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An Approach to Diarrhea
Acute Diarrhea
• Otherwise Healthy Dogs
• Unwell patients
Acute Diarrhea: Therapy
• Fluid therapy
• Diet
• Protectants and adsorbents
Therapy
• Anticholinergics
• Opiates (loperamide, Lomotil)
• When to use antibiotics?
• What to use?
Chronic Diarrhea
• Diarrhea lasting >3 weeks
• History
Small vs. Large Bowel
Chronic Diarrhea: Diagnostics
• Healthy dogs
• Always rule out secondary GI disease with a minimum database
• Fecal examination
• Giardia ELISA
Chronic Diarrhea: Diagnostic Approach
• Tryspin like immunoreactivity
– Decreased: Exocrine pancreatic insufficiency
– Increased: pancreatic inflammation, GI inflammation, decreased GFR
Folate
• Derived from diet
• Brush border enzymatic transformation
• Absorbed in proximal small bowel
• Decreased (rare): severe, long standing proximal small bowel disease
• Increased: suggestive of small intestinal bacterial overgrowth (especially with concurrently decreased cobalamin)
Cobalamin
• Derived from diet
• R protein
• Intrinsic factor
• Absorbed by distal small intestine
• Increased: clinical relevance unknown
• Decreased
• Consequences
• Cobalamin supplementation
Hypoalbuminemia
• Rule out hepatic disease
• Rule out renal disease
• Atypical Addison’s (ACTH stimulation)
• Fecal a1-proteinase inhibitor concentration
• Full thickness biopsies are ideal
Chronic Diarrhea
• Dietary trial
• If no response: referral
Ultrasound
• Visualize masses, foreign bodies, other internal organs
• Stomach and intestinal wall thickness
• Lymphadenomegaly
Biopsy
• Gastroduodenoscopy, colonoscopy
• Surgical
Treatment
• Empiric anthelmintic therapy
• Diet (see previous)
• Diet
Therapy
• Fructo-oligosaccharides
• Probiotics
Treatment
• When to use antibiotics?
• What to use?
• Metronidzole
• Tylosin
• Oxytetracycline
• When to use steroids?
The cat named Pug
• 1.5 year CM DSH
• Several months of intermittent diarrhea and hematochezia
• Transient improvement after deworming
• Eating duck and green pea
• Amoxicillin then metronidzole
• PE within normal limits
• Treated with longer course of fenbendazole
• No improvement
• Occasionally vomiting
• Gastric, enteric and colonic biopsies
• Treated with prednisone 1 mg/kg PO q 12 h
• Rabbit and green pea
• Responded well
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