Small Ani. Med- Acute & Chronic Gastroenteritis

wilsbach's version from 2016-02-26 21:13

Chronic diarrhea work-up

Question Answer
chronic diarrhea is for how long? (vague)weeks/months/years
2 types of chronic diarrhea (classifications)Chronic diarrhea, Chronic recurrent diarrhea
main ddx of an animal UNDER ONE YEAR with chronic diarrhea?PARASITES!!!!!!!!******** (worms, giardia, tritrichomonas), Ileus, Dietary intolerance, Antibiotic responsive diarrhea, Fiber responsive diarrhea
***Cat + large intestinal diarrhea-- test for what?Tritrichomonas testing (flagellated protozoan parasite--- important ddx for large intestinal dairrhea in cats)
if you want to do a diet trial, what should you try?2/3 rice + 1/3 TURKEY NOT CHICKEN (new protein / new carbohydrate)
Large intestinal vs small intestinal diarrhea: main hints for eachLARGE: tenesmus, small portions but inc freq, mucous/blood (fresh blood) SMALL: large portions, weight loss
3 major large bowel diarrhea parasite contenders? small?LARGE: trichuris, giardia, tritrichomonas...... SMALL: worms/giardia
DDx LARGE INTESTINE chronic diarrhea? (6)(1) Parasites (trichuris, giardia, tritrichomonas) (2) Dietary intolerance (3) Fiber responsive diarrhea (4) Antibiotic responsive diarrhea (5) Colitis from IBD (Inflammatory bowel disease) (6) (histiocytic) ulcerative colitis (Boxer)
DDx SMALL INTESTINE chronic diarrhea? (10)(1) Parasites (worms, giardia) (2) Dietary intolerance (3) Antibiotic responsive diarrhea (4) Hyperthyroidism,FeLV, FIV (5) Hypoadrenocorticism (6) Pancreas insufficiency, pancreatitis, liver, biliary (7) Vitamin B12 deficiency (8) Lymphangiectasia (9) IBD (Inflammatory bowel disease) (10) neoplasia
hyperthyroidism/FeLV/FIV-- small or large bowel chronic diarrhea?small
B12 (cobalamin) deficiency-- small or large bowel chronic diarrhea?small
would you do a strict dietary trial for chronic small or large bowel diarrhea? and for how long?small, and for 2-4 weeks.
if you are using endoscopy to bx, how do you want to position the bx tool to take a sample?try to go perpendic to mucosa. Also try to get tension out of intestines, has fold so then you can get a good piece
if you want a full thickness bx you will have it sx
how does endoscopy vs sx compare for sites you can bx?Endoscopy= Limited on upper SI & Colon until Ileocolic valve. (Gastric, duodenal, and colonic observation and mucosal biopsies) Sx= bx of more sites
what are two dzs she emphasized need a FULL THICKNESS BX (meaning you will need to do sx to dx)lymphoma, lymphangiectasia
some good pros of the endoscopic method of bx?Minimally invasive, Home sooner (Less expensive?), Directed biopsies, Can initiate immunosuppressive therapy sooner
some pros of the sx method of bx?Full thickness (lymphoma, lymphangiectasia), Evaluate all abdominal organs & biopsy, Potential for correction (like obstructions),

Histiocytic Ulcerative Colitis, Inflammatory Bowel Disease IBD

Question Answer
which breeds are prone to histiocytic ulcerative colitis?Boxers and French bulldog
HUC is a type of what dz?IBD
what kinda diarrhea does HUC cause?recurrent large bowel diarrhea (boxers, big intestine)
etiology of HUC?unknown-- possibly infectious agents? E.coli,Mycobacteria, rickettsiae, mycoplasma?? (prolly e coli invasive, she said in class)
how do you tx HUC?since theorized to be infectious agent... Enrofloxacin
what causes Inflammatory Bowel Disease IBD?Idiopathic intestinal inflammation---- (diagnosis of exclusion) They think it might be a Exaggerated response to normal bacterial or dietary antigens
where is the GI affected with IBD?Can affect any portion of GI tract
how is the GI tract affected by IBD?(any portion can be affected) you will see Mucosal cellular infiltrates, Inflammatory mediators, Intestinal dysmotility
IBD can look like what other problem it must be differentiated from?Can look like lymphoma
if you do histology, IBD and what other problem will look the same?food allergy (hence think it might be exaggerated response to bacterial or dietary antigens)
how do you dx IBD?DX OF EXCLUSION!! look at histopath (remember can look like food allergy) -- might also see a cobalamin deficiency
A clinical diagnosis of IBD (inflammatory bowel disease) is considered only if(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.
Treatment of chronic diarrhea-- how can you try to do this with diet? Hypo/low allergen diets
Treatment of chronic diarrhea-- you can try abx-- with that prob would you want to try abx, and which abx?If you suspect ARD you can try tylosin or metronidazole
Treatment of chronic diarrhea-- you can suppliment cobalamin--- you never want to go below how much cobalamin?200/300
Treatment of chronic diarrhea-- what can you give to try to have antiinflammatory/immunosuppressive effects?sp diffs? how should you admin? what are some additional immunosuppressive drugs you can try? Prednisolone/prednisone-- cats might need more! Start with a strong dose and then Try and wean to lowest dose necessary (might need to be on long term esp if IBD or sthing like that).... additional drugs you can try= Cyclosporine, chlorambucil (cat only)

Lymphangiectasia (LA), Neoplasias

Question Answer
what is Lymphangiectasia?Dilation and leakage of lacteals (the terminal ends of the lymphatic vessels in the gut) (so will loose Protein, Lymph, Chylomicrons because lacteals usually pick these up)
which breeds are prone to Lymphangiectasia?Yorkies (Wheaten Terriers, Lundehunds)
what kinda diarrhea would you see with this?Diarrhea/Protein loosing enteropathy
*what lab values scream Lymphangiectasia?low albumin/low TP (bc this causes PLE) --> Ascites/transudate from low iv oncotic pressure
what will Lymphangiectasia look like on US?stripes/stippling/triangles
what bx method do you wanna do to dx LA?Surgical biopsy superior to endoscopic Biopsy
how do you tx/provide therapy for LA? (1) DIET: Ultra low fat diet (bc if lymph vessels can't absorb the fat/chylomicrons it just causes osmotic diarrhea) and high protein (since PLE) (she said inc fiber too, idk why). (2) Prednisone (dec inflammation) (3) +/- additional immunosuppressives
how do you tx intestinal lymphoma?chemo only
how do you tx Adenocarcinoma?Surgical resection +/- chemo
how do you tx Leiomyoma/sarcomas?Surgery +/- chemo
how do you tx polyps? Surgery/Endoscopic surgery

treatments and such, tenesmus/dyschezia, constipation, idiopathic megacolon

Question Answer
if there is diarrhea, do you wanna feed them or do NPO?Feeding is better than NPO (feed small amounts of what the animal is used to eating. Need to supply nutrition to enterocytes for them to recover)
2 possible sources of fiber you can use to help tx diarrhea?Metamucil, Canned pumpkin
what are some Antibiotics for intestines-- and which one shouldn't you use in cats?Metronidazole, tylosin, Sulfasalazine – not in cats
when is giving an anti-diarrheal indicated? what are some examples of anti-diarrheals you could use?Rarely indicated “But: first line vet has to do something… ” ??? so, can consider Loperamide (Imodium) 1 x …?, Buscopan 1x …?, Bismuth subsalicylate (NEPHROTOX!)
what is the diff between a pro-biotic and a pre-biotic? what should you know about these supplimentals?PRO=are bact. PRE= help feed the bact. *no real proof of if these work tho
in order to try a HYPOALLERGENIC DIET, what do you and the owner need to do? (how long?)New protein source, New carbohydrate source, *STRICT COMPLIANCE!!!, Slow transition from current diet, 2-8 weeks, some improvement within first 2 weeks
what are some things you can suppliment to help inc the fiber in a diet? be cautious of what?can give Ispaghula granulate, Carob flour, formulated high fiber diets, metamucil (LOOK OUT FOR citrus flavored metamucil with cats)
sulfasalzine / salazosulfapyridine (same thing) are good for which part of the GI and who? why?COLON* and RECTUM in DOGS. This is bc it is broken down into sulfapyrimidine (an abx) and 5-amino-salicylic acid (antiinflammatory)
Salazosulfapyridine / Sulfasalazine--> although this can give good abx and antiinflammatory actions, what are the adverse effects?**CAUTION IN DOBIES! AND ******OH MY GOD DO NOT GIVE IN CATS EVER EVER EVER(anemia/vomiting/anorexia) Can cause... KCS keratoconjunctivitis sicca, Arthritis (Doberman), Cholestasis, Hemolytic anemia, Leukopenia, vomiting, dec Sperm production, allergic dermatitis
read case studyy
Differential diagnoses low MCV ?Microcytosis= Iron deficiency absolute or relative: Congenital portosystemic shunt/Acquired shunting secondary to cirrhosis, Hepatic lipidosis (some cats), Lead toxicity, chronic gastrointestinal blood loss (chronic inflammation or neoplasia)
Tenesmus/Dyschezia: inflammatory causes? Anal sacculitis / abscess, perianal fistula, tumors
Tenesmus/Dyschezia: infectious causes?pythium, histoplasma
Tenesmus/Dyschezia: obstructive causes?Neoplasia,Granulomas/abscesses, Prostatic disease, Pelvic fractures
Tenesmus/Dyschezia might be shown with this non-GI related problem?urethral obstruction
Perianal fistula-- WHO is most prone to this?GSD
what is the etiology of perianal fistulas?Idiopathic-- Immune mediated disease
how does a pt with perianal fistulas present?Painful draining tracts around anus -> Caution, might bite out of pain
you must differentiate perianal fistula from what?Differentiate clinically from Anal gland abscess
how do you tx perianal fistulas?Daily cleaning, Cyclosporine (immunosuppressive), (+/- ketoconazol / metronidazol for p450 induction)
what are two kinds of drugs which can cause constipation?opioids, barium
how can fiber affect constipation?too much or too little can cause constipation
Colonic weakness can result in constipation-- what things can cause colonic weakness? Hyper Ca++, hypoCa++, hypoK+, Hypothyroidism
common causes of Obstruction/deviation leading to constipation?Perineal hernia, Masses (neoplasia, abscess, etc), Strictures, Prostatic disease, Lymphadenopathy, Spinal cord disease, idiopathic
3 major treatment types to help with constipation (And examples of each)(1) inc fiber (Metamucil, canned pumpkin, isogel) (2) Stool softeners (lactulose) (3) Enema (+/- anesthesia)-- 5-10 ml/kg warm water and lubricant, NO PHOSPHATE ENEMAS
WHO/what age is most prone to Idiopathic Megacolon?> 5 years old cats
with idiopathic megacolon, you will see slowly progressive signs likeabdominal discomfort, dec appetite, lethargy, tenesmus
in order to dx idiopathic megacolon, you need to exclude what other problems as the cause?pelvic fractures, tumors, strictures, hernias
with idiopathic megacolon, how do you want to tx?Tx early! inc water intake, give cisapride, give stool softeners, provide more soluble fiber in their diet....if all else fails, subtotal colectomy
why might analsac adenocarcinoma cause conspitation?BC CAUSE MALIG. HYPERCALCEMIA-- and too much Ca--> dec motility--> constipation (also causes PU/PD)
2 kinds of neoplasia which might cause constipation?(1) Anal Sac Adenocarcinoma (2) Perianal gland adenomas
which neoplasia has hepatoid gland cells?perianal gland adenomas!!!
Perianal gland adenomas-- how malig? how to id? tx?Benign, testosterone responsive tumor. ID'd by hepatoid gland do cytology. TX= SX, INCLUDING NEUTER BC T-RESPONSIVE