Acute Diarrhea

What is diarrhea that lasts < 3 weeks in duration?

Acute diarrhea

What is diarrhea lasts >3 weeks, can be episodic or continuous?

Chronic Diarrhea

What diarrhea is ± weight loss, polyphagia, increased fecal volume, vomiting, and melena?

small bowel diarrhea

What diarrhea is ± increased fecal frequency, mucous, hematochezia, dyschezia, occasionally vomiting with straining?

Large Bowel Diarrhea

This is from a chart, he said a good question would be to differentiate Small bowel vs Large Bowel in a sentence

slay king

How would the volume be if there is Small Bowel diarrhea?

increased

How would the volume be if there is Large Bowel diarrhea?

Decreased

How would the frequency of Small Bowel Diarrhea be?

normal to mild increased

How would the frequency of Large bowel diarrhea be?

increased

Which form of bowel diarrhea has mucus?

large bowel diarrhea

Which form of bowel diarrhea has melena?

Small bowel diarrhea

Which form of bowel diarrhea has Hematochezia?

large bowel diarrhea

What are THREE causes of PRIMARY GI diarrhea?

1. dietary indescretion

2. foreign body

3. Infectious

What are FOUR infectious causes of PRIMARY GI diarrhea?

Parasitic, Bacterial, Viral, Protazoal

T/F Bacterial causes of diarrhea is very common

False, it is typically rare

What are FIVE causes of EXTRA GI Diarrhea?

1. Pancreatitis

2. Hypoadrenocorticism

3. Uremia

4. Hepatopathy

5. EPI

What are THREE things that can cause DIETARY INDISCRETION GASTROENTERITIS? (3)

dietary changes, stress, spoiled food

What is gastroenteritis (gastroenterocolitis)?

Inflammation of the GIT (stomach, intestines -SB and LB)

What is the etiology of gastroenteritis?

unknown, likely multifactorial

What are some things that might lead to gastroenteritis? (7)

• Dietary indiscretion (contaminated/spoiled food)

• Dietary change

• Undiagnosed self-limiting infectious disease

• Medications (NSAIDs, antibiotics)

• Stress (psychosomatic GI, physiologic stress)

Gastroenteritis is the most common cause of acute ____ diarrhea in ____

STABLE, dogs

What are some clinical signs of gastroenteritis?

• Vomiting

• Diarrhea

• Hyporexia/anorexia

• +/- Abdominal pain

How do you go about diagnosing gastroenteritis?

• Diagnosis of exclusion - history, history, history!!!

What disease may be confused with gastroenteritis if you suspicion index is low?

canine parvovirus (CPV)

If there is suspicion to parvo, what should you preform to confirm it?

perform a SNAP test!

What would a parvo blood smear demonstrate?

leukopenia

USUALLY outpatient, symptomatic care - acute and self-limiting, what is the timeframe that it should be better in?

72 hours

What can you do medically and in the diet for Gastroenteritis?

• Probiotics, prebiotics

• Low fat, easily digestible diets

What NK1 receptor antagonist is NOT technically labeled for nausea - labeled as an "anti-emetic" aka anti-vomiting medication?

Cerenia

What are the clinical signs of foreign bodies?

• Vomiting, unable to keep food/water down

• Diarrhea

• Abdominal pain

• +/- Melena, +/- hematochezia

• Hyporexia/anorexia

If you suspect a foreign body, what should you do for diagnosis?

• Abdominal radiographs (3 view)

• Abdominal ultrasound

• History, history, history

How would you go about treating a foreign body?

• Surgical explore vs. Endoscopy (gastric FB

ONLY)

• +/- RNA depending on what is found

• +/- GI biopsies

T/F Absence of evidence is not evidence of absence

true

What is a diagnostic and therapeutic procedure involving the use of a specialized instrument called an endoscope to visualize and access the interior of a body cavity or organ?

Endoscopy

Flexible scopes are used for ____ ___

removals

foreign body

Indications for scoping foreign bodies:

Object confirmed in ____ ONLY on x-

rays/ultrasound

STOMACH

What are some contraindications for Endoscopy?

• Objects past the stomach

• Sharp or irregular objects.

• Objects that the stomach has

bunched up into a firm mass too

big to pull through the LES

• Evidence of perforation, sepsis, or significant peritonitis (indicating the need for surgical intervention).

• Recent GI surgery (cannot safely insufflate)

What is it called when there is invagination of two segments of adjacent intestines and can occur anywhere in the GI tract?

Intussusception

Where are the most common locations of intussusception?

▪ Jejunum

▪ Ileocecocolic junction

What are some things that can cause intussusception?

o Intestinal parasites

o Protozoal, bacterial, viral infections --> PARVO!

What are the clinical signs that are associated with intussusception? (5)

• Vomiting, unable to keep food/water down

• Diarrhea

• Abdominal pain

• Hematochezia

• Palpable abdominal "mass"

What is the MOST helpful diagnosis tool for intussusception?

Abdominal ultrasound

What would you expect to see on ultrasound with an intussusception?

"bulls eye" lesion

What would you expect to feel on palpation with intussusception?

sausage like intestines

What are THREE parasitic causes of infectious diarrhea?

Ancylostoma caninum (Hookworms)

Trichuris vulpis (Whipworms)

Toxocara canis/cati (Roundworms)

What is the common name for Ancylostoma caninum?

hookworms

How is Ancylostoma caninum transmitted?

• Ingestion of larvae (feces, soil)

• Transplacental (dog and cat) and transmammary (cat)

What is the signalment for Ancylostoma caninum?

Young puppies and dogs not on

preventatives

What are the "unique" clinical signs to Ancylostoma caninum?

Weakness, pallor - anemia - can cause iron deficiency anemia

How do you diagnose diarrhea caused by Ancylostoma caninum?

Fecal float

What is the treatment for Ancylostoma caninum?

Pyrantel pamoate or fenbendazole

What is the major health concern with Ancylostoma caninum?

common cause of cutaneous larval migrans in people

T/F Ancylostoma caninum is most commonly diagnosed in the NE US

Fasle, SE

You have a child that is playing in a sandbox. You as a mother/father are a hypochondriac, are mostly concerned about what?

Ancylostoma caninum

What is the common name for Trichuris vulpis

Whipworms

How does an animal become infected with Trichuris vulpis?

Infected by ingesting eggs

T/F A puppy can get Trichuris vulpis from the mother via transplacental or transmammary routes

False, there is no transplacental or transmammary routes

What is the signalment for acute diarrhea caused by Trichuris vulpis?

Dogs, young puppies and dogs not on preventatives

What can Trichuris vulpis result in clinically?

hemorrhagic colitis

If there is a severe infection of Trichuris vulpis, what clinical signs would you expect to see? (5)

bloody diarrhea, weight loss, dehydration, anemia, death

What are TWO ways that you could diagnose Trichuris vulpis?

• Fecal float

• Antigen testing allows dx during prepatent period,

earlier tx

What would you expect to see on a fecal float of Trichuris vulpis?

football shape egg

T/F Trichuris vulpis causes small bowel diarrhea

False, large bowel

What is an important differential for Trichuris vulpis because it causes the same electrolyte profile with large bowel diarrhea?

addison's disease

What do you use to treat Trichuris vulpis PO once?

Drontal Plus (febantel, pyrantel, praziquantel)

What do you use to treat Trichuris vulpis monthly for 3 months?

Fenbendazole 50 mg/kg PO x 3 days

What is the common name for Toxcara Canis?

Roundworms

How is toxacara canis transmitted?

• Ingestion of larvated eggs from a contaminated environment, ingestion tissue from hosts that have consumed larvate eggs

• Transplacental transmission

What is the signalment for toxocara canis?

Young puppies/kittens, adult dogs not on preventatives

What are the clinical signs of Toxocara Canis?

• Diarrhea, Ill-thrift , "Pot belly" appearance

• Coughing

Why would an animal with a toxocara canis be coughing?

due to the migration of the worm

How do you diagnose toxocara canis?

• Fecal float with centrifugation

• Fecal test for ascarid antigen - commercially available assay

How do you treat toxocara canis?

Fenbendazole, milbemycin oxime, moxidectin, and pyrantel pamoate

What are some of the bacterial causes of infectious acute diarrhea?

- Salmonella

- Campylobacter jejuni

- Clostridium difficile

- Clostridium perfringens

- Escherichia coli

T/F Bacteria is a common cause of diarrhea

False, NOT common

If you suspect a bacterial driver of

acute diarrhea, what should you do?

submit PCR panel

and/or culture and treat

accordingly

What are the THREE most important bacteria that causes acute diarrhea?

E.coli, Salmonella and

Campylobacter

T/F When you send fecal for culture, you will grow a zoo.

True (you would expect to grow a zoo)

What is the most common spp of Salmonella that causes acute diarrhea?

S. typhimurium

What is the signalment for a patient with diarrhea caused by Salmonella?

young dogs and cats, raw

food diets***

How is Salmonella transmitted?

fecal oral

What type of bowel diarrhea does Salmonella cause?

small bowel

What disease is Salmonella sepsis the main cause of death in puppies and kittens?

parvo

How do you diagnose Salmonella? (2)

• Fecal culture/PCR (confirms presence NOT infection)

• Blood culture definitive for Salmonella septicemia

When should you give an animal antibiotics when dealing with Salmonella and why do you not give antibiotics?

patient is septicemic, prolongs shedding

T/F Salmonella is zoonotic

True

How is Salmonella transmitted to humans?

Transmission to people via coming in contact with fecal material from pet

What is apart of the normal GI flora that is transmitted fecal oral?

Campylobacter jejuni

What is the signalment of Campylobacter jejuni?

dogs and cats younger than 6 months in group housing, raw diets

What are the clinical signs of Campylobacter jejuni?

• Fever

• Lethargy

• Anorexia

• Mucoid diarrhea

• +/- Hematochezia

T/F Campylobacter jejuni is usually self-limiting BUT - signs are worse with concurrent infection, stress, + overcrowding

True

How do you diagnose Campylobacter jejuni?

Fecal exam with CS, PCR

C. jejuni is one of the most common causes of

what syndrome in people

Guillain-Barre

When should you treat C. jejuni and what do you use?

If immunocompromised or having hemorrhagic diarrhea

- Erythromycin 10-15 mg/kg PO q8h x 7days OR

• Azithromycin 5-10 mg/kg PO q24h x 7 days

T/F Resistance can become an issue - can consider Enrofloxacin 10 mg/kg po q24h

True

T/F CAMPYLOBACTER JEJUNI is zoonotic and causes GBS (Guillain-Barré syndrome) in people

True

What is the Gram-positive, anaerobic, spore-forming motile rod that is transmitted fecal oral?

CLOSTRIDIUM DIFFICILE

What major toxin of C difficile has effect on canine epithelium unknown; rare in cats?

B

What are the clinical signs of C difficile?

small and large bowel diarrhea

How do you diagnose C diff?

Antigen ELISA + PCR/culture/toxin ELISA