Differential Diarrhea - Small Animal Medicine


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Explain the differential diagnose of diarrhea in small animal

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Differential Diarrhea - Small Animal Medicine

  1. 1. Veterinary Teaching Hospital Airlangga University Small Animal Practice Differential Diagnose
  2. 2. Diarrhea • Diarrhea is define simply as passage of feces that contain an excess amount of water. This results in an abnormal increase in stool liquidity and weight. In some patients there may simply be an increase in frequency of defecation. • Diarrhea has also been described in broad, simple terms as “the too rapid evacuation of too loose stools.” • Definitions notwithstanding, however, it is most important that the clinician carefully determine exactly what the owner means when the term diarrhea is used. triakoso 2014
  3. 3. Diarrhea • Small intestine diarrhea • Large intestine diarrhea triakoso 2014
  4. 4. Clinical Signs Small intestine Large intestine Mucous Rarely present Frequently present Volume Increased Normal to decreased Feces Quality of stool Shape Steatorrhea Color Melena Hematochezia Varies from nearly formed to quiet watery. Loose to nearly formed. Mucus may be absent or Often appears soft formed (“cowpile”). Undigested be present in small amounts, or constitute nearly food or fat droplets or globules may be the entire volume of material expelled. No present. Malodorous undigested food. Vary, depends on amount of water present in feces Normal, reduced in diameter (narrowed) Present with maldigestive/malabsorptive disorders Absent Considerable variation—tan to dark brown, black (not always indicative of melena), grayish brown. May be altered by certain medications Variable—usually brown, may be nearly clear (increasedmucus) or laced with bright-red blood Maybe present -- black, tarry stool Absent Absent, except in HGE syndrome Maybe present triakoso 2014
  5. 5. Clinical Signs Small intestine Large intestine Frequency Usually increased to 2-4 times a day but may remain normal in some patients Almost always increased. May be as frequent as 3-10 times per day (average 3-5). The combination of increased frequency of defecation and passage of decreased amounts of stool strongly suggests large intestinal involvement Dyschezia Absent Frequent in dogs, less common in cat Tenesmus Absent Frequent in dogs, less common in cat May be present in cases of acute severe enteritis, with rapid transit of large volumes of fluid through the gastrointestinal tract Frequent. Common reason for owner being awakened during the night to allow a dog outdoors to defecate. Often Defecation Urgency triakoso 2014
  6. 6. Clinical Signs Small intestine Large intestine Vomit Common in patients with inflammatory bowel disorders and acute infectious disorders May occur in 30%-35% of patients with acute colitis. Sometimes occurs before onset of abnormal stools Appetite Usually normal or decreased. May be cyclic, often decreasing in conjunction with flare-ups symptoms. May be ravenous in some dogs with inflammatory bowel disease (especially shar-peis).Appetite may be increased in cats with inflammatory bowel disease or lymphoma (transiently in the latter). Usually remains normal. May be decreased if disease is severe (neoplasia, of histoplasmosis). Usually occurs as disease becomes more chronic. Occurs with both malabsorptive and maldigestive disease processes. Unusual. May occur in conjunction with severe colitis, diffuse neoplasia, or histoplasmosis. If both small and large bowel signs are present, any weight loss that has occurred is more likely due to the small intestinal disease component Associated signs Weight loss triakoso 2014
  7. 7. Clinical Signs Small intestine Large intestine May be associated with maldigestive or malabsorptive diseases Absent Borborygmus Maybe present Absent Flatulence Maybe present Absent Fecal incontinence Rare—would only be associated with severe enteritis and rapid transit of large volumes of watery diarrhea May be present Scooting or chewing perianal area Absent Occasionally present—may be quite pronounced in some patients with proctitis Associated signs Halitosis triakoso 2014
  8. 8. Causes Small Intestinal Diarrhea • Diet • Extra-gastrointestinal diseases • Infection • Inflammatory/immune mediated • Idiophatic • • • • triakoso 2014 Neoplasia Partial obstruction Motility disorders Drugs/toxins
  9. 9. Causes Large Intestinal Diarrhea • Diet • Extra-intestinal conditions • Infection • Inflammatory/immune mediated • Idiophatic • • • • triakoso 2014 Neoplasia Obstruction Miscellaneous Drugs/toxins
  10. 10. Small Intestinal Diarrhea • Diet – Dietary intolerance [Food hypersensitivity; Food intolerance; Gluten-sensitive enteropathy] • Extra-gastrointestinal diseases – EPI – Hepatic disease – Hyperthiroidism – Hypoadrenocorticism triakoso 2014
  11. 11. Small Intestinal Diarrhea • Infection – Bacterial [Campyovacter spp; Clostridium spp; Salmonella spp; E coli; Staphylococcus, SIBO] – Fungal – Helminth [Hookworm; Roundworm; Tapeworm; Whipworm] – Protozoal [Cryptosporidiosis; Giardia spp] – Rickettsial – Viral [Corona virus; Parvovirus; Feline panleukopenia] triakoso 2014
  12. 12. Small Intestinal Diarrhea • Inflammatory/immune mediated – – – – Basenji enteropathy Duodenal ulceration Hemorrhagic gastroenteritis Inflammatory bowel disease [Eosinophilic; Granulomatous; Lymphoplasmacytic] – Protein-losing enteropathy and nephropathy of the Soft-Coated Weaten Terrier • Idiophatic – Lymphangiectasia triakoso 2014
  13. 13. Large Intestinal Diarrhea • Diet* – Dietary hypersensitivity – Dietary indiscretion • Extra-intestinal conditions – – – – – Metastatic neoplasia Neurological disease leading to ulcerative colitis Pancreatitis Toxaemia Uraemia • Infection – Bacterial*, e.g. [Campylobacter spp; Clostridium difficile; Clostridium perfringens; E. coli; Salmonella spp; Yersinia enterocolitica] triakoso 2014
  14. 14. Large Intestinal Diarrhea • Infection – Viral* [Coronavirus; Feline immunodeficiency virus (C); Feline infectious peritonitis (C); Feline leukaemia virus (C); Parvovirus] – Fungal, e.g. [ Histoplasmosis; Protothecosis] – Parasitic*, e.g. [Amoebiasis; Ancylostoma spp; Balantidium coli; Cryptosporidiosis; Giardia spp; Heterobilharzia americana; Roundworm; Tapeworm; Tritrichomonas foetus(C); Uncinaria spp; Whipworm] – Protozoal, e.g. [Toxoplasmosis] triakoso 2014
  15. 15. Large Intestinal Diarrhea • Immune-mediated/inflammatory disease – Histiocytic ulcerative colitis of Boxers (D) – Inflammatory bowel disease* • Idiopathic conditions – Fibre-responsive large-bowel diarrhoea – Irritable bowel syndrome • Neoplasia* – Benign, e.g. [Adenomatous polyps; Leiomyoma] – Malignant, e.g. [Adenocarcinoma; Lymphoma] triakoso 2014
  16. 16. Large Intestinal Diarrhea • Obstruction – Caecal inversion – Foreign body* – Intussusception* – Neoplasia – Stricture • Miscellaneous – Secondary to chronic small intestinal disease – Stress triakoso 2014
  17. 17. Large Intestinal Diarrhea • Drugs/toxins – – – – – – – – – – – – – – – – – Acetazolamide Adder bite Allopurinol Aminophylline Amoxicillin Amphotericin B Ampicillin Atenolol Benzalkonium chloride triakoso 2014 Bethanechol Blue-green algae Borax Calcium edetate Carbamate insecticides Cardiac glycosides Cephalexin Chloramphenicol
  18. 18. Large Intestinal Diarrhea • Drugs/toxins – – – – – – – – – – – – – – – – – – Chlorphenamine Colchicine Cotoneaster Cyclophosphamide Cyclosporin Cytarabine Daffodil Diazoxide Diclofenac sodium triakoso 2014 Dieffenbachia Doxycycline Glyphosphate Honeysuckle Horse chestnut Ibuprofen Indomethacin Iron/iron salts Laburnum
  19. 19. Large Intestinal Diarrhea • Drugs/toxins – – – – – – – – – – – – – – – – Lactulose Levamisole Lithium Loperamide Mebendazole Metaldehyde Methiocarb Misoprostol triakoso 2014 Mistletoe Mitotane Naproxen Nicotinamide NPK fertilisers NSAIDs Organophosphates Oxytetracycline
  20. 20. Large Intestinal Diarrhea • Drugs/toxins – Pamidronate – Pancreatic enzyme supplementation – Paracetamol – Paraquat – Pentoxifylline – Petroleum distillates – Phenoxy acid herbicides – Piperazine triakoso 2014 – – – – – – – – – Poinsettia Procainamide Pyracantha Pyrethrin/pyrethroids Pyridostigmine Quinidine Rhododendron Rowan Salt
  21. 21. Large Intestinal Diarrhea • Drugs/toxins – Selective serotonin reuptake inhibitors – Sotalol – Theobromine – Theophylline – Vitamin D rodenticides – Yew – Zinc sulphate triakoso 2014
  22. 22. Thank you….. triakoso 2014