Approach to chronic diarrhoea and constipation

List of differential diagnoses for chronic diarrhoea

What would your differentials be for the following signs:

• Haematochezia

• No mucus, diarrhoea or tenesmus

• Rectal polyp

How does a small intestinal diarrhoea present?

• Inc volume

• Colour change

• Normal to slight inc in freq

• +/- weight loss

• +/- flatulence, borborygmi, halitosis

How does a large intestinal diarrhoea present?

• Dec volume

• Inc freq

• Urgency and tenesmus

• Mucus and haematochezia

• Dyschezia (pain on def.)

• Constipation +/- variable consistency

How will a diffuse intestinal diarrhoea present?

Signs with both large and small

What is melaena a sign of?

Upper GI disease (tarry black)

What prep does a colonoscopy require?

• Starve 48 hours

• Poly eythlene glycol

• Warm water enemas

How does treatment differ between small and large intestinal disease?

• Fibre supplementation used for large intestine only

• Sulfasalazine- large intestine only

How can you symptomatically treat a chronic diarrhoea case

• Dietary trial

• Anthelmintic medication

What lab tests can you perform for the chronic diarrhoea case?

• Stage 1: Faecal analysis

  • Parasites

• Stage 2: Haem/ Biochem/ Urinalysis (Rule out systemic disease)

• Stage 3: Endocrine tests (ACTH stim, thyroxine), TLI (exocrine pancreatic insufficiency), Total lipase or pancreatic lipase, folate and cobalamain

What are the main parasites that cause chronic diarrhoea

• Giardia

• Cryptosporidia

• Tritrichomonas foetus (cats)

In what cats does tritrichomonas foetus typically present?

• Pedigree

• Young

• Colony

• Large intestinal signs

What does hypocobalaminaemia indicate?

• Negative prognostic indicator

• If present treat with cobalamin

What are the different biopsy procedures and what are the pros and cons?

• Endoscopy

  • Minimally invasive and direct examination

  • Requires equipment and expertise

  • Small superficial samples from a limited region

• Coeliotomy

  • Can get multiple full-thickness biopsies

  • Surgical risk

  • Best for cats

What are some examples of different biopsy diagnosis?

• Non-specific: normal /mild inflammation

  • Adverse reaction to food

  • IBD ~ “chronic enteropathy”

• Moderate-severe inflammation

  • IBD ~ “chronic enteropathy”

• Lymphoma Lacteal dilation

• Lymphangiectasia (if severe, dogs)

  • Secondary to another disease

What are the causes of constipation?

How do you treat constipation?

• Remove underlying cause if possible

  • i.e. surgery for fracture

• Oral laxatives i.e. lactulose

• [Cisapride]

• Enemas

• Oral polyethylene glycol

• Gentle manual evacuation under anaesthetic

• Surgery (if megacolon)

• Dietary management

  • High fibre diet