try to feed small meals consistantly throughout the day
if you have acute diarrhea, should you giv abx? why?NO!! This will lead to dysbacteriosis (she said dont use the big ones unless you have a specific indication or pt is septic). there are EXCEPTIONS THO: sepsis, leukopenia, bacterial overgrowth--> metronidazole, tylosin
should you give motility inhibitors to an acute diarrhea pt? why?maybe if fluid loss too high
how does a motility inhibitor work and what is an example?decrease segmental motility & secretion-- loperamide
should you provide absorbing medications to an acute diarrhea pt?Maybe but not evidence based

Canine Parvovirus, Feline panleukopenia, enterotoxemia, bacterial enteropathies

Question Answer
what cells does parvo attack? Rapidly dividing cells (so, crypt endothelium, and bone marrow)
which breeds are prone to pavo infections? Age? Doberman, Rottweiler, Pitbull, Labrador, GSD...most affected are at 8-12wk old
what are some things severity of parvo infection depends on?Size and virulence of inoculum, Age (most 8-12weeks), host defenses, Vaccination status
what should you know about doing a SNAP for parvo?IT CAN BE FALSELY NEG in first 12-24 hours-- test again if unsure
how do you dx parvo and what should you keep in mind?consider PE and History, find a neutropenia on CBC, ELISA/SNAP/IFA after 12-24h for 1-2 weeks positive -> redo neg test?
If you are treating a parvo, #1 thing is..ISOLATE THEM
how should you be feeding these parvo pts? Microenteral nutrition for enterocytes (help repair/fight)
what is tx for parvo?(1) DONT FORGET TO ISOLATE. (2) Antibiotics ( Newer IV potentiated β-lactams, Amox clav/enrofloxacin<-- caution with cartilage damage). (3) Microenteral nutrition-- ASAP for enterocytes! (4) Deworming (5) antiemetics (6) Gastric protectants
what are possible complications of parvo?Intussusception!!! Do frequent palpation to make sure doesnt happen
once again, how many layers does the GI have, and why do i care in terms of parvo?5 layers- if see more than 5 layers on US, you prolly have an intuss (common complication with parvo)
feline parvoviral enteritis is aka?panleukopenia
feline panleukopenia-- what are CSs/lab parameters like?CSs vary widely in severity-- you will see drastic changes on the CBC leukopenia obv
how do you dx panleukopenia (feline parvo)?in early infection you can detect it with the canine ELISA. Otherwise dx is presumptive with Hx, PE, and dec leukocytes
what is the most common complication to panleukopenia (feline parvo)?sepsis
if you suspect enterotoxemia, should you do a fecal culture?she said bacterial causes often never IDed, and the cultures are often not useful
how might an enterotoxemia patent present to you?Critically ill, probably in shock.
what will CBC look like with an enterotoxemia pt?INFLAMMATORY LEUKOGRAM-- left shift (more immature band cells) +/- toxic WBCs (inflammatory leukogram= can be neutropenia or philia and might have left shift/toxic changes)
how do you dx enterotexemia?dx of exclusion
how do you tx enterotoxemia?aggressive fluids, abx iv, monitor serum proteins-- might need colloidal support
common complications of enterotoxemia?DIC, MOFS, MODS (Multi-organ failures and dysfunction)
bacterial enteropathies are difficult to isolate- why? how do you dx them?most problematic agents are naturally in gut to begin with, so culture often not diagnostic. Often limited to finding consistent CSs and response to tx.
main way to dx campylobacter?PCR available
main way to dx salmonellosis?PCR or blood cultures
how can you dx clostiridium?Spore forming bacteria on fecal smear-- Suggestive/ contamination? (consider how many)

Small vs large bowl diarrhea

Question Answer
**small vs large: frequency?LARGE > small (it's right at the door, so shorter time before next diarrhea)
**small vs large: tenesmusONLY LARGE HAS TENESMUS (you arent really pushing sthing unless its in your large bowel anyway)
**small vs large: quality of BLOOD present?small=digested blood. LArge= fresh blood
**small vs large: MUCOUS presentLARGE HAS MUCOUS (feces lubrication)
**small vs large: general impression of pt healthin SMALL THEY WILL APPEAR SICK (in small is where we get all the important stuff, so prob here, not getting nutrition-->sick)
small vs large: fecal quantitysmall has much more quantitiy
small vs large: weight losssmall= loss
small vs large: flatulanceboth have it, small has it more
small vs large: borborygmi (bowl sounds)small has it, large might or might not
small vs large: painful abdomen?small more than large but can be present with either
small vs large: vomiting?more likely with small
small vs large: inappetance?small will cause inappetance, large wont
DDx’s small intestinal diarrhea-- infections? (what is #1?)#1 is PARASITES!!, can also be bacteria, fungi (pythium/histoplasma), viral
DDx's sm int diarrhea-- what vitamin deficiency can lead to diarrhea?B12 (cobalamin)
which two breeds in particular have breed-related enteropathies?Basenji, Wheaten Terrier
DDx’s small intestinal diarrhea(1) infections (2) Diet (3) Antibiotic responsive diarrhea / Bacteriel overgrowth (4) B12 deficiency (5) IBD (6) Exocrine pancreatic insufficiency EPI (7) Lymphangiectasia (8) Neoplasia (9) Breed specific enteropathies (10) Systemic diseases
6 systemic dzs which might cause sm int diarrhea?Pancreatitis, Hyperthyroidsm, Hepatic disease, Hypoadrenocorticism, Renal disease, Toxins
giant diarrhea flow chart
you would know if the diarrhea is due to maldigestion with what test?TLI- trypsin like immunoreactivity
Steatorrhea might be a indication of what dzs?+/- malabsorption, EPI, lymphangectasia


Question Answer
what are the two fecal float mediums?Sheather’s (centrifugation), Zinc sulfate
what are you looking for if you are doing a baermann on a fecal?lung worms! (since they have larvae in feces)
2 types of cytology you can do with fecals?either a direct smear or a rectal scraping.
which is better- Centrifugal flotation or static flotation? Centrifugal flotation superior to static flotation
give _________ to all GI patientsfenbendazole (she said)
what are the heavier eggs you can see on a fecal float?Trichuris vulpis (whipworms), Taenia spp. (tapeworms), Capillaria spp, Isospora (coccidia)
Whipworms-- where do they live? Do they make large or small bowel diarrhea?Live in Caecum, Chronic large > small bowel diarrhea (a large whip is a big problem)
which intestinal worm did she emphasize caused a protein losing enteropathy?whipworms
which intestinal worm can mimic what an addisonian dog might look like?whipworms
what are the CSs of a whipworm infxn, and how do you tx?will see a protein losing enteropathy, Hematochezia, Pseudoaddisonian (hyperkalemia, hyponatremia). Tx with Fenbendazole.
Do roundowrms cause small or large bowel diarrhea? what are possible clinical signs and how do you tx?SMALL BOWEL. you will see Inflammatory SI infiltrates, Ileus possible in puppies. tx: Fenbendazole or pyrantel
which worms live in the cecum?whips
which worms cause sever anemia?hooks
where do hookworms live? CSs? tx?SMALL intestine, Severe anemia, Fenbendazole or pyrantel
What do you treat tapeworms with?PRAZIQUANTEL! (diff from others!!)
how do you tx Strongyloides?fenben
*which intestinal parasite is a human health risk?Strongyloides (roundworm)
Coccidiosis is aka? how do you tx it?aka Cystoisospora, +/- clinical relevance. Can treat with Sulfadimethoxine, but CAUTION IN DOBIES WITH SULFAS
how do you tx Cryptosporidia? Spontaneous elimination? No proven therapy. Some success with tylosin, etc…
how can you treat giardia?Fenbendazole +/- metronidazole
Trichomoniasis-- tx?+/- Ronidazole, +/- tylosin, +/- metronidazole
how do you tx Heterobilharzia?(Canine Schistosomiasis, flatworm) Fenbendazole plus praziquantel
**what are the 4 tests on the GI panel?PLI, TLI, cobalamin, folate
when is cobalamin low?malabsorptive dzs
when is folate high?intestinal bacterial overgrowth
what does Serum trypsin-like immunoreactivity (TLI) tell us?sensitive and specific test for exocrine pancreatic insufficiency (EPI). These assays quantify trypsinogen that normally leaks from the pancreas into the blood, and hence provide an indirect assessment of functional pancreatic tissue. In animals with EPI, functional exocrine tissue is severely depleted and hence serum TLI concentrations are extremely low.
who do we esp. care about if their cobalamin (B12) is low in?cats
how does bacterial overgrowth affect cobalamin? folate?inc folate (bact make this) and dec cobalamin (bact use this to make the folate)
dec folate indicates..PROXIMAL sm int damage
dec cobalamin indicates...DISTAL SI damage/ malabsorptive dzs (lymphosarcoma in cat)
wut dis? histoplasma
wut dis? clostridium
explain the relationship between cobalamin, intrinsic factor (IF) and receptorsCobalamin is a very large molecule that cannot cross the intestinal epithelial barrier without help from a specific cobalamin-binding protein called “intrinsic factor” (IF). A second site on intrinsic factor subsequently binds to specific receptors present only on the surface of ileal epithelial cells. This binding induces cell-mediated endocytosis of the IF-cobalamin complex and hence transport of cobalamin into the blood. IF is synthesised by the stomach in most mammals including humans. However, the pancreas is an important site of IF synthesis in the dog, and is the sole site of IF synthesis in the cat. Pancreatic proteases also degrade non-specific R proteins (glycoprotein produced by the salivary glands of the mouth. It primarily serves to protect cobalamin (Vitamin B12) from acid degradation in the stomach by producing a Haptocorrin-Vitamin B12 complex.) from the stomach which would otherwise bind cobalamin and prevent binding to IF. Interference with production of pancreatic IF and pancreatic proteases in EPI can therefore result in cobalamin deficiency in dogs and particularly severe cobalamin deficiency in cats.
how do you exclude possibility of ileus?rads
A clinical diagnosis of IBD (inflammatory bowel disease) is considered only if there are what 4 things?(1) persistent (**>3 weeks in duration) gastrointestinal signs (2) failure to respond to symptomatic therapies (3) failure to document other causes of gastroenterocolitis by thorough diagnostic evaluation (4) histologic diagnosis of benign intestinal inflammation