Acute diarrhoea

9 Acute diarrhoea


Acute diarrhoea is a frequently encountered clinical sign in emergency medicine. The majority of causes of acute diarrhoea relate primarily to the intestinal tract although small intestinal diarrhoea in particular may be associated with extraintestinal causes. There are a large number of causes of acute diarrhoea and some of the most important with respect to emergency cases are listed in Boxes 9.1 and 9.2. Clearly some of these conditions may also cause, or even be more frequently associated with, chronic diarrhoea.



BOX 9.1 Causes of acute small intestinal diarrhoea




Intestinal disease



• Dietary indiscretion

• Food intolerance

• Food allergy

• Infectious disorders (bacterial, viral, parasitic, protozoal)

• Foreign body ingestion

• Intoxication

• Inflammatory bowel disease (IBD)

• Canine haemorrhagic gastroenteritis (HGE)

• Intussusception

• Neoplasia


Extraintestinal disease



• Acute pancreatitis

• Hepatic disease

• Renal disease

• Hypoadrenocorticism (Addison’s disease)

• Hyperthyroidism (cats)


BOX 9.2 Causes of acute large intestinal diarrhoea



• Dietary indiscretion

• Food intolerance

• Food allergy

• Infectious disorders (bacterial, parasitic)

• Foreign body ingestion

• Inflammatory bowel disease (IBD)

• Neoplasia

Features used to distinguish small and large intestinal diarrhoea are listed in Box 9.3 but a definitive patient assessment should be made cautiously on the basis of the type of diarrhoea alone and both types may occur in the same patient (e.g. with diffuse inflammatory bowel disease). Animals with haemorrhagic watery diarrhoea are likely to be suffering from small intestinal disease (especially canine haemorrhagic gastroenteritis or parvovirus) but short transit time prevents the formation of melaena (i.e. as there is insufficient time for bacteria to break down haemoglobin).



BOX 9.3 Distinguishing features of small versus large intestinal diarrhoea




Small intestinal diarrhoea



• Normal to slightly increased frequency of defecation

• Increased faecal volume

• Watery/fluid consistency

• Tenesmus rare

• Blood (melaena) and mucus rare/occasional

• Weight loss common


Large intestinal diarrhoea



• Increased frequency and urgency of defecation

• Small amount passed each time (overall volume may be normal)

• Soft consistency

• Tenesmus typical

• Blood (fresh) and mucus common

• Weight loss occasional

Possible iatrogenic causes of diarrhoea as a side effect of drug therapy must also be considered.



Nursing Aspect


Owners quite commonly ring for advice with respect to cats and especially dogs that have diarrhoea and the duty nurse is often the person from whom this initial advice is obtained. Acute diarrhoea is often the result of dietary indiscretion or food intolerance and may be self-limiting without the need for veterinary intervention. The recommendation to examine the animal at the clinic should be guided by the owner’s wishes but also after obtaining adequate information with respect to:


• The animal’s current status

• The nature of the diarrhoea

• The duration, frequency and severity of diarrhoea

• Any known history of dietary indiscretion, especially with respect to foreign bodies and intoxication.

In the author’s opinion it is reasonable to recommend withholding food for a short period (e.g. 12–24 hours) with continued monitoring at home if the animal remains relatively bright, is tolerant of water, and especially where there is a suspicion of dietary indiscretion not relating to a foreign body. An easily digestible food can then be introduced, feeding small amounts frequently. Owners should be advised to contact the clinic again should the animal’s condition deteriorate, at which time examination can be arranged.



Approach to Diarrhoea



Signalment


Signalment may allow certain differential diagnoses to be viewed with a lesser or greater index of suspicion. For example, younger animals are more likely to present with dietary indiscretion, foreign body ingestion, or infectious diarrhoea including intestinal helminthiasis.



History


A thorough history is mandatory in all animals with diarrhoea, although the timing should be guided by the stability of the patient. It is important to try to determine from the owner’s description whether small or large intestinal diarrhoea is present. The history may provide useful information with respect to the possible cause of the diarrhoea (e.g. witnessed scavenging, change of diet, other animals affected), and the nature, severity and duration of the diarrhoea will help establish the likelihood of clinically significant dehydration. In addition, the presence of other concurrent signs may raise the index of suspicion for systemic diseases. Worming and vaccination history should also be established as well as details of any recent drug therapy.

Related posts:

  1. Jaundice
  2. Shock and dehydration
  3. Pelvic limb paresis and paralysis
  4. Ocular emergencies

Stay updated, free articles. Join our Telegram channel
Tags:
Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Acute diarrhoea

Full access? Get Clinical Tree
Get Clinical Tree app for offline access