Approach to dog or cat with chronic diarrhea
What Tests for Pancreatitis causing diarrhea
cPL/fPL
What test for EPI for chronic diarrhea
cTLI/fTLI
What are our options for diet trials
intestinal diet hydrolyzed antigen - dogs novel protein - cats Fiber supplemented
What percentage of cats and dogs respond to diet changes
50%
If giardia is present does that mean it is the cause of the diarrhea
no
Stage IV diagnostic approach
Abdominal Ultrasound and rads if haven't done already Intestinal Biopsy
A sick patient without a stress leukogram
Addison's
What endocrine diseases can cause GI signs
Addison's Hyperthyroidism Hypothyroidism
Dietary Responsive causes of Chronic Diarrhea in cat
Allergy Intolerance
Dietary responsive causes of Chronic Diarrhea in dog
Allergy/intolerance
Stage 1 diagnostic approach
rule out parasites - fecal float, giardia, fenbendazole Diet trial with highly digestible diet
Is the long term response to immunosuppressant responsive therapy good?
usually suboptimal
What does a high folate mean for chronic diarrhea
Bacterial imbalance
Neoplastic causes of Chronic Diarrhea in dog
Carcinoma Lymphoma
When to supplement dogs or cats with cobalamin
Concentrations below 400 ng/L
If our animal does respond to a diet trial does that mean it is a food allergy?
Could also be an intolerance
How to supplement Cobalamin
Cyanocobalamin - SQ once weekly for 6 weeks than once monthly
What does it tell you with: Folate: Normal Cobalamin: Low
Distal Small intestinal Disease: EPI, Dysbiosis
If you have low cobalamin where is your diarrhea most likely
Distal small intestine
What does it tell you with: Folate: Normal Cobalamin: Normal
Doesn't rule out SI disease
Why is it difficult to tie clostridium to diarrhea
Enterotoxin strains of clostridium have been found in healthy dogs
use of chemistry panel with chronic diarrhea
Evaluates patients for consequences of diarrhea Evaluates for systemic disease that can cause diarrhea
how to dx Tritrichomonas Foetus
Fecal PCR
Stage V diagnostic approach
Further treatment based on histopath Corticosteroids for inflammation therapy for infectious agents Chemo or surgery
Infectious causes of Chronic Diarrhea in dog
Helminths Protozoa Bacterial Fungal
Infectious causes of Chronic Diarrhea in cat
Helminths Viral Protozoal Bacterial Fungal
Extra-GI causes of Chronic Diarrhea in dog
Hepatobilliary Pancreatitis EPI Hypercalcemia renal Dz Addison's
Function of intestinal biopsy
Histomorphological diagnosis but not the etiology
What are the best diagnostic tests for diarrhea
History and PE
Extra-GI causes of Chronic Diarrhea in cat
Hyperthyroidism Pancreatitis EPI Renal Disease
Inflammatory causes of Chronic Diarrhea in cat
IBD
Inflammatory causes of Chronic Diarrhea in dog
IBD Granulomatous Colitis
Causes of low cobalamin
IBD Lymphoma EPI Bacterial Imbalance
Dx for Cryptosporidium
IFA assays and PCR
When to move on to stage IIa
If there are no parasites, or no response to diet/parasite trial
When would cryptosporidium cause diarrhea
In animals that are immunosuppressed
What species and type of diarrhea are caused by Tritrichomonas Foetus
Large bowel in cats
Small vs Large Bowel Diarrhea: Small Quantity Frequency Tenesmus and Urgency Mucus Blood Weight Loss
Large volumes of watery diarrhea Normal to mildly increased Absent Usually absent Melena May be present
Neoplastic causes of Chronic Diarrhea in cat
Lymphoma MCT Carcinoma
Stage IIb diagnostic approach
Non-invasive tests for GI disease: cPLI cTLI Serum Folate Serum Cobalamin Abdominal Ultrasound
Small vs Large Bowel Diarrhea: large Quantity Frequency Tenesmus and Urgency Mucus Blood Weight Loss
Normal to mildly increased Markedly increased Usually present Frequently present Fresh Blood Uncommon
Why do some dogs respond to abx for diarrhea
Not clear, younger, GSD Diarrhea tends to come back once we stop the abx
Should we use abx for Clostridium?
Not necessary, unless febrile, septic, or really sick
What is the best way to test for Giardia
PCR or Snap test
Use of UA for Chronic Diarrhea
PU/PD may suggest metabolic Urate crystals or Bilirubinuria might suggest hepatic disease
What would make you do a GI biopsy sooner?
Palpable Mass Losing weight profoundly Bleeding Owner's Patience PLE
What can help a fecal exam be more useful
Pool 3 days of feces to increase sensitivity
What does it tell you with: Folate: High Cobalamin: Low or Normal
Possible Dysbiosis
What to do for immunosuppressant responsive therapy
Prednisone or Cyclosporine
What does it tell you with: Folate: low Cobalamin: Normal
Proximal Small Intestinal Disease
Is Radiographs useful for chronic diarrhea
Rarely, more used for evaluating the patients with vomiting
Stage IIa diagnostic approach
Rule out metabolic disease CBC/Chem/UA Baseline Cortisol Thyroid
What to do if your client won't let you biopsy
Rule out what you can rule out Treatment trial with Prednisone for lymphoma and IBD
How long to treat for abx responsive enteropathy
See response in 2 weeks Treat for 6-8 weeks
how long should a diet trial last
See results in 2 weeks Continue for 12 weeks May keep on this diet or switch back to the OG
What type of diarrhea does Giardia cause in dogs and cats
Small bowel in dogs Large Bowel in cats
What does it tell you with: Folate: low Cobalamin: Low
Small intestinal disease or EPI
How to do a therapeutic trial
Start with diet trial looking for food responsive enteropathy Then try a tylosin trial to look for abx responsive enteropathy then try biopsy and immunosuppressent to look for IBD
What are our options for intestinal biopsy
Surgical Endoscopic
Stage III diagnostic approach
Therapeutic Trials: Parenteral Cyanocobalamin Diet Trials Abx Trials Probiotics
use of Fecal exam for chronic diarrhea
To look for Giardia and other helminths and parasite
What antibiotic should we use for antibiotic responsive enteropathy
Tylosin 20 mg/kg PO Metronidazole - 10 mg/kg PO
What does it mean if you have low folate concentarations
You have a problem with absorption in the proximal SI
What is the best diagnostic imaging option for chronic diarrhea
abdominal ultrasound