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Dealing with Diarrhea in Dogs & Cats

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Dealing with Diarrhea in Dogs & Cats What to Do About “The Trots” Dealing with Diarrhea In Dogs & Cats Wendy Blount, DVM • Contents of the gut are actually outside the body • This illustrates the importance to the integrity of the mucosal GI barrier, which must be selectively permeable • GALT (gut associated lymphoid tissue) monitors what and what does not enter into the body Gut Tissue Layers 1. Mucosa 2. Submucosa/Lamina Propria 3. Muscularis – Longitudinal smooth muscle – Submucosal nerve plexus – Circular smooth muscle – Myenteric nerve plexus – Longitudinal smooth muscle 4. Serosa - connects to mesentery, everywhere but esophagus and rectum Gut Tissue Layers Memory Aid: “The Sun is Bright • Submucosa is white • Serosa is white • S#!t is white And it’s Dark at Midnight.” • Mucosa is black • Muscularis is black DDx Diarrhea • Extra-intestinal causes (13%) – Everything that causes vomiting – Exocrine pancreatic insufficiency • Intra-intestinal causes (87%) – 52% are food responsive – 12% IBD – 9% antibiotic responsive diarrhea – 3% prednisone responsive but no inflammation on histopath – 12% GI parasites (Volkmann et al, 2012) Acute vs. Chronic Diarrhea • Most cases of acute diarrhea respond to empirical therapy • HGE is a particular clinical picture that responds well if treated early • We will spend most of the hour talking about chronic diarrhea Diagnostics for Diarrhea 1. Empirical Treatment 2. MDB – CBC, panel, electrolytes – Urinalysis – Fecal flotation and direct smear (repeated) – Heartworm test for dogs, FeLV/FIV for cats – T4 and free T4 for cats (55% v, 30% d) 3. Abdominal x-rays and ultrasound, GI Lab tests 4. Endoscopy (always do GI panel first) 5. Diagnostic surgery – multiple organ biopsies Abdominal Radiographs and US • Abdominal Radiographs lymphoma – obstruction (foreign body, intusussception) – ileus – Mass • Abdominal ultrasound - above plus – Increased intestinal thickness for IBD/lymphoma – Obliteration of the layers of the gut for neoplasia and normalphycomycosis Inflammatory bowel disease Abdominal Radiographs and US • Abdominal Radiographs – obstruction (foreign body, intusussception) – ileus – Mass • Abdominal ultrasound - above plus – Increased intestinal thickness for IBD/lymphoma – Obliteration of the layers of the gut for neoplasia and phycomycosis – Muscularis:mucosa > 1:1 suggests lymphoma – Enlarged LN • >5mm abnormal – LSA or IBD • >3 cm probably neoplasia Abdominal Radiographs and US • Abdominal Radiographs – obstruction (foreign body, intusussception) – ileus – Mass • Abdominal ultrasound - above plus – Increased intestinal thickness for IBD/lymphoma – Obliteration of the layers of the gut for neoplasia and phycomycosis – Muscularis:mucosa > 1:1 suggests lymphoma enlarged – EnlargedMesenteric LN lymph nodes • >5mm abnormal – LSA or IBD • >3 cm probably neoplasia MDB and GI Panel • More often normal with LI except Boxer Colitis • Low albumin - SI disease + Boxer Colitis • Low albumin and globulin - GI bleeding – Especially if BUN increased, creat/phos normal, PCV low • Low B12 (TAMU GI Lab Form) – Distal small intestinal disease – EPI – Dysbiosis in upper small intestine in dogs • High B12 - not clinically significant MDB and GI Panel • Low Folate - proximal intestinal disease • High folate - proximal intestinal dysbiosis • Low TLI indicates EPI – Dogs <2.5 mcg/L – definitely EPI – Dogs 2.5 – 3.5 mcg/L – borderline EPI – Dogs 3.5 – 5.7 mcg/L – subclinical EPI • Repeat in 30 days with strict fasting – Cats < 8 mcg/L – EPI – Cats 8-12 mcg/L – borderline EPI • Repeat in 30 days with strict fasting MDB and GI Panel • High TLI >50 mcg/L in dogs & >100 mcg in cats – acute pancreatitis (30-40%) – short lived – malnutrition – Minimal elevation in renal disease • High PLI Canines – 200-400 mcg/L – borderline • Recheck 2-3 weeks – >400 mcg/L - pancreatitis MDB and GI Panel • High PLI Felines – 3.6-5.3 mcg/L – borderline • Recheck 2-3 weeks – >5.4 mcg/L – likely pancreatitis • False positives for diabetes, IBD, hepatitis • Margie Scherck says this test is useless in cats • Dr. Suchodolski et al probably don’t agree • I have found it clinically useful for monitoring chronic recurring pancreatitis and adjusting therapy Small Intestinal Diarrhea Large Intestinal Diarrhea Large volume stool Small volume stool Digested blood - melenaPresence of Fresh blood? blood – hematochezia Fecal score 6-8 (watery) Fecal score 4-5 (soft) Mucus not often present Mucus on stool is common Maybe normal frequency Usually increased frequency Urgency, Dyschezia/Tenesmus Urgency, Dyschezia/Tenesmus possible common Can be flatulent Can be flatulent Steatorrhea if EPI No steatorrhea Weight loss common with Weight loss is rare except Boxer chronicity colitis, histoplasmosis, neoplasia Glutamine is preferred Fermentable fiber is a good enterocyte nutrient source of preferred enterocyte nutrient butyrate Low residue diet preferred High fiber diet preferred Small Intestinal Diarrhea Large Intestinal Diarrhea Large volume stool Small volume stool Digested blood - melena Fresh blood – hematochezia Fecal score 6-8 (watery)Both – raspberry Fecal jam score stools 4-5 (soft) Mucus not often present Mucus on stool is common Maybe normal frequencyFecal Score? Usually increased frequency Urgency, Dyschezia/Tenesmus Urgency, Dyschezia/Tenesmus possible common Can be flatulent Can be flatulent Steatorrhea if EPI No steatorrhea Weight loss common with Weight loss is rare except Boxer chronicity colitis, histoplasmosis, neoplasia Glutamine is preferred Fermentable fiber is a good enterocyte nutrient source of preferred enterocyte nutrient butyrate Low residue diet preferred High fiber diet preferred Small Intestinal Diarrhea Large Intestinal Diarrhea Large volume stool Small volume stool Digested blood - melena Fresh blood – hematochezia Fecal score 6-8 (watery) Fecal score 4-5 (soft) Mucus not often presentPresence of Mucus Mucus? on stool is common Maybe normal frequency Usually increased frequency Urgency, Dyschezia/Tenesmus Urgency, Dyschezia/Tenesmus possible common Can be flatulent Can be flatulent Steatorrhea if EPI No steatorrhea Weight loss common with Weight loss is rare except Boxer chronicity colitis, histoplasmosis, neoplasia Glutamine is preferred Fermentable fiber is a good enterocyte nutrient source of preferred enterocyte nutrient butyrate Low residue diet preferred High fiber diet preferred Small Intestinal Diarrhea Large Intestinal Diarrhea Large volume stool Small volume stool Digested blood - melena Fresh blood – hematochezia Fecal score 6-8 (watery) Fecal score 4-5 (soft) Mucus not often present Mucus on stool is common Maybe normal frequencyFrequency of Usuallydefecation? increased frequency Urgency, Dyschezia/Tenesmus Urgency, Dyschezia/Tenesmus possible common Can be flatulent Can be flatulent Steatorrhea if EPI No steatorrhea Weight loss common with Weight loss is rare except Boxer chronicity colitis, histoplasmosis, neoplasia Glutamine is preferred Fermentable fiber is a good enterocyte nutrient source of preferred enterocyte nutrient butyrate Low residue diet preferred High fiber diet preferred Small Intestinal Diarrhea Large Intestinal Diarrhea Large volume stool Small volume stool Digested blood - melena Fresh blood – hematochezia Fecal score 6-8 (watery) Fecal score 4-5 (soft) Mucus not often present Mucus on stool is common Maybe normal frequency Usually increased frequency Urgency, Dyschezia/TenesmusUrgency to defecateUrgency, and straining? Dyschezia/Tenesmus possible common Can be flatulent Can be flatulent Steatorrhea if EPI No steatorrhea Weight loss common with Weight loss is rare except Boxer chronicity colitis, histoplasmosis, neoplasia Glutamine is preferred Fermentable fiber is a good enterocyte nutrient source of preferred enterocyte nutrient butyrate Low residue diet preferred High fiber diet preferred Small Intestinal Diarrhea Large Intestinal Diarrhea Large volume stool Small volume stool Digested blood - melena Fresh blood – hematochezia Fecal score 6-8 (watery) Fecal score 4-5 (soft) Mucus not often present Mucus on stool is common Maybe normal frequency Usually increased frequency Urgency, Dyschezia/Tenesmus Urgency, Dyschezia/Tenesmus possible common Can be flatulent Can be flatulent Flatulence? Steatorrhea if EPI No steatorrhea Weight loss common with Weight loss is rare except Boxer chronicity colitis, histoplasmosis, neoplasia Glutamine is preferred Fermentable fiber is a good enterocyte nutrient source of preferred enterocyte nutrient butyrate Low residue diet preferred High fiber diet preferred Small Intestinal Diarrhea Large Intestinal Diarrhea Large volume stool Small volume stool Digested blood - melena Fresh blood – hematochezia Fecal score 6-8 (watery) Fecal score 4-5 (soft) Mucus not often present Mucus on stool is common Maybe normal frequency Usually increased frequency Urgency, Dyschezia/Tenesmus Urgency, Dyschezia/Tenesmus possible common Can be flatulent Can be flatulent Steatorrhea if EPIFatty stools? No steatorrhea Weight loss common with Weight loss is rare except Boxer chronicity colitis, histoplasmosis, neoplasia Glutamine is preferred Fermentable fiber is a good enterocyte nutrient source of preferred enterocyte nutrient butyrate Low residue diet preferred High fiber diet preferred Small Intestinal Diarrhea Large Intestinal Diarrhea Large volume stool Small volume stool Digested blood - melena Fresh blood – hematochezia Fecal score 6-8 (watery) Fecal score 4-5 (soft) Mucus not often present Mucus on stool is common Maybe normal frequency Usually increased frequency Urgency, Dyschezia/Tenesmus Urgency,
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