Acute Vomiting and Diarrhea

What is acute gastroenteritis?

Acute vomiting and or diarrhea due to sudden GI mucosal irritation

What are causes of acute gastroenteritis?

Dietary indiscretion, foreign material, drugs/toxins

What are the idiopathic GI diseases?

Acute gastroenteritis

Acute hemorrhagic diarrhea syndrome (AHDS)

How do you usually have to diagnose acute gastroenteritis?

Exclusion

How do you treat an acute gastroenteritis case that is an outpatient?

One dose of anti-emetics, change to easily digestible diet, SQ fluids

What laboratory change is most concerning for pyloric outflow obstruction?

Hypochloremic metabolic alkalosis

How do you treat an impatient acute gastroenteritis case?

IV fluids, anti-emetics, and switch an easily digestible diet

What is AHDS (acute hemorrhagic diarrhea syndrome)?

Acute onset severe bloody diarrhea and vomiting associated with increased GI permeability

What is the pathophysiology of AHDS?

Unknown but predisposing factors include

• Dietary indiscretion

• Intestinal type 1 hypersensitivity reaction

• microbiome dysbiosis

• Clostridium toxins

Describe the importance of Clostridium perfringens

Usually asymptomatic normal flora in dogs and cats

Can sometimes produce enterotoxins causing acute or chronic diarrhea

How can you determine C. perfringens is the cause?

No gold standard. Best is culture and ELISA for toxins, but toxins does not confirm cause of disease.

Spores do not mean anything on a fecal smear

How do you treat Clostridium spp.?

Non in asymptomatic or mildly affected. Good prognosis

What are the C/S of AHDS?

Severe bloody diarrhea, vomiting, hypovolemic shock

What is on bloodwork for AHDS?

Severe hemoconcentration with normal serum total protein

Thrombocytopenia in 50%

Leukopenia, neutropenia if patient is septic or DIC

What can the blood pressure be during AHDS?

Hypotensve

Describe abdominal radiographs for AHDS

Can be normal or have a diffuse ileus

How do you treat AHDS?

Intensive IV fluid resuscitation. Antimicrobials are only needed if there is sepsis

What are signs of sepsis that would indicate antibiotics with AHDS?

Leukopenia + degenerative left shift

Fever

Non-responsive hypotension or hypoglycemia

Coagulopathy

What parasites cause vomiting?

T. cati, T. canis, hookworms (dogs), ollulanus (cats), physaloptera

What parasites can cause SI diarrhea?

T. cati, T. canis, Hookworms

What parasites can cause LI diarrhea?

Trichuris vulpis

What can cause systemic illness from a parasite?

Hookworms, T. canis, T. cati

What parasites can be found on a fecal float?

T. cati, T. canis, Hookworms, Trichuris vulpis

How can you diagnose physalopetra?

Fecal sedimentation, treatment trial, endoscopy

What parasite can be diagnosed on a vomit exam?

Ollulanus

What parasites can you diagnose with endoscopy?

Physaloptera

Ollulanus

What is the etiology of parvovirus?

Canine parvovirus 2

What cells does parvovirus infect?

Rapidly dividing cells like intestinal crypts, bone marrow, lymphoid tissue

How is parvo transmitted?

Fecal oral, shedding 10-14 days after illness onset

Stable in environment for months

What are C/S of parvo?

Begins 4-7 days after infection with anorexia, depression, dehydration, and fever

GI signs start 24 hours after with vomiting and severe bloody diarrhea

How do you diagnose parvovirus?

Fecal SNAP ELISA

PCR if ELISA was negative but parvo is still suspected

What is on bloodwork for parvovirus?

Severe leukopenia with hypoglycemia, hypoalbuminemia, electrolyte problems

How do you treat parvovirus?

Supportive care with IV fluids with potassium and dextrose

Prophylactic antimicrobials (ampicillin, amp sulbactam, cefoxitin)

Anti-emetics

Enteral nutrition

What do dogs with parvo also often have?

Concurrent parasites, so you should always test or empirically deworm

What are complications of canine enteric parvovirus?

Sepsis, anemia, hypoalbuminemia, intussusception

What is the prognosis for parvovirus?

<10% with no treatment

<50% with outpatient

>80-90% with hospitalization

How can you prevent parvo?

Vaccination, isolation of affected, disinfect with bleach

What is the feline equivalent to canine parvovirus?

Feline panleukopenia

Describe the significance of salmonella in dogs and cats?

Can have transient or asymptomatic signs or a chronic carrier

What are C/S of acute gastroenteritis due to salmonella in dogs?

Very high fever, with severe bloody diarrhea and systemic bacteremia

What is the signalment for salmonella?

Young, concurrent disease, immunocompromised, or high-density kellens

What are the C/S of salmonella in birds?

Rarely GI signs unless it is S. typhimurium which causes acute diarrhea and fever

How do birds get S. typhimurium?

Seasonal infection due to ingestion of songbirds

How do you diagnose salmonella?

Culture of feces or blood

How do you treat salmonella?

Fluoroquinolones if severely affected. None if healthy

What is a zoonotic GI bacteria?

Salmonella

What is the prognosis for salmonella?

Good unless septic

What signs decrease prognosis of salmonella?

Peracute disease

Fever >104

Degenerative left shift

Hypoglycemia

What is the pathogenesis of Neorickettsia helminthoeca?

Ingestion of raw salmon with Nanophyteus salminocola

Fluke has Neorickettsia

What are C/S of Neorickettsia helminthoeca?

Acute onset of hemorrhagic diarrhea 1 week after eating raw salmon

Vomiting, high fever, lymphadenomegaly, ocular/nasal discharge

How do you diagnose Neorickettsia helminthoeca?

C/S and history of eating raw fish or being in NW coast

Operculated eggs on fecal

Intracytoplasmic inclusions on a lymph node cytology

How do you treat Neorickettsia helminthoeca?

Doxycycline and praziquantel

What is the prognosis of Neorickettsia helminthoeca?

Good with aggressive and prompt therapy

What is the efficacy of fecal panels?

Not validated and a positive PCR does not correlate with clinical signs