Differential Diarrhea - Small Animal Medicine

Small Animal Practice

Veterinary Teaching Hospital

Airlangga University

Differential Diagnose

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.

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Diarrhea

• Small intestine diarrhea

• Large intestine diarrhea

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Clinical Signs Small intestine Large intestine

Feces

Mucous Rarely present Frequently present

Volume Increased Normal to decreased

Quality of stool Varies from nearly formed to quiet watery.

Often appears soft formed (“cowpile”). Undigested

food or fat droplets or globules may be

present. Malodorous

Loose to nearly formed. Mucus may be absent or

be present in small amounts, or constitute nearly

the entire volume of material expelled. No

undigested food.

Shape Vary, depends on amount of water present in

feces

Normal, reduced in diameter (narrowed)

Steatorrhea Present with maldigestive/malabsorptive

disorders

Absent

Color 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

Melena Maybe present -- black, tarry stool Absent

Hematochezia Absent, except in HGE syndrome Maybe present triakoso 2014


Defecation

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

Urgency 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

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Associated signs

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).

Weight loss 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 triakoso 2014


Associated signs

Halitosis 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

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Causes Small Intestinal Diarrhea

• Diet

• Extra-gastrointestinal diseases

• Infection

• Inflammatory/immune mediated

• Idiophatic

• Neoplasia

• Partial obstruction

• Motility disorders

• Drugs/toxins

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Causes Large Intestinal Diarrhea

• Diet

• Extra-intestinal conditions

• Infection

• Inflammatory/immune mediated

• Idiophatic

• Neoplasia

• Obstruction

• Miscellaneous

• Drugs/toxins

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Small Intestinal Diarrhea

• Diet

– Dietary intolerance [Food hypersensitivity; Food intolerance; Gluten-sensitive enteropathy]

• Extra-gastrointestinal diseases

– EPI

– Hepatic disease

– Hyperthiroidism

– Hypoadrenocorticism

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• 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]

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• 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

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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]

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• 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]

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• 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]

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• Obstruction – Caecal inversion

– Foreign body*

– Intussusception*

– Neoplasia

– Stricture

• Miscellaneous – Secondary to chronic small intestinal disease

– Stress

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• Drugs/toxins

– Acetazolamide

– Adder bite

– Allopurinol

– Aminophylline

– Amoxicillin

– Amphotericin B

– Ampicillin

– Atenolol

– Benzalkonium chloride

– Bethanechol

– Blue-green algae

– Borax

– Calcium edetate

– Carbamate insecticides

– Cardiac glycosides

– Cephalexin

– Chloramphenicol

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• Drugs/toxins

– Chlorphenamine

– Colchicine

– Cotoneaster

– Cyclophosphamide

– Cyclosporin

– Cytarabine

– Daffodil

– Diazoxide

– Diclofenac sodium

– Dieffenbachia

– Doxycycline

– Glyphosphate

– Honeysuckle

– Horse chestnut

– Ibuprofen

– Indomethacin

– Iron/iron salts

– Laburnum

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• Drugs/toxins

– Lactulose

– Levamisole

– Lithium

– Loperamide

– Mebendazole

– Metaldehyde

– Methiocarb

– Misoprostol

– Mistletoe

– Mitotane

– Naproxen

– Nicotinamide

– NPK fertilisers

– NSAIDs

– Organophosphates

– Oxytetracycline

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• Drugs/toxins

– Pamidronate

– Pancreatic enzyme supplementation

– Paracetamol

– Paraquat

– Pentoxifylline

– Petroleum distillates

– Phenoxy acid herbicides

– Piperazine

– Poinsettia

– Procainamide

– Pyracantha

– Pyrethrin/pyrethroids

– Pyridostigmine

– Quinidine

– Rhododendron

– Rowan

– Salt

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• Drugs/toxins

– Selective serotonin reuptake inhibitors

– Sotalol

– Theobromine

– Theophylline

– Vitamin D rodenticides

– Yew

– Zinc sulphate

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Thank you…..

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Health & Medicine

Differential Diarrhea - Small Animal Medicine