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73 Cards in this Set
- Front
- Back
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What is the hallmark sign of intestinal disease?
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Diarrhea
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What is an important factor of a disease that can aid in diagnosis and may guide therapy
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localization (SI or LI)
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If you have a purely LI disease, should you expect the TLI, cobalamine, and folate tests to be abnormal?
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No - those are SI tests
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what are some characteristics of diarrhea with a small intestinal disease?
frequency, volume, tenesmus, inappetance |
little increase in frequency
increased volume rarely tenesmus seen variable inappetance |
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What are the characteristics of LI diarrhea?
frequency, volume, tenesmus, inappetence |
frequent (>3x/day)
smaller volume than normal commonly see tenesmsus rarely inappetance seen |
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In which type of intestinal disease do we see hematochezia
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LI - if in SI, then the entire intestine is destroyed
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In which type of disease is weight loss commonly seen
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SI
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In which type of disease is the urgency to defecate present?
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LI
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Is there mucus in SI disease diarrhea?
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NO, in the LI
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are diseases that are localized and isolated to the SI common or uncommon? how about large intestin?
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SI - not uncommon
LI - uncommon (usually diffuse disease involving SI as well) |
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What are some examples of a strictly LI disease
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granulomatous colitis in boxers, ulcerative colitis in cats
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what is a common history and common clinical signs of acute SI disease?
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acute onset
typically seen in younger animals large volume diarrhea, but not increased frequency patient may appear quite ill - febrile, dehydrated, tachycardic |
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what are typical presenting signs of chronic intestinal disease
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dogs: diarrhea, possibly inappetance, weight loss
cats: weight loss and inappetance (+/- vomiting) |
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describe the diarrhea/BM of chronical small intestinal disease
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soft, pulpy, fetid. NOT watery
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what are some potential etiologies of acute SI diarrhea?
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dietary intolerance**, hypersensitivity, spoilage**, recent diet change
infectious: Viral, bacterial, helminthiasis |
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What are some important differentials to acute SI diarrhea
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acute pancreatitis
hemorrhagic gastroenteritis hypoadrenocorticism intussusception - can result from acute enteritis portal hypertension |
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True or false: many cases of acute SI diarrhea are self-limiting and may require little to no therapy
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True
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Should you attempt shotgun therapeutics with antibiotics for a BAR patient with acute SI diarrhea?
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No
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How long before most cases with acute SI diarrhea resolve?
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within 48 hours
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under what circumstances should we treat acute SI diarrhea more aggressively?
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pyrexia, obtunded, tachycardic
with significant abnormalities of Big 4 abdominal masses palpated melena, hematochezia, vomting |
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What specific blood chemistry change will we see in cats that are stressed out?
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Stress hyperglycemia
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What are the two significant viral entities that will have increased morbidity and mortality?
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Canine Parvovirus
Feline Panleukopenia |
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Is viral SI enteritis more typically seen in younger or older animals?
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younger
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what two viral entities will often occur in epidemic fashion? dog viruses
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parvo adn coronavirus
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which presentation is milder, parvo or coronavirus?
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coronavirus
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what are three protozoal SI enteritis entities that we should be award of?
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giardia**
cryptosporidium isospora |
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what type of disease do we see with giardia spp infection
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subclinical to severe SI diarrhea with weight loss
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what type of disease do we see with crypto infection?
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typically subclinical - only important zoonosis if owner immunocompromised
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is giardia zoonotic?
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yes
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How are protozoal SI enteritis diagnosed?
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fecal flotation
may need to repeat, due to transient shedding (esp with giardia) |
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which protozoal cysts are very very small - need an oil-immersion lens to see them?
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cryptosporidium
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Are most of these infections self-limiting?
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yes
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What medications should you use to treat giardia?
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Albendazole/fenbendazole**
metronidazole |
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What medications should you use to treat isospora?
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trimethoprim-sulfa for a week
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Many of hte bacteria that are associated with opportunist infections/pathology are also part of _____ _____ of healthy animals
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normal flora
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do normal flora restablish in most animals so long as enough medications are provided?
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no - normal flora with reestablsih without significant intervention
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what two bacterial agents that we talked about causing SI disease are zoonotic?
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salmonella spp and campylobacter sp
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____ is an important bacterial differential for acute/peracute diarrhea with pyrexia
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Salmonella
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True or false: salmonella can be isolated from normal animals as well as asymptomatic carriers
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true
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What is songbird fever?
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consumption of carcasses of songbirds that are infected with S. typhimurium by cats
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If you are looking for salmonella in a sample, do you need to tell the lab anything in particular?
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yes, that you are looking for specific salmonella so that they can ID and subtype them
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What bacterial agent is good at gaining resistance to drugs?
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salmonella
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when should you use antibiotic therapy for salmonella?
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marked pyrexia, sepsis/septicemia, severe hemorrhagic diarreha
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What are the best first line choice of antibiotic for salmonella infection?
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fluoroquinolones
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How often should you check fecal samples to determine eradiation of salmonella?
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3x on separate days
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true or false: Most animals infected with campylobacter show significant disease
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false - most asymptomatic
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what is characteristic of campylobacter organisms that is useful for diagnosis?
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"sea gull" shaped
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What medications should you use for campylobacter infections?
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fluoroquinoloes IV 2-3 days, follwed by orally for 10 days
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what is the agent that causes salmon fever?
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Neorickettsia helminthoeca*
neorickettsia elokominica |
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What signs are seen with salmon poisoning?
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high fever, hemorrhagic gastroenteritis, vomiting, peripheral lymphadenopathy
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Is salmon poisoning present all year round in pacific NW?
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no - common seasonal presentation in pacific NW
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What are considered "Ecological diseases?"
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intestinal dysbiosis, SIBO, tylosin-responsive enteropathies, etc
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What signs are seen with Intestinal dysbiosis?
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weight loss, poorly formed stools, poor hair coat
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What animal is most commonly affected with intestinal dysbiosis?
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German shepherd - possible secretory IgA deficiency
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what are some factors that influence SI bacterial numbers?
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Exocrine pancreatic sections - high volume = washout effect
gastric acid secretion - long term gastric acid suppresion leads to increased numbers gastric and Si motility - slower speed, bacteria grow rapidly, those that grow fastest do the best GI immune system function Fermentable substrate input - EPI |
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what are 5 effects of excessive SI microbes
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Direct competition for substrates
competition for cobalamin deconjucation of bile acids** - many things use this mechanism Synthesis of hydroxylated fatty acids Destruction of brush border enzymes |
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What animals are typically seen with excessive SI microbes?
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large breed dogs, young adult GSD most common*
rotties, goldens, labs |
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What are signs of excessive SI microbes
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chronic diarrhea, SI predominately or mixed SI/LI signs
increased stool volume, soft but not watery steatorrhea, fetid usually no melena usually no fecal incontinence, urgency, or tenesmus |
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what are some differentials for excessive SI microbes?
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EPI - check serum TLI
IBD - may occur 2 to IBD Intestinal neoplasia - LSA, intestinal adenocarcinoma parasitism - giardia, helminths (whipworms) intussusception, chronic partial obstruction dietary intolerance/allergy: food responsive enteritis |
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How do we diagnose excessive SI microbes?
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minimum database: CBC/Chem + UA (probably find nothing)
serum TLI, cobalamin and foalte concentrations fecal float and smears +/- endoscopy |
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If we see low cobalamin adn low folate, what shoudl we suspect?
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mucosal infiltrative disease
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what do we suscept when we see low cobalamina dn high folate?
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consistent with altered SI microflora - dysbiosis
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True or false: endoscopy in chronic enteropathy is a valuable diagnostic approach
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false: often unremarkable and they're $$
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True or false: beyond the neonate, all individuals have a unique, stable GI microflora that will return after long term antimicrobials
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true
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what is an example of probiotic organisms - name brand
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fortaflora
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Do probiotics truly colonize the gut?
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NO - must keep giving them and keep them sustained at high dose
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Can the time to effect be prolonged in prebiotic and probiotics?
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yes
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What probiotic can you provide in kittens with chronic diarrhea for 6-8 weeks
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lactobacillus
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which is probiotics better indicated for, acute or chronic diseases?
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acute
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what diet that contains prebiotics currently provides teh best results
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iams?eukanuba LR diet
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When considering combination therapy, what means are we combining?
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diet (containing a prebiotic) and medication (tylosin)
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How often should we give Tylosin in regards to combination therapy?
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6 weeks
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At what level should we supplement cobalamin
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<300 pg/L
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